Wednesday, September 17, 2008

Is our Maternity system failing? A Freebirth gone wrong.

In NSW a newborn baby dies, after the mother birthed at home with her husband and no health professional, a freebirth. The woman attended a hospital three days prior to the birth and was told the baby was fine however that she was at high risk of complications, including the rupture of a scar from previous caesarean. They wanted to induce her labour immediately. The woman refused and return to her home in the Blue Mountains where she gave birth to a stillborn baby several days later.
Two doulas, who are not medically trained but provide emotional support for women before and during childbirth, and a qualified independent midwife were called but arrived too late.

The baby's father told The Sun-Herald the doulas had told him the baby was stillborn due to an infection contracted inside the womb.

This tragedy confirms the fears of maternity experts who are alarmed at the growing trend of women evading the health system in favour of unsupervised home births.
This begs the questions, what information did the hospital doctors give this woman to scare her away and make the decision she did? Why do women make these choices? Was this woman suspicious that she may be coerced into something she did not want, and made a hasty decision? did she feel she had "no choice"
The Australian College of Midwives supports homebirth for low risk women. Midwives are trained in the 'normal' and can recognise the 'abnormal' therefore refer when necessary to an obstetrician. However the College does not support "freebirthing" its too risky.
Associate professor Dahlen said in this case the woman had been traumatised by a previous hospital experience and fears she might be forced into induction or a caesarean. Against medical advice, she made a last-minute decision to leave the hospital and go home and soon after the baby died in the womb.

If we fix the system we won't have women resorting to a last-minute panicked decision like this......... The increase in women freebirthing is a symptom of a system that does not give women choice. We're seeing more and more of these concerning incidents in the last two years. It has to be addressed, and urgently.

The NSW Health Department spokesman said;
Patients have the right to decline medical intervention or treatment, as as the freedom to choose where, when and from whom they will receive medical advice and assistance

It is suspected that this baby died of Group B streptococcus, not as a result of the homebirth. This case is currently with the coroner, so watch this space........

As a midwife I have to say, that there are enormous risks associated with 'freebirthing' and it is not advisable. I am an advocate for homebirth in low risk women, that is with no risk factors. However it is important to talk about your concerns and collaboration is the key. I urge any woman considering the option of Freebirth to seek advice, from your doctor, midwife, someone who can give you appropriate advice.

Look at all your options carefully, be fully informed in the risks associated with your condition and your babies condition before you make a decision. Write the risk and benefits down so that the facts are clear and there can be no mistakes, get a health professional to read your list so you have a balanced view and you have not left something out, then make a decision.

Remember to act on the FACTS not the EMOTION, after all it is your life, dreams and aspirations that your are considering. Take the time to make that decision, there are always consequences to actions.



Sarah Stewart said...

This is an interesting post. Do you have any stats about freebirth - I certainly get the sense that there is more of it generally, although I have no idea if it's a growing movement in New Zealand.

Lisa Barrett said...

As you can tell if you are reading this post it wasn't a planned freebirth and independent midwife had been employed and was on her way to the birth. a BBA midwife not a freebirth. Also the baby wasn't still born at time of birth it had demised at least 24 hours earlier. Misinformation about birth is what often drives fear.
Lisa Brrett
p.s. I wasn't the midwife I'm in SA.

Anonymous said...

The hospital staff suggested inducing labour in a woman with a scarred uterus? This is not good practice as induction of labour increases the risk of uterine rupture in those with a previous caesarean section. No wonder the woman didn't want the care offered there!

infomidwife said...

Hi Sarah, no I do not have current stats it is a project I am working on and will let you know. It is becoming more of an issue in Australia and certainly more women are talking about it. I find it very disturbing that women feel they can not go to a midwife and have no other choice but to go it alone - that is sad. I suspect that NZ would not have the same issues relating to freebirth, as you have such a good homebirth program, and a midwifery led system. Hopefully with the new Maternity Services Review midwives in Australia will get more recognition and a medicare number therefore giving as the autonomy we should have as you do and the UK midwives.
Ideally we need to rally together and get Independant Midwives indemnity insurance, that really is a problem here. How does that work in NZ? do your independant midwives have insurance?

infomidwife said...

Yes Lisa you are correct, I think it was a planned homebirth, however the article did talk about freebirth - and it is becoming an issue. It will be interesting to read the coroner's report in relation to the condition of the fetus. I couldn't agree with you more when you say that 'fear' and misinformation drives women away.

Sheryl from A Much Better Way said...

Your title is very misleading. This was not a freebirth gone wrong. Nothing about this stillbirth was freebirth related in fact.

The doctors wanted to induce because of concerns of uterine rupture...(like anonymous said, a recipe for disaster)...they did not want to induce because of a stillbirth risk from a strep b infection.

Only the divine powers will know if the baby might have been coincidentally saved because of an induction or cesarean for unnecessary and arbitraty reasons.

There may be legitimate risks in UC and I would love to hear about them (I am planning a UC in Nov) , but please don't blame UC for unrelated issues that would have occurred with a doctor or midwife anyway.

Anonymous said...

Too, too, too many unanswered questions.

- Why did she present at the hospital in the first place? If she was planning a homebirth with a midwife, *something* sent her to the hospital. Fever? (Sign of GBS) Meconium? (Sign of fetal distress)

- Did she get on the monitor at all? Were they able to do an NST? What did it show?

- There are rare instances when a nip of pit can kick-start a labor without causing uterine rupture; I've seen it happen a number of times, successfully avoiding a repeat cesarean. What did they see/know that made them want to weigh the risk of using pitocin over the benefit of delivering the baby vaginally?

- If they were SO hard-ass, they wouldn't have even considered pit, they would have jumped right to leading her to the OR. In my opinion, they were giving her a shot at delivering.

- Did she have a GBS test? Did they do it in labor? Were there signs of GBS infection as she presented to the hospital? Did the woman disbelieve what they were telling her?

- That she left in fear meant she left without logical thinking. (If, in fact, that is why she left.) That a mother would be SO afraid and ignoring the advice of health care providers to deliver her child alive demonstrates the serious amount of terrorizing she had in a previous delivery. THAT HAS GOT TO STOP! What do we think she'll do next time? Who's going to be civil to her in a hospital next time?

- We all know they played the Dead Baby Card to the hilt - and look, she was dealt it. I pray she looks at hospital birth/induction/doctors and nurses a WHOLE lot different than she did when she walked out AMA. I have written how hard it is to know when to believe the docs because they cry wolf so often, how/when do we know when they aren't exaggerating? This was one of those times, but how was she to know? Everything you read on MDC demonizes docs and most nurses - certainly hospitals. I agree that things HAVE to change there, but seriously, in a crisis, they have a WHOLE lot more to offer than a homebirth midwife - or a UC.

infomidwife said...

Thanks Sheryl thanks for your comments. There are not enough facts to determine what actually has happened in this case.
Yes I think that this may have been a planned homebirth, however a birth that has occured without any medical or midwifery assistance is therefore by definition a freebirth.

Having a health professional present may have made the difference in recognising the symptoms prior to the birth, therefore allowing an opportunity to intervene, ie antibiotics during labour.

infomidwife said...

Hi Navelgazing thanks for the comments, yes I have to agree there are lots of unanswered questions. I will be watching this case closely and when the coronor's report is published I will summarise the finding.

Lisa Barrett said...

Infomidwife. you are assuming it's a coroners case. Is this because of the homebirth label? Coroner doesn't have jurisdiction over stillbirth. He has the option to look at it and decide. If the decision is the baby didn't take a breath and it was not negligence then they do not hold an inquest or release a report.

Navel gazing midwife, sometimes I find you very medicalised in your assumptions. This woman employed a homebirth midwife AFTER being treated badly at the hospital. She went in because she thought she may be been in labour. No other reason. All was well but she was treated abominally as is often the case in Australia. As we know augmentation is not recommended for VBAC. I find speculation and gossip on issues like this totally unjustified and misleading.

Women don't just walk out of the system that late in pregnancy without good reason. Contrary to common belief midwives and women aren't running around trying to endanger life and limb for the experience.

At the end of it the woman lost her baby and it wasn't anyone's fault. They have to live with the decisions they made for the rest of their lives.

infomidwife said...

Hi Lisa,
This case will go to the coroner as it is the norm - all these cases go to the coroner, there was no medical person at the birth therefore it has to be established that it was a stillborn and the reason for death. This is not about negligence, this is about finding out the cause of death and trying to look at system errors, in other words a bit like a root cause analysis.

There have been very few facts realised about this case so everything is speculation on everyones part unless you know something I don't, so lets stop speculating about the care of this woman and wait for the facts and if there are no facts realised we really can not make any further comment.

Anonymous said...

You can consider me medicalized all you want. I believe I am very balanced between the medical world and the midwifery world. I have been around a long time and have seen a LOT, including a woman die; that changes the view of things dramatically.

I believe someone IS at fault and your saying it is no one's fault yet the family has to live with their decisions is contradictory.

I said there are a lot of unanswered questions and *was* guessing and asking questions. I wasn't speculating or spreading gossip. I was using my head and wondering what some answers were.

Aren't we all wondering? If not, we should be. Others can learn from this tragedy. Myself included.

Lisa Barrett said...

Hi Infomidwife, I am involved with lots of different committees etc and not all cases go to the coroner. A baby that doesn't take a breath is classed as stillborn. If the coroner establishes that the baby was stilborn then it is NOT a matter for the coroner. He can decide that immediately and not need a post mortem or have a post mortem and then decide. I have been involved in a case that the baby was still born. The coroner looks at the case on the same day as it occurs. He decides if there is enough evidence to support the baby was still born and it wasn't foul play of any sort. In the case I refer to within 24 hours he had decided no post mortem was necessary and the clients buried their baby at home.
Navel gazing midwife. Yesterday I transferred a woman to the hospital where she went on and had a normal birth. I Certainly think there are occasions where the system can be the safest place.

I too have been around a long time over 20 years. I have also seen a woman die. 24 hours after and elective section from a complication caused by the operation. Birth and death are closely related.

We all carry the responsibility for our decisions. If she's had an augmentation and ruptured her uterus would they blame the hospital? NO. In South Aus this week a woman ruptured her uterus after getting an epidural and augmentation. She was a VBAC. Well she is made to feel terrible for trying to birth her baby when in reality someone should get struck off for it, as all research says you shouldn't be doing this to women who had had a section before.

The woman in the story wasn't an intentional freebirth and her baby died in her belly before labour. This is not the fault of homebirth. It doesn't make homebirth dangerous the baby didn't die from anything that happened at the birth. Babies die of infection at the hospital all the time. Still births occur at the hospital all the time. Check the figures. Nobody is pointing a finger and saying don't go there. In the main a death of a baby in the belly isn't anyones fault it just happens.

Anonymous said...

I'd encourage being careful with words.

Babies do NOT die "all the time" in the hospital. They may die more frequently in hospitals than at home, but when the numbers are averaged, it's probably a dead heat.

Tubal Reversal said...

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