Thursday, December 15, 2011

What Can Go Wrong in a Homebirth?

I am planning on having a homebirth in the near future. When I tell people this, some people get such a look of horror on their face! It's as if I'm telling them that I'm planning on killing my baby, God forbid, or doing something so dangerous like jumping out of an airplane without a parachute.
Homebirths scare the heck out of many people. There are so many stories passed around about how homebirths are deadly and dangerous, and that they heard of a person whose baby died during a homebirth. You'll also have people telling you how homebirths are a terrible idea, because their babies survived only because they were born in the hospital; had they been born at home, they would either have either died or been damaged long term.
They often don't realize the other side of the story, that things can and do go wrong in hospital births as well, and that hospital births actually are just as risky, if not more so, than homebirths for low risk births, according to numerous studies.

However, once again, I'll reiterate the same point I made in my last homebirth post- babies and mothers die in childbirth. Its an unfortunate reality. Proper medical care can eliminate this much of the time, but there are risks to both the mothers' and the babies' lives no matter where they are born, whether in the hospital or at home. There are things to do to minimize the risks, such as evaluating whether you're a proper candidate for homebirth or whether a hospital would be safer for you, and by hiring an experienced, qualified medical personel to assist in your birth. (I do not advocate unattended homebirths and have convinced my friend who was considering an unassisted homebirth to hire a midwife, despite the extra cost.) Other than that, you hope for the best and pray that everything will go smoothly, and that you have a healthy mother and baby, whether you're in the hospital or at home.
But again, you can't prevent all problems, no matter where you choose to birth. All you can do is minimize risks.

So here you have it- what can go wrong in a homebirth?

Misconceptions About Homebirths
The first thing that I need to mention about things that can go wrong in a homebirth is that "having a homebirth" doesn't mean that no matter what happens, you'll stay at home with the baby, even if it puts your life and the baby's life at risk.
Absolutely not.
One of the most important things that a qualified midwife needs to know is how to be aware when there is a problem that requires transfer to a hospital, and transferring to the hospital! Someone who sees that there are problems with the birth and insists on staying home even so is not acting smartly. Honestly, I try to be accepting of different people's birth choices, but if your life or the baby's life is at risk and the midwife recommends a transfer to a hospital, someone who chooses to stay home is a blockhead. Sorry...

Someone I know was trying to convince me that homebirths are dangerous because her baby needed intervention by a large team of medical professionals the moment she was born, and prior to that, it wasn't a high risk pregnancy. She was telling me that had her baby been born at home, her baby wouldn't have survived, and that's why, even for a low risk pregnancy, its better to be in a hospital.
Before I jumped to any conclusions, I decided to ask this lady more about what she meant, and what exactly happened during her daughter's birth.
She told me that no, her baby wasn't born via emergency Cesarean; her baby was born vaginally, but the second after she was born, the medical team was taking care of her.
I asked her "How did you know that you'd need a medical team as soon as she was born?"
Her answer? "Because for the last half hour or more of labor, my baby was in distress!"
Do you know what I answered her that actually shocked her and made her realize that homebirths aren't so dangerous after all?
I told her "Did you know that if you were having a homebirth and your baby was in distress, your baby would not have been born at home? When a baby is in distress, a midwife will transfer a mother to a hospital so that her baby can get proper medical care the second it is born, and if necessary, have an emergency Cesarean to get the baby out even faster."
No, homebirthers usually don't stubbornly decide that they're going to deliver the baby at home even if the baby is showing major signs of fetal distress. No, that is one reason why a mother might transfer to the hospital via ambulance in the middle of labor.
Usually if there is fetal distress, it doesn't start suddenly. It gradually builds up and the baby becomes more and more in distress, and a midwife will transfer you to a hospital before it gets to the point of no return. In the event of a transfer, the hospital usually will be contacted to let them know that a woman in labor with fetal distress is coming, and to prepare the OR for a possible emergency Cesarean. This is how a lot of the potential problems assumed to happen in homebirths are prevented- by transferring to a hospital in the middle of labor!
This is a big reason why homebirths only within 30 minutes of the nearest hospital are considered to be safe enough- because in the event of an emergency (spotted at the earliest possible point, ideally), you'll be able to get to the hospital in time to get the necessary interventions to save both mother and child.

What types of things would necessitate a transfer to the hospital?

  • Discomfort at Home. I mentioned in my post about potential problems with hospital births that if someone is stressed out by birthing in a hospital, this actually can stall her labor because stress causes biological changes in the mother that can stop labor. This goes both ways. If a mother is stressed out by the concept of giving birth at home, and isn't comfortable and trusting enough of the setting and would feel more comfortable in the hospital, she may need to transfer to the hospital to lower her stress levels so that her labor can progress once more.
  • Stalled labor. If there is a labor that isn't progressing after a really long time, to the extent that the mother's energy is completely depleted and she can't manage anymore, a midwife may recommend transferring to the hospital to get some pitocin to get things moving again. There also are some women who stress out and tense up too much during labor and getting an epidural is the only thing that allows them to relax enough for their uterus to open up, in which case, a midwife may recommend transferring to the hospital for the purpose of getting an epidural.
  • Prolapsed cord. The baby gets oxygen and nutrients via the umbilical cord; sometimes, when a woman's membranes rupture (her water breaks) and the baby's head isn't down low, the cord can start coming out of the cervix and the baby's head will press down on it, restricting blood flow to the baby, which can be very dangerous because the baby isn't getting the necessary oxygen. Prolapsed cord is more common with breech babies, premature babies, and in mothers with hydroamnios (too much amniotic fluid) but can also happen without any of these contraindications. When someone has a prolapsed cord, the midwife will stick a gloved hand inside the mother and hold the baby so its not pressing on the cord, and then the mother will be transferred to the hospital for an emergency Cesarean, with the midwife's hand staying there the whole time. While this may seem like enough of a reason to not have a homebirth, because it can be dangerous if a prolapsed cord happens at home, a prolapsed cord can happen at any point in pregnancy that a woman's amniotic sac ruptures, even if she is planning on having a hospital birth; the only way to prevent cord prolapse at home is to have a hospital pregnancy, not just a hospital birth, because this doesn't only happen during homebirths.
  • Fetal Distress. As I mentioned to my friend, if a baby is showing signs of distress, a transfer to the hospital is in the books. Midwives use something called a fetoscope, like a stethoscope, only to hear the baby's heartbeat, which they use to keep track of how the baby is handling labor, which has all the benefits of the monitoring they do in the hospital, but none of the drawbacks.
  • Cephalopelvic Disproportion. This is pretty rare, but in some rare cases, babies do get "stuck" inside the mother, and even after giving the woman time to try to birth the baby naturally, the baby may be too big to fit through the mother's pelvis, in which case she may be transferred to have a Cesarean.
  • Postpartum Hemorrhage. If a woman starts hemorrhaging after birth, if she's losing too much blood, midwives have pitocin/methergine shots which they give to the woman to help stop the hemorrhaging, and then transfer her to the hospital.
What Complications Can a Midwife Handle on Her Own?
  • Stitches and episiotomies. Midwives are fully trained in giving episiotomies in the rare cases that they're actually a good idea, and midwives can stitch up nearly all tears and cuts from giving birth.
  • Cord around the neck. No biggie, usually. Midwives just slip the cord from around the kid's neck and all is good.
  • Shoulder Distocia. This is when the baby's shoulders get stuck inside the mother's pelvis and stop the baby from depending further. Ina May Gaskin, one of the most famous home birth midwives today, actually taught a technique called the "Gaskin Maneuer" to take care of shoulder distocia, and its a technique practiced all over, including in hospitals. Midwives can do the Gaskin Maneuver at home to get a "stuck baby" "unstuck".
  • Blue baby/baby not breathing. Midwives are taught how to resuscitate babies and carry along oxygen. Suctioning, stimulating, rubbing the baby, doing mouth to mouth possibly, and/or giving oxygen to the baby is usually enough get the baby breathing properly; if not, a transfer to the hospital ICU is necessary.
I'm sure there are some other things that I missed, such as problems that can go wrong with birth, and I'm not aware of every single one under the sun. However, after reading the book by Ina May Gaskin, called Spiritual Midwifery, which was teaching women how to be homebirth midwives, I learned that there is what to do in nearly every situation that comes up in labor, and even if I don't know them all, I trust that my midwife, who has been practicing almost as long as I've alive, does know what to do, and will either take care of the issue or advise transferring to the hospital as necessary.

Yes, there are some rare issues that may come up that my midwife would not be equipped to handle, which would put both my life and the baby's life at risk; unfortunately, such is the case while giving birth in the hospital. All we can do is hope for the best and pray that these things don't happen to us.

I feel perfectly confident in my decision to homebirth. I know that it is a safe option for giving birth, and I am glad that I will have the ability to birth at home very soon.

See my other posts about homebirth in this series-
Why Homebirth?
Is Homebirth Safe? What can go wrong in a hospital birth?

If you're concerned about issues that can occur during homebirths, what are your concerns? What do you think can happen that a midwife won't be able to handle?
If you've had a homebirth, have you had any complications for which you transferred to a hospital or that your midwife dealt with at your house?

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