Ten “medical emergencies” which people imagine would be tragic in a home birth.


I’ve often been asking medical professionals what the bottom line is for maternity services as regards the cost of home birth versus hospital birth because we so often hear of women being told “you can’t have a home birth because we just don’t have the resources, sorry”.  So it is very useful that Oxford University researchers have dug about and come up with the following figures:

AVERAGE COST OF BIRTH

  • £1,066 – births planned at home
  • £1,435 – births in freestanding midwifery units
  • £1,461 – births in midwifery units alongside hospitals
  • £1,631 – births in hospital obstetric units

Which is funny really… because one of the excuses used to marginalise home birth is that that it is a luxury which NHS Trusts “don’t have the resources for”. Yet they do have the resources to offer caesareans on demand. Strange!

So can we knock that one on the head now please?

Which reminds me, there was recently a very odd interview on Sky News with doula Rebecca Schiller, from Hackney. The Sky anchorman interviewing Rebecca about home birth was utterly obsessed with the fact that he had always advised his wife against home birthing their five children and felt vindicated when the youngest suffered shoulder dystocia. The anchor (can’t remember his name) was under the impression that only a doctor could have sorted it out – wrong. He seemed unaware that rescuscitation equipment as used in hospital would be available at a home birth – wrong! Midwives should and do always have oxygen with them. We also did not know whether or not the mum had an epidural which would also have tipped the scales towards shoulder dystocia – and of course would not have been an option at a home birth. Please check this page at Angela Horn’s Homebirth UK website for details of midwife management of shoulder dystocia

Most interesting to me was the anchorman’s memory of the room filling with people. It must have been a very frightening moment for him and my heart goes out to him, as I’m sure it still haunts him. It is very normal and typical for a dad to be deeply impressed by the atmosphere in a case like this, and it’s normal for that memory to over-ride actual events.

He may not be aware that when the red button is pressed in a labour ward everyone who is free rushes to the room – and then most of them, when they see that the situation is in hand, quietly leave. It’s the crowd rushing in that the dad remembers, not the staff quietly slipping out one by one.

Ten medical emergencies which people imagine would be tragic at a home birth…

Earlier today I was talking to a BBC news researcher and she came up with the old question: “But what if something goes wrong?”

Let’s review some of those “medical emergencies” which journalists so often vaguely bring into any interview about home birth:

1 Shoulder dystocia: see above.

2. Placenta abrupta: would be flagged up by monitoring just as quickly as in hospital and possibly more so because midwife is watching mum more carefully. Time saved being in hospital instead – marginal and debatable.

3. Postpartum haemorrhage: midwife has syntometrine on hand. Does not have facilities for a blood transfusion but once in ambulance this can be set in train. Same as in hospital. Believe it or not, they don’t have a bag of your blood type sitting by your door the labour ward, either.

4. Failure to progress: not an emergency, a judgement call which IMHO is often the result of a less experienced midwife playing super-safe.

5. Baby floppy and needs resuscitation: midwife has oxygen and resuscitation equipment at home birth.

6. Any delivery requiring episiotomy – midwife can do.

7. Forceps./ventouse: transfer to hospital…but actually, much LESS LIKELY TO BE NEEDED in a home birth.

8. Need for Epidural: if she really wants one, she can transfer to hospital…but funnily enough home birth mothers hardly ever do. Despite the pronouncements of the epidural Nazis who declare that all women should have one. Need for other pain relief: Gas and air, diamorphine, pethidine – all available at a home birth.

9. Breech birth: diagnosable before labour starts – and contrary to popular belief a breech baby CAN be delivered safely vaginally as long as the midwife knows what she’s doing. What, didn’t you see Miranda Hart doing it on ”Call the Midwife”?

10. Baby in distress – again would be picked up by a home birth midwife as soon if not sooner than in hospital because her attention is focussed on this one woman. And let’s not forget that a major cause of “non-reassuring” (to use the jargon) baby vital signs is the stress caused by very powerful contractions induced by a syntocinon drip administered to speed up labour…in hospital!

There is an eleventh disaster which comes to mind, of which I have had experience through my contact with two different Hypnobirthing clients, and that is the case of a “true knot” – where the cord has been knotted and is tightening as the baby descends. Scary, yes.

In one client’s case, she pushed the baby out and he was fine. The birth was filmed, and you can see it for yourself on www.mybirth.tv.

In another case – same situation, second time mum, birth pool, home birth – tragically the baby died before she was out. But, as the shattered parents told me later, it was determined by the post mortem inquiry that exactly the same thing would have happened if she had been in hospital. And the ultrasound scans did not pick up the true knot at any stage. Nobody, I’m glad to say, blamed the mum for having endangered her baby by choosing a home birth and nobody ever should.

CAROL THE MIDWIFE ADDS………………..

Hi Sarah – thought I’d comment on the “true knot” thing -  my understanding is that unless the baby is unwell and cardiac output faltering for some other reason, a knot in the cord will not and cannot tighten enough to hinder circulation.  It is explained (I am thinking Marden Wagner here, but guessing) as if one tried to tighten a knot in a garden hose with the water flowing fast, or even moderately -  the hose will bend like a pretzel but not keep in a knot and certainly not tighten.  If the flow is slow, as on my allotment, an attempt at knotting the hose might well be successful.  Umbilical cords with less/little wharton’s jelly likewise could more easily be tightened, but stringy cords are a sign of a poorly functionning placenta (likely IUGR/Smoking mum/>BP) as I understand…..   I suppose a baby who is being very shocked during second stage could have poor cardiac output then a knotted cord would be a sudden big problem, but as with most midwifery emergencies, one should see it coming a mile off!

 

 

 

 

 

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