February 6, 2012
Home birth, a controversial subject in the world of maternity will gain even greater controversy based on the recent death of 36 year old Carol Lovell, an Australian home birth advocate who collapsed and died after the birth of her second daughter. Lovell was rushed to the hospital after she developed symptoms of heart failure during labor and ultimately died.
Despite warnings from the American College of Obstetricians and Gynecologists (ACOG), homebirths in the U.S. has increased by 29% from 2004 to 2009, according to Bloomberg Business Week. Caucasian women over 35 with previous children are more likely to have homebirths and over 60 percent of them are attended by midwives, 5 percent by physicians and 33 percent by “others.” Admittedly, twenty years ago, the thought of having a homebirth seemed farfetched. However, when patients lost their freedom of choice regarding hospital selections based on managed care restrictions and healthcare became more focused on profit as opposed to quality healthcare, the landscape changed dramatically.
Women opt to give birth at home for a multitude of reasons. Some want minimum interventions such as the I.V., meds and fetal monitoring. Others prefer to deliver in the comfort of their home based on its familiarity and then of course, there’s the issue of cost. It is much cheaper to deliver a baby at home rather than in a birth center or hospital. But here’s the dilemma: obstetrics is a specialty of the unexpected and a low risk pregnancy can transform into a high risk condition abruptly with little warning. Unfortunately, when a complication occurs during homebirth, the babies will die 2 to 3 times faster than if they were born in the hospital. Why? Because of the advantage of life-saving neonatal technology that is used in most hospitals. If a mother has a difficult birth in a hospital, the pediatricians and neonatal specialists are in the delivery room at the time of birth. The baby is whisked away to the neonatal intensive care unit where life-saving procedures are performed. A home birth does not offer this advantage.
Although ACOG does not support homebirth, they make the following recommendations:
- Have standard prenatal care, including Group B Strep screening
- Work with a certified midwife, certified nurse midwife or physician that practices in an integrated or regulated health system
- Be able to obtain professional consultations from obstetricians or specialists quickly
- Have a plan for safe and quick transportation to a nearby hospital in the event of an emergency
- Be a low risk patient
- Do not have a home birth if you are beyond 42 weeks
It is also time for ACOG to meet these women halfway. We know that the numbers of homebirths are steadily increasing. ACOG needs to devise new methods and innovations of improving patient safety. Homebirths are here to stay, whether we like it or not.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 17, 2010
On February 10, 2010, Katy Hayes, a free lance massage therapist and mother of two, gave birth at home to her 10 pound daughter after 8 hours of labor without medication or intervention. (See AOL’s link http://alturl.com/8bh9). It is not known whether the home birth was attended to by a midwife.
Katy did not have health insurance, nor did her husband, Al. Four days later, Katy was rushed to the hospital because of increased excruciating pain and almost died shortly thereafter. She experienced massive organ failure, and then lapsed into a coma. Katy had Group A streptococcal disease which causes strep throat or mild soft tissue disease. However if this bacteria gains access into the blood stream its effects can be devastating. It causes necrotizing fasciitis or the “flesh eating bacteria.” It is also responsible for Streptococcal Toxic Shock Syndrome, commonly referred to as either “Toxic Shock Syndrome” or TTSS. This infection has been on the rise in the U.S. since the 1980’s with 8 to 10 thousand cases occurring annually and 30% of people affected still die each year.
Katy’s husband faced a major dilemma. The physicians informed him that the only way to save Katy’s life was to remove the source of the infection which was her uterus. In addition, all four of her legs and arms had to be surgically removed as well as her ovaries, stomach and part of her intestines. And there was still the possibility that she might die. Al made the heart-wrenching decision for Katy to have the surgery.
Katy regained consciousness on March 12th and is on a slow but steady road to recovery. She will have to be fitted for prosthesis of her arms and legs and her greatest desire is to hold her baby and return to her family. Her friends and family are conducting fund raisers to pay for her hospital bills.
Some schools of thought will argue that Katy should have never had a home birth. Others will defend her right to do so. I hope Katy did not opt to deliver at home because she lacked healthcare insurance. That would be a moral tragedy. I wish I could turn back the hands of time because here’s what Katy should have known:
- Older women (those over 35) have an increased risk of birth complications. Katy was 41.
- There are federally funded community health centers to take care of the uninsured.
- A fever after childbirth needs PROMPT attention. Katy had a fever for four days before she was taken to the hospital.
Let’s all pray for Katy’s continued recovery and a swift return home to her baby.
Join the FB page created for Katy by clicking here http://www.facebook.com/group.php?gid=343063085090