15 responses to “Hosptal Birth/Home Birth”

  1. Rixa

    Phew! What a wild ride for all of you. I hope the baby heals quickly.

  2. Kneelingwoman

    As a recently retired homebirth midwife, I have a couple of things to offer here: First: every labor has a birth built in! Always go prepared to attend the birth, even if that isn’t the “plan”. We all know that babies come when they want, not when we want. Especially with a multip! Second, and this is more sensitive material: if you have “stuff” around SD; please work it out before you agree to attend another woman with a positive history. I was taught by a very savvy senior midwife that SD needs to be positively identified at the “yellow light” stage and acted upon ie. change position, corkscrew, extract nuchal arm etc. But ACT. A baby who is on the perineum and ‘turtling’ isn’t going to come out on its own! We ignore the baby’s communication to us at our, and most importantly, the baby’s, peril! If you have a lot of fear and anxiety about SD, you are going to tend to have some “denial” about the issue when it happens ie. to wait to long, hoping it will just “fix”–it won’t. When we, as Midwives, have a lot of fear around particular complications; we need to engage it, get some help and extra training so that we develop a comfort level, and confidence, about dealing with it. The fact that you took on a woman with a history that you have “stuff” around indicates that you need to address the issues; the next time, everyone may not be so lucky!

  3. Laura Jane

    Ooh, crikey Lisa, a quick birth is a quick birth.

    It would have been worse in a car hon. I’m so glad you kept calm and they feel it was good, but oh boy, I bet your heart was in your mouth.

    It must have seemed like forever, I hate it when baby’s face darkens with an SD and you can’t get in yet to do internal maneuvres. The starters position is the only extra thing i would have done, it will sometimes help to free it up from all fours.

    Commiserations, and I’m so glad and relieved the baby came good with your E.A.R. It would have been an ugly rerun, instead of a calm rerun.

    A fast unexpected homebirth is just that, and thank heavens you were there for resus.

  4. Anonymous

    i am glad for the woman that she chose to birth the way that she wanted to. I am glad to hear that the baby is also doing well at home. thankyou for the story on her behalf i enjoy reading what you have to write keep up the good work

  5. Lisa Barrett

    Thanks for your comments Kneeling midwife. I am a midwife with over 20 years experience and I would love to know what “stuff” would have made it any difference.
    Plus, we had planned a hospital birth and the woman only asked me early so we could all go in together. I did all the changes required and I think if you were to read another birth story that is on this blog you wouldn’t be quite so judgemental, plus I had asked her when I got there about transferring immediately and she didn’t want to, she had never done this before and was sure of herself. I respect that. There was no denial on my part but I am never going to move a woman who is fully without an ambulance, who kindly arrived promptly. My admission of fear I feel that you have mis interpreted. the actions as you are well entitled to.
    I was certainly confident of my actions and would honestly think that anyone without a healthy reverence of the potential complications one should NEVER practice.
    This post seems to reflect some of your own fear surrounding birth which you often talk about on your own blog. How sad for you.

  6. Kel

    cant help but get caught up in this one. have had my two bobs worth over on mad amys website even though i KNOW its futile. i cant imagine the stress on a professional in these situations, have seen it and appreciate the skill involved and as the birthing mother of a SD no 3, with 2 previous uncomplicated home births, its one of those situations that just is. its .02% of births. RARE. but they happen and you dont want to practice invasive obs just to mitigate the rare. Having faced the bare truth of a SD, id still want to do it how i did it, at home, but definitely not freebirthing, you need an experienced practitioner to assist. No amount of modern tech is gonna help when a head has been birthed.

  7. Radical Midwife

    Great job, to mama, baby, and youself! SD is terrifying, no matter how many times you handle it, or how well trained you are to resolve it.

  8. maria

    Hi Lisa,
    I was wondering: if SD only occurs .02% (is that correct? seems to be what someone here mentioned), what are the risks of a vaginal birth compared to an elective c-section?
    It seems that regular OB thinking would put a woman with prior SD in the elective c-section category. Does this indeed reflect the alleged risks of a repeat SD?

    Not sure if I am asking this correctly LOL Having a hard time getting into words what I want to know but maybe you know what I mean.

    Thanks!
    maria.

  9. Kneelingwoman

    LIsa; I don’t think I”ve ever talked about “fear” of birth on my blog–fear of the current cultural/legal situation around birth; yes, absolutely. I really wasn’t being ‘Judgmental” and I’m sorry you heard it that way. I too, practiced Midwifery for over 20 years and I’ve handled several SD’s successfully in that time. I’ve also been at peer reviews for baby deaths and all but one were mismanaged or miscalculated SD’s. It is surprising to me that there is often a fairly “casual” attitude towards this particular complication. In my State, we had a Midwife end up in court over two SD”s that simply were not acted upon in time–both babies died. I too, believe in respecting the mother but I also think that perhaps there was more conversation/dialogue that needed to happen between you and the mother given her history. The “stuff” I was referring to is what you described as your issues around this particular complication. We all go through periods when certain things just “worry” us and I’ve found, throughout my time attending births, that it was truly helpful and increased both my skill level and confidence; to work with my ‘worry’, get more training or even some good counseling……I wasn’t being critical of the fact that you have issues with SD. My only criticism, if it can be called that, would be to attend any birth without all your equipment, or with the assumption that you are only there as a “support” person. As Midwives, we have a responsibility to assume that our skills and knowledge may have to be used in ways we hadn’t anticipated.

    As an aside: I find it interesting, but disturbing, that whenever a Midwife illustrates a cautionary tale, meant to be helpful; it is often projected back as some kind of “fear of birth” issue. I can honestly say that I was never afraid of birth. I began attending them in my early 20′s and the only “fear” I ever experienced was when Midwifery decided that it was no longer interested in being “with women” but preferred to work towards being ‘with health care system”….now that scared me–right out of the Profession!

  10. Lisa Barrett

    Stuff doesn’t mean fear either. Healthy respect for birth is necessary as I said.

    I have certainly handled more than one SD. I am not advocating that this woman should have planned a homebirth but being honest on the internet is open to being pull apart constantly. Believe me in this State of Australia at a birth in the hospital you are no more than a support person or a friend. I mentioned my equpiment for no other reason than to highlight my honesty over NOT planning to be at home. Neither I or the woman thought it the best idea. There is not a lot of equipment that would change much about birth and nothing that would change a shoulder dystocia. I was never casual about the birth and I certainly did a good job of managing it.

    I constantly work with myself get regular counselling and update. This is a healthy way to live you life regardless. You made unfounded judgements in your first comment. Surely you can leave that to the Obstetric blogger who will be no doubt sued for slander in the future.

  11. maria

    Mmm, wonder why my comment/questions were not posted?
    Did I say something offensive?
    maria@unassistedchildbirth.com

  12. Lisa Barrett

    Maria, of course your comments weren’t offensive. I wanted to publish then answer and then I forgot. Thanks for the reminder.

    The risk of surgery is higher than the risk of repeat shoulder dystocia, simply because only 0.2% of babies will die from SD. The surgeon prefers the odds of a section as SD isn’t a risk they can control but they feel that c/s is.

    It’s about weighing up the risk you want to take as a woman and as a practitioner over the risk you want to hand over to an OB. They are not god and regardless to common belief they do not come risk free

  13. maria

    No problem, Lisa!

    “The risk of surgery is higher than the risk of repeat shoulder dystocia, simply because only 0.2% of babies will die from SD.”

    So, you are saying that the risk of a fatal c-section is higher than 0.2%? Tried finding that online but was not successful.

    Thanks,
    maria.

  14. Lisa Barrett

    copied from Wikki
    Statistics from the 1990s suggest that less than one woman in 2,500 who has a Caesarean section will die, compared to a rate of one in 10,000 for a vaginal delivery.[9] However the mortality rate for both continues to drop steadily. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[10] However, it is misleading to directly compare the mortality rates of vaginal and caesarean deliveries. Women with severe medical disease often require a caesarean section which can distort the mortality figures.

    A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that women that have planned Caesareans had an overall rate of severe morbidity of 27.3 per 1000 deliveries compared to an overall rate of severe morbidity of 9.0 per 1000 planned vaginal deliveries. The planned Caesarean group had increased risks of cardiac arrest, wound haematoma, hysterectomy (alt PPH – Post Pregnancy Hysterectomy), major puerperal infection, anaesthetic complications, venous thromboembolism, and haemorrhage requiring hysterectomy over those suffered by the planned vaginal delivery group.

    A study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery.
    The risk to the baby of contracting diabetes is increased significantly by being delivered by Caesarean section. The risk of developing diabetes is 20% greater for children born by Caesarean section compared to those born naturally.

    Nov 2007 BMJ study of 94,000 women. In the study, seven women out of more than 62,000 (0.01 per cent) died following a natural birth, five out of 13,000 (0.04 per cent) died after a caesarean section and 11 out of 18,000 (0.06 per cent) died following a planned caesarean section that was carried out after labour had started.

    Out of more than 62,000 natural births, 1,125 women died or suffered complications (1.8 per cent), compared with 723 women out of 13,000 (5.5 per cent) having a planned caesarean section.

    Out of 18,000 women who had a caesarean section after labour had begun, 742, or (4 per cent) died or suffered a complication

  15. maria

    Thanks!
    Didn’t check Wikki! LOL