July 2, 2012
Do You Know How to Avoid a Homebirth Disaster?
A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.
Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists. To all pregnant moms who want to have their babies at home, I get it. I truly do. You want a comfortable intimate environment to have what you deem is a “natural event” without “unnecessary intervention.” You want to be like the celebrities who have had successful home deliveries. But here’s the problem: your home is not equipped to deal with emergencies and they DO occur. Just ask celebrity mom Christine Turlington Burns, who experienced a postpartum hemorrhage and had to be rushed to the hospital in order to save her life. Obstetrics is a specialty of the unexpected. You MUST be prepared for emergencies.
Fielding entered Johns Hopkins Hospital because the baby was “stuck.” The midwife couldn’t deliver the baby because it was either too large or she couldn’t manage a shoulder dystocia. According a blogger, Dr. Amy Tuteur, Midwife Evelyn Muhlhan’s license was suspended by the State of Maryland because of five homebirth disasters including Fielding’s delivery.
An ambulance brought Fielding to a hospital where she allegedly waits for over 2 hours for blood test results. A c. section is delayed. A baby has brain damage. Take home message?
- Know your midwife’s professional record. Does she have malpractice suits? Has she been sanctioned by the state medical board for negligence?
- Meet your midwife’s ob-gyn back-up. The Smart Mother’s Guide to a Better Pregnancy discusses this in detail. At the first sign of trouble, Muhlhan should have contacted her ob backup. If she didn’t have one, she was begging for trouble.
- Have a PERSONAL copy of your prenatal chart with you and your back-up hospital or birthing center should have a copy as well. This is standard prenatal procedures. Having a homebirth doesn’t change that. Your prenatal record contains all of the important information including blood type and blood count. No one, I repeat NO ONE, is going to bring you into the operating room without knowing your blood type unless you are hemorrhaging to death. Had Fielding had a copy of her prenatal record, she might not have encountered the delay.
If you’re going to have a homebirth, then please take the necessary precautions. An ounce of prevention is always worth more than a pound of cure.
Norma Ritter IBCLC, RLC said,
July 2, 2012 at 12:02 pm
I am wondering why, in an emergency situation at the hospital, the mother had to wait for over 2 hours for blood test results, and why the c-section was delayed.
drlindagalloway said,
July 2, 2012 at 5:04 pm
The procedure was delayed because they didn’t have the blood type and other labs such as a 1-hr glucose test for diabetes and other labs that are required. This is why it’s important for pregnant women to have a record of their prenatal labs. The hospital obviously didn’t know her. There was no relationship. No physician involved in her care so she was treated like a new patient. This is not a good thing in the midst of an emergency.
Kim Smith said,
July 2, 2012 at 6:30 pm
I have seen REAL emergency c/s and they happen NOW, not two hours from now. Obviously not a real emergency c/s. Stop ringing alarm bells, please.
drlindagalloway said,
July 2, 2012 at 8:58 pm
And when those emergency c/sections are done, the labs are in place. No one, and I repeat, no obstetrician is going to operate on a woman without knowing her blood type and O negative is reserved for hemorrhaging. Mrs. Fielding was not hemorrhaging, there was a baby STUCK in her birth canal because the midwife could not deliver it.
Paula said,
July 2, 2012 at 10:22 pm
Both home births and hospital births would be safe if the “professionals” did their jobs to support mom and baby properly. I get the message that this midwife wasn’t doing her job properly. Don’t think for a second that most women choose a midwife because a celebrity did it. Did you ever stop to think that the majority Ob/Gyns aren’t supportive of natural, normal births?
You can’t tell me that it takes an hour to determine blood type for emergency surgery. The hospital obviously wasn’t doing their job properly either.
drlindagalloway said,
July 2, 2012 at 11:30 pm
You are right. It should not take an hour to obtain a blood type but a seasoned professional knows that a hospital is an imperfect institution and that’s why patients need advocates and someone to “watch their back.” This was the role of the midwife. She should have made certain that the patient received the best care which would include having a collaborative back-up obstetrician and a working knowledge and contingency emergency plan. I have reviewed the midwife’s record with the Maryland Nursing Board and will blog about it on Wednesday. It is truly unfortunate that Mrs. Fielding was not aware of the midwife’s record. It was very revealing.
Molly1958 said,
July 4, 2012 at 12:42 pm
No, this was to punish them. An emergency is an emergency. They could have used O negative blood as it is the universal donor and used a drop from that lab draw to get a fingerstick SCREEN of blood sugar. Hogwash that labwork is necessary. ALL hospitals take UNASSIGNED patients – no relationship necessary. Punitive through and through… HMMM – what emergency medical services do when they bring in a GSW victim: oh, wait, we don’t know you. We need to get your blood and other information so we’ll let you bleed for 2 hours? Baloney. Have a bridge in Brooklyn to sell you. A– T—— is not a credible nor a worthy resource – this article is looking for the most vile so-called-proffesional-who-has-casted-out-amongst-her-colleagues for ignoring all kinds of current EVIDENCED based literature and then spouts off her opinion as knowledge.
drlindagalloway said,
July 5, 2012 at 6:22 pm
O negative blood is ONLY use when there is active bleeding to the point of hemorrhage. A gunshot wound involves active bleeding. Rebecca Fielding was not actively bleeding. Hence, the standard of care would not be to use O negative blood. I did independent research after reading Dr. Tuteur’s comments and the Maryland Board of Nursing did in fact, suspend the midwife’s license based on egregious breaches of the standard of medical care. A “little” knowledge is dangerous. That’s why there are institutions of higher learning, standards, licensing exams and peer reviews to make certain those standards of maintained because when they’re not, as was the Fielding case, serious preventable injuries occur. I hope you’ve had an opportunity to read Part 2 of the blog.
Knitted in the Womb said,
July 2, 2012 at 12:09 pm
Your suggestions are all very good suggestions…but unfortunately, in many areas of the country, they are completely IMPOSSIBLE.
Dr.s and or hospital administrators are refusing to integrate women who desire homebirth into the system to facilitate hospital transfer when it becomes necessary. This only makes homebirths more dangerous. In my local area the hospitals have informed the OB’s that if they provide back up to homebirth midwives they will loose their hospital admitting priviledges.
This means that midwives can not have a back up OB, expectant women working with them can not meet the non-existant back up, and a copy of the woman’s pre-natal care records can not be kept on file with the non-existant OB or the hospital. In many cases even when the midwife has kept very neat and complete records in a case like this, the records will be disregarded when they are given to the hospital staff upon transfer. If I were to need to transfer to a hospital during birth, I would need to travel at least one hour of drive time to get to a hospital that allows for the kind of integration of care suggested above–even though I have hospitals that are 5, 10, 15, 25, and 30 minutes drive time from me (the ones that are 5 and 25 minutes from me also both have Level III NICU’s, so would presumably also be the most desirable for emergency transfer).
There definitely is a risk taken when a woman chooses to have an out of hospital birth. Interestingly, if a woman has a qualified midwife, the exact same emergency equipment will be available at a homebirth as at a birth center birth–and ACOG approves of birth center births.
Until homebirth become integrated into the hospital system in America as it is in many other countries, it will continue to have a higher risk than it needs to have. When will the rights of women be respected enough to make this happen?
drlindagalloway said,
July 2, 2012 at 5:02 pm
Just as women lobbied and won for the acceptance of VBACs in hospitals, you MUST do the same regarding home births if you choose to have one. You have to get political. You have to go to the hospital board as well as your politicians and lobby for these changes. Please be aware that most insurance companies will not pay for a home delivery and especially if there are complications that are brought to the hospital. It’s a “Catch 22″ dilemma. ACOG thinks by saying “no,” the problem will go away. It won’t. Women are going to continue to want to deliver at home. There is where there needs to be a compromise on the part of the mother and ACOG. The hospitals say no because ACOG and the pediatricians say no. Yet, inevitably a woman MUST go to the hospital if she has a problem. I’m a believer in prevention. There are innocent babies at stake here.
Jeremy Galvan said,
January 17, 2013 at 5:49 pm
“There are innocent babies at stake here”
Dr. Galloway you are absolutely correct. There are babies at stake here. 500 babies died in Maryland hospitals in 2010. Maryland is ranked as one of the most dangerous states in the US to deliver a baby. In addition our Neonatal death rate is horrible. You speak of innocent babies and yet all you say of women is that they need to give a little.
The facts are really simple and you of all people should be honest with the information we have. Most credible studies related to birth location show that the Perinatal outcomes are the same when comparing Low Risk hospital and home birth. This is largely assumed to because midwives are experts in selecting appropriate home birth moms, and that they get women with complication to the hospital in a timely manner.
Even the Wax Report shows that Perinatal outcomes of home births were better than the hospital. When explaining why, Wax simply states that midwives are selecting low risk women. Shocker.
So babies are doing fine in either location. Lets talk about women for a moment. In many states, Maryland being one of them, women are being forced thru lack of options, manipulation, and lies to have surgical births they do not want to have. Any woman who is a VBAC in the state of Maryland has to fight her OB’s to allow her to let the baby enter the world thru her vagina. Ob’s are lying by pulling the bait and switch. They say come to us and have a great birth only to spring a 39 or 40 week C-Section requirement on them. There is no reason for this being as ACOG published recommendations that OB’s should allow for TOLAC in VBAC mothers. In a work group at the Department of Health the ACOG rep stated that OB’s dont have to follow the recommendations of ACOG if they feel its to dangerous. I dont disagree with that however when studies are showing that VBACs got a bad name because of the Uterine Ruptures that were caused by an over use of Cytotec we have a problem with the medical world being willing to admit mistakes. That sadly is paid for by women having repeat C-Sections today because of past doctor mistakes.
A study out of the UK recently showed that women who go to the hospital have a 3 times higher risk of postpartum bleeding when compared to home birth.
So what we have here is a TURF war. We have studies that show babies are safe in either location, and that women do far better in home births than at the hospital. I wonder why Postpartum depression is one of the fastest rising problems in our country. Its almost non-existent in the home birth community.
The responsible thing for Doctors to do is support licensure for Certified Professional Midwives. If they can pull their heads out of the sand for a few minutes and realize that home births are becoming more popular then they will realize that the safest way to deal with this is NOT by fighting the increase by limiting options to women. Licensing allows regulation and enables a working relationship to start. This is what will create safety for newborns. Doctors complain about liability but then take on all the responsibility by not allowing other professions to come in and do what their training allows them to do. They fight everyone from Naturopaths to Midwives. Chiropractors where considered voodoo magic only a few years ago by doctors. Many still view them as trouble because they call themselves doctors. If doctors were really concerned for safety they would encourage other professions to be licensed and they would want them to add to the pool of professionals in our hospitals. After all we have a severe OB shortage in our state and not even the docs can answer how to fix that. There solutions are, get rid of liability, and pay us more.
The Board of Nursing did not find Evelyn guilty of anything more than poor documentation. And for those reasons she was able to continue as a Nurse Midwife. They did however say she could not attend home births. The Board of Nursing has been working to get rid of home birth midwives for 20 years in Maryland. Sadly they won this fight.
If you were to look at an OB and grade them based on their 5 worst outcomes. I bet we’d look at OB’s in a completely different light. Making a midwife with 20 years worth of excellent outcomes look bad because of 5 calls is immature and childish.
As a paramedic I have run 6 pediatric Cardiac Arrests. All 6 of those kids are still dead. I hope that the thousand plus calls that were not that bad somehow outweigh the failed effort I made in keeping those kids alive. I would hate to be judged by that effort alone.
For someone who is a believer in prevention you need to look into what CPM’s do. Midwives are far better at prevention because they take the time to be with the woman. I have never heard a story where a women gives birth in a hospital and had the OB or Nurse in her room keeping an eye on whats going on. They check in every hour or so. Maybe longer in some hospitals. Midwives spend an hour at ever prenatal meeting. They spend the entire labor with the woman supporting her and watching whats happening. They practice prevention by making sure the woman is eating right, working out, and preparing by taking classes in natural child birth. OB’s almost never offer any of that. The OB my wife and I say gave us 5 minutes to ask questions and listen to a heart beat.
We need to have a real conversation about whats going on here. Your message is not reflecting anything close to the truth.
I hope that one day we can chat about the problems and perhaps find ways to create real solutions.
Jeremy Galvan
President
Maryland Families for Safe Birth
drlindagalloway said,
January 18, 2013 at 2:04 am
Thank you for your comment, Jeremy but please don’t tell me that “I’m giving the wrong message.” Pregnancy is a specialty of the unexpected. A presumed “low risk” pregnancy during labor can become “high risk” in a heart beat if the fetus isn’t tolerating contractions and starts having decelerations. Let me preempt my next statement by stating that I am the descendant of not one but two “lay” midwives who delivered babies on a Virginia plantation and in Dinwiddie County Virginia until the 1930′s when my great-great grandmother died. I was taught how to deliver (and properly I might add) a baby by a midwife from Belize during my internship who couldn’t practice midwifery in the U.S. and worked as a labor and delivery nurse instead so this is NOT an affront on midwives but the law is the law. A midwife MUST have an obstetrician back-up if she is going to perform a home birth and most OBs won’t cover the midwife in that setting because of medical liability. I am concerned with patient safety. My OB colleagues are not without fault. I have issues with some of them myself. I have tried (and failed) on numerous occasions to have be on ACOG committees for 20 years. It’s politics and I’m not a politician. I’m a physician. The organization is out of touch with the reality that some women want to have a baby at home. The problem is if the baby is born with a problem, you cannot provide the support it would receive in an NICU at home. You can’t give surfactant, you can’t intubate, you can’t give pressors, you can’t do ECMO, you can’t provide the support a critically ill baby requires STAT in someone’s home and therein lies the dilemma. Do we need a dialogue with all concerned parties? Yes we do. Will it happen? Don’t hold your breath and wait. Again, thanks for your comment.
Jennifer said,
July 2, 2012 at 12:31 pm
Isn’t the take home message that a hospital allowing a women to wait 2 hours in an emergency situation in negligence? This has nothing to do with competence of a midwife who saw a potential complication, took appropriate action of a transfer, and then the hospital did not follow through with the same professionalism.
Home birth is not about “being like the celebrities who have had successful home deliveries.” Research supports that for low risk women home birth is a safe option (and one that has a significantly lower chance of interventions).
drlindagalloway said,
July 2, 2012 at 5:08 pm
This patient was obviously not a “low risk” patient because she had a baby that was “stuck” and the midwife couldn’t deliver the baby. The midwife also had 4 other cases of negligence. The take home message is that both the patient and the midwife should be prepared in the event of an emergency. Where was the midwife’s babk-up obstetrician? How come she didn’t have the proper lab results that would have thwarted the delay? Who’s going to operate on a patient without knowing the blood type? No one. I’m not defending Johns Hopkins but I know how things work in a hospital. It is an imperfect system and the challenge is to minimize and avoid the imperfections which can be done if people adhere to protocols. This was not done in this case.
Jennifer said,
July 2, 2012 at 5:26 pm
Sorry, but I live and work in country where home birth is “normal” so a situation where there is a transfer at full dilation and no progress happens in low risk births, and should be manageable. YES, the american system is not adequate, period. Mother and infant mortality rates in HOSPITAL are higher than they should be. I would love to see this midwife’s stats next to the most qualified OBGYN in the area and see how they compare on all fronts. Maybe you can find someone from the hospital willing to volunteer their stats?
I also don’t know the details, but if someone arrives from a car accident, they don’t wait two hours. Period. It doesn’t take 2 hours for blood results. If a mother has full dilation, baby is not descending, AND in distress you MUST operate without delay. The fact that the parents won this case also speaks to the hospitals negligence.
And what you say in your other reply “the blood type and other labs such as a 1-hr glucose test for diabetes and other labs that are required. ” a 1 hr glucose test??? What relevance does this have if a baby is in distress and needs to be born? It is not relevant.
Kim Smith said,
July 2, 2012 at 6:32 pm
two words… O negative!
Dr Linda Burke Galloway said,
July 2, 2012 at 7:06 pm
The woman was not fully dilated. The baby was “stuck.” Big difference because the mother was obviously pushing and not making progress. The midwife should have had a back up obstetrician which she obviously did not. The wait was allegedly for a blood type, not a diabetes test. But to know if a pregnant woman has diabetes is important because both mother and fetus could potentially die if proper precautions are not adhered to.
The hospital was not correct for the profound delay in obtaining the blood type but the midwife breached the standard of care as well as evidenced by her previous malpractice cases and her loss of her medical license.
TXMidwife said,
January 22, 2013 at 3:48 am
If the woman wasn’t fully dilated, why was she pushing? And a shoulder dystocia can happen to any woman, low or high risk. and all licensed midwives are trained in managing SD. I feel like the story you tell does not add up..and Dr. Amy is very well known for skewing birth stories and research to fit into her anti-informed choice birthing agenda. However, i completely agree that midwives need to follow laws and ethics, i just think this story is too flawed and skewed to prove your point.
Leah said,
July 2, 2012 at 2:32 pm
What would be truly helpful is if a hospital birth could become more like a homebirth. You knw, leave the woman alone unless help is needed. Hospitals are so focused on the ‘what-ifs’ that they treat every birthing woman coming through the door as is she’s a disaster waiting to happen. They immediately stick her with needles, put her in bed, and hook her up to so many gadgets that she can’t do anything ‘natural’. And my question to the above scenario….the midwife transferred….why did it take so long for the hospital to help the woman? I have a friend that was transferred in an emergency and from the time she hit the hospital doors until the time the baby was delivered was maybe 15 minutes. What is up with this ’2 hours’?
drlindagalloway said,
July 2, 2012 at 5:11 pm
The hospital didn’t have her blood type. They didn’t know the woman and labs were not available. Where was the midwife’s ob backup? If a physician was made aware of the circumstances IN ADVANCED, the scenario would be different. The type of management you described occurs in birthing centers. If you don’t want intervention, than please have a baby in a birthing center where there is backup and support in the event of an emergency.
Kim Smith said,
July 2, 2012 at 8:14 pm
o negative, immediate cross and match. there are all kinds of lab tests available to negate your scare tactis.
drlindagalloway said,
July 2, 2012 at 8:56 pm
O negative blood is only used in the case of hemorrhaging and in case you hadn’t noticed, there is a blood shortage. Again, there are protocols and standards. Giving someone O negative blood in the absence of hemorrhage is not the standard of care. The midwife should have had a backup OB who should have been alerted. There should have been a prenatal record. This is not a scare tactic. This is reality. This is why we have standards in medicine and if you’re going to have a home birth, you need to have standards as well.
Make Midwifery Safer Now! said,
July 2, 2012 at 10:07 pm
Getting in an argument about whether a c/s happened quickly enough on the hospital’s part, or whether blood was available is beside the point that Dr. Galloway is making.
If women are going to choose homebirth, then they should consider the risks carefully and make preparations in case they need to transfer to a hospital.
Homebirth advocates always tell women to do research when choosing a midwife. “Do your research !” is a common refrain.
While I agree with Dr. Galloway that you should do a background check on your midwife, that is easier said than done. Most states do not have a publicly available database where a potential client can look up a prospective midwife. Most homebirth midwives are not overseen by any kind of regulating board or agency.
I personally know one mother who heard nothing but rave reviews about the midwife who delivered her daughter. These were all word of mouth. There was no database where the mother could search for information in her state or nationally.
The midwife failed to recognize evident signs of respiratory distress, declared the baby healthy, and left. The baby died. Later, the mother found out that the midwife had several losses on her watch prior to her being hired. Yet, the midwife mentioned none of them to the mother.
Incidentally, when the mother complained about her situation, many in the homebirth community placed blame on her for “not doing (her) research,” rather than on the midwife.
As far a pre-natal charts are concerned, I agree that a homebirthing mother should bring them during a hospital transfer.
Again, easier said than done. One issue is that some lay midwives do not know how to chart correctly and therefore their records might not be clear to hospital staff. They also may be incomplete. As the “hands off” approach to midwifery and birth grows more popular, there is a growing trend of avoiding routine prenatal care including labs, scans and screenings.
Another issue is that during an emergency transfer, the parents are in distress and may rely on the midwife to bring the chart. There are cases where the midwife has “forgotten” the chart, or simply did not come to the hospital at all and is not there to provide information of any kind.
drlindagalloway said,
July 2, 2012 at 11:26 pm
Thanks for your comment. At 36 weeks, all prenatal charts should be sent to the labor room as a matter of protocol. I advise patients to carry a copy of the chart in the event the hospital misplaces it but theoretically, the hospital should be in possession of the chart. The most important part of the prenatal record is the blood type and hemoglobin level as well as the Group B strep test. I applaud this debate because it will hopefully facilitate change.
Kaytee said,
July 2, 2012 at 10:24 pm
There is a lot more to this story. The CNM mentioned used IM oxytocin at the home and didn’t treat the GBS+ mother. We don’t know what the strip looked like when she arrived @ JH; maybe it didn’t look profoundly awful and they felt like they could wait the 2 hours while waiting for the appropriate blood testing. We’ll never know because the CNM doesn’t carry insurance so the lawyers in essence “don’t care” about her actions that contributed to this baby’s outcome.
This is not a “scare tactic” – this is precisely what could and what HAS happened to women across the country. Women have been lured into the false premise that the hospital is just waiting with a full complement of staff for the homebirth train wrecks that come in. Homebirth midwives have spread the misinformation that home birth is just as safe when in reality the neonatal mortality rate is 3X higher for the ‘low-risk’ baby. Birth is normal until it gets “high-risk” pretty damn fast and then the mother and baby pay for the delay.
drlindagalloway said,
July 2, 2012 at 11:35 pm
Thanks for your comment, Kaytee. I reviewed the CNM’s record with the Maryland Board of Nursing and it read like a horror story. I will be blogging about it on Wednesday. I’m not bashing CNMs. I am the descendant of two 19th century midwives and have the utmost respect for them. However, as I advise patients to check out their OB’s backgrounds, I encourage home birth moms to do the same regarding midwives. Patient safety is the central issue regarding this case. Prevention is the cure.
Molly1958 said,
July 4, 2012 at 12:34 pm
She must not be named opinion’s is not worth any credibility for letters there are in her name…
Michelle said,
July 5, 2012 at 4:26 pm
I’m really concerned about the tone of this blog message and particularly the title. Such a scenario (baby stuck, not able to be birthed vaginally) could have happened even if the mother was IN hospital.
The error here was not that home birth was chosen or that the midwife in question had a bad record (in fact, the midwife recognized a problem and transferred the mother for urgent care and a potential unplanned c-section), the error was an ADMINISTRATIVE one (and political one caused by ACOG refusing to allow it’s members to act as back-ups to some midwives), which caused a delay and it’s the DELAY that was the problem, not the choice to home birth.
The real message here: if you choose home birth, ensure all your records are in order, keep copies at home and in a transfer bag, and send all your test results to your back up institution in your final trimester so that ADMINISTRATIVE delays are minimized.
drlindagalloway said,
July 5, 2012 at 6:10 pm
Michelle, please read Part 2 of the blog. The midwife had a horrific record. Evelyn D. Muhlhan License Number R060032 vs. The Maryland Board of Nursing. She had 5 complaints that ranged from a uterine rupture, a failed attempt at delivering an 10#9 oz baby at home that had to be transferred to a labor room, accepting a patient who had Leiden Factor 5 deficiency, not consulting an ob back-up, misrepresenting her ob collaborating physician to whom she informed the Board of Medicine that he covered her home births, when in fact, he did not; treating a Group B Strep infection with Hibiclens which incensed the NICU department, calling EMS for an emergency and then requesting that they wait “a few more minutes” while she continued her futile attempt at a vaginal delivery that ultimately became a c-section; NOT accompanying any of her patients to the hospital despite their emergent conditions. Shall I continue? You should thank me for writing this blog. Until I wrote it, no one had the common sense to advise patients to have their records sent to a back-up hospital although there is a planned home delivery. I have 25 years of managing high risk pregnancies and I have witnessed MANY preventable mistakes. The tone of my blog was VERY appropriate.
The Deranged Housewife said,
July 6, 2012 at 9:31 am
Christy Turlington did not give birth at home – she gave birth in a birthing center in NYC. Interestingly, some reports say that the placenta became embedded in the uterine wall, a complication that occurs more frequently with women who’ve had multiple cesareans, correct?
Also, I encourage you to find a more reputable and respected source than Dr. Amy Tuteur, who is often negative and condescending to just about anyone who doesn’t agree with her, displaying a complete lack of professionalism to the point where she has been kicked off of science writing blogs because of it. Surely there has to be a less biased source than she.
drlindagalloway said,
July 6, 2012 at 12:17 pm
My error and I stand corrected. I was not aware that Ms. Turlington gave birth in a birth center which makes me feel better but the title of her article says it all: “I would have died if I wasn’t a rich Western Model” http://www.dailymail.co.uk/health/article-1331367/Christy-Turlington-I-died-giving-birth-I-wasnt-rich-Western-model.html and that’s the point. She said that the medical intervention saved her life. And that’s the point. People have to know there’s a problem and the patient has to be in an environment where IMMEDIATE emergency care can be provided which is why I love birthing centers. It gives the mom the opportunity to have the type of birthing experience that she desires but also provides the IMMEDIATE emergency care should there be a problem.
Regarding Dr. Tuteur, I did my own research although I named her as a reference. I’m sorry there’s so much animosity regarding her. I don’t know her personally but any obstetrician who’s worth their weight in salt is going to express concern when they think that patients are exposing themselves to unnecessary harm. In the end, we all (patients, midwives and physicians) want a healthy outcome, not a catastrophe.
lia_joy said,
July 6, 2012 at 4:55 pm
“You want to be like the celebrities who have had successful home deliveries.”
Ick. what a condescending statement. Anyone who believes this most certainly does not “Get it.”
drlindagalloway said,
July 6, 2012 at 7:10 pm
What I “get” is that there was a celebrity, Ricki Lake to be exact, who produced a documentary that was biased and gave women false expectations. That’s a dangerous premise. Some people, let me quality, SOME people will look at that documentary and feel falsely empowered. Ricki Lake has celebrity as her leverage. Most pregnant women who seek home birth do not. What I’m trying to drive home is that it’s not the institution i.e., hospital that will save a woman. It’s the nurses, physicians, techs who make the difference and some are better than others. In the event of an emergency, you have to go to those institutions and it would behoove the midwife who’s doing the delivery to have an emergency plan in place which the law mandates that she does. Maybe I should teach a course about this. Most physicians don’t want any part of home birth because they usually end up “cleaning up someone else’s mess.” I think physicians HAVE to get involved in this movement in order to PREVENT a mess. There’s a big difference. I’m going to make a very bold statement because I know how my colleagues think. If there are documented and continuous catastrophes, someone will lobby at a very high level to make it illegal to have a baby at home. You don’t want that. Is that “fair” no, but he who holds the power makes the rules. If you’re going to do a home birth, or have a home birth, you’re going to have to document that there are safety measures in place.
Rachael, RN and homebirth mom said,
July 7, 2012 at 7:41 am
If only we could have our cake and eat it too. Why do we as healthy low risk pregnant women have to fight in the hospital to have a healthy low risk birth? The answer Medical Malpractice. Until there is malpractice reform, OB/GYNs have their hands tied. They are not allowed to practice evidence based care because it might not be standard of care. Evidence tells us that continuous fetal monitoring does nothing but increase C/S rates but if MDs don’t order it then they are liable for malpractice due to standard of care. There are risks to entering a hospital for any reason. I would know I have been an RN for over 15 years. My husband is an MD. For these reasons, I have chosen to have my last 5 babies at home with either a CNM or CPM. I think the difference in my situation is that I am educated. I know the risks. I could die and my baby could die. This could happen at anytime during pregnancy, birth and post partum. It is a fact of life. It can happen in the hospital and it can happen at home. Which is better, which is worse? I think it totally depends on the mother/family. I choose to take my risks at home where I don’t have to fight to have a healthy low risk delivery.
drlindagalloway said,
July 7, 2012 at 6:49 pm
Thanks for your comment, Rachael. Let’s be realistic. Your husband is an MD and you are an RN. God forbid there’s a problem, both you and your husband know the protocols. You know what to do. The fact that your husband is an MD means you would have a bed ready, anesthesia greeting you at the door and your C-section would be over in 20 minutes. You are not the typical home birth patient although your your five home births suggest that you are a true low risk patient and a very fortunate one because you’ve had no problems. I think we both agree that education is the key if we’re going to prevent adverse outcomes. I’m a proponent of fetal monitoring because without it, how would I ever know that the baby is having a problem. Does it have to be continuous? Probably not but for any of my patients, I would like to know what’s going on in real-time at least on an hourly basis intermittently. Let us continue to think of innovative ways to achieve the goal of patient satisfaction but also patient safety. The future of our healthcare system relies on both.
Bettie said,
July 15, 2012 at 9:54 pm
I am a CPM practicing in the State of Virignia. I do my best to provide complete prenatal care for my clients, including routine labwork, referring for ultrasound when necessary, and referring potentially high-risk clients to physicians for evaluation. There isn’t a single physician in my are who will provide me formal back-up, though I am able to refer clients to a local teaching hospital’s MFM practice. Most midwives have no desire to provide shoddy or inadequate care, they are prevented from giving complete care by the attitudes from the local ob-gyn’s.
Most midwives carefully monitor their clients and transfer for anything indicating that their client needs medical attention outside the scope of a out of hospital midwife. We are still met with disdain and often hear that we are bringing “train wrecks” even when transfer is immediate. I am grateful for the two hospitals where Incan transfer clients without meeting this kind of attitude. It makes the decision to transfer all the more expedient. I always have a complete record when transferring, and this is either happily accepted or completely ignored depending on the facility.
I agree that midwives must do their part to ensure the safety of the woman and child, but very often the hospitals record of treating transferring women and their midwives dictates a reluctance to transfer that becomes a risk in and of itself. This must change if we want home birth to be as safe as possible and I agree that getting polictical is the only solution a this point.
drlindagalloway said,
July 16, 2012 at 3:10 am
Thanks, for your comments, Bettie. Here’s a suggestion: Since you have 2 hospitals that are willing to accept your transfers, including an MFM clinic, you might think about approaching them to do collaborative studies looking at the types of patients you transfer, what are the diagnosis and outcomes. You will have to dispel the “train wreck” myth with quantifiable data. Just curious: do you deliver at birthing centers as well?
Jeremy Galvan said,
January 19, 2013 at 11:20 am
Dr. Galloway,
I would have responded to your comments above but for some reason I couldn’t.
I wanted to also mention that I appreciate the intention of this blog. Unlike most of your colleagues you are trying to take the approach of offering advice to those you will never convince home birth is dangerous. I appreciate that approach as it is far more helpful that adding to the overwhelming amount of advice calling for the elimination of midwifery as a whole.
I wanted to comment specifically on your insistence of an OB back up. I don’t think I have to spend a lot of time commenting on the hypocrisy of suggesting that midwives must have an OB back up… while admitting OB’s will not back them up because of liability.
The answer to this is simple. The best part is it parallels other professions that already work together in a collaborative manner without Doctors having the authority to control the practice of others.
Delaware is perfect example of how a legal CPM system can result in no legal CPMs. They required an OB back up… and the OBs agreed only to never back a midwife up. Shocker.
Health professionals need to be able to refer clients/patients to higher levels of care in a smooth manner. Dentists do not need a collaborative plan with an oral surgeon to refer someone to a higher level of care. Midwives and hospitals need to have agreements on how transfers happen in a appropriate manner.
In a perfect world 88%+ of all home births never transport to the hospital. However for the 12% that do for a variety of reasons there needs to be effective communication and effective transfer of care. This means that the midwife needs to be on the phone with the hospital if things are heading toward a transfer. And the hospital needs to be ready for transfers if they occur… (oh wait, they already take walk-ins on a regular basis).
It needs to be said that health care providers are big on elaborating on stories and making themselves out to be heroes in every situation. Doctors are not immune to that. Out of 100 home births 88 are born at home and neither the mom or child need a transfer. of the 12 remaining 8 are for failure to progress and pain management. The 4 remaining are higher risk transports that depending on who you are could be considered more emergent. If you ask OB’s what they are scared of… they all say its the transports that are happening all the time. They are lying. If we believe the stats and not the doctors… then its safe to say that most OB’s have never even had a home birth transfer. Let alone an emergent one.
So my hope is that Doctors like you can realize that the safety is in licensure and not in ad campaigns and more biased research spit out by highly paid lobbyists. The answer to safety is making sure Midwives are held accountable for their actions or lack of actions, having a midwife board who is able to issues licenses and take them away if needed, and having doctors able to work along side respectfully so that the woman and child are the focus of everyone attention… not who did what and why they were not here earlier and any other garbage that can be discussed later.
Licensure makes midwives accountable and it helps protect doctors from care they had no control over. It puts the accountability where it belongs. I also hold families responsible for their decision. If there is good informed consent, refusal forms, and transport guidelines then there will be a far better system. Lottery payouts to families with bad outcomes is not helpful. A more reasonable system would be Hopkins being found guilty (like they were) and them having to pay for all medical care and maybe an average adult salary for 50 years to the family. That would be far less than 55 million and would help that family take care of that child who sadly was the victim of many layers of failure.
If you stop and think about why we license anyone… You will see how all those reasons scream out justification for licensing Certified Professional Midwives. I would think Doctors would always encourage licensure as opposed to the chaos we have going on right now.
Thanks for your time. I think based on this blog you are a reasonable OB and your priorities are in the right direction.
Jeremy Galvan
President
Maryland Families for Safe Birth.
drlindagalloway said,
January 22, 2013 at 11:37 pm
Thanks for your comments, passion and opinion, Jeremy. It would be so nice to have a forum about this topic with all stakeholders (midwives, patients, docs and ACOG) but unfortunately, it will never happen. In the meantime, my prayer is that moms who deliver at home be safe.