What do you think? When babies die regardless of location.

What about those situations when no matter what one does the outcome is that the baby doesn't live?

“ …. we don't know if they'd have been fine at home! But...the same is true of homebirth deaths. We don't KNOW if being at the hospital would have saved them.”
--- Heather B. on this blog

This circular argument has been going on regarding hospital versus homebirth deaths for mother and baby -- for a long time. It can’t be answered. It can’t be researched. While people debate it mothers and babies are dying and being harmed in medical birth and in improper homebirths. Physicians and midwives bear the moral and legal responsibility for the women and babies.

I am sharing below the experience of an obstetric resident caught in the middle between trusting nature, honoring woman's choices, and going against what he was being taught is necessary because “birth is a medical crisis” (and that maintains the system that pays him and his malpractice insurance). The resident supports her wishes and he advocates for her and the outcome is not a healthy, live baby. It is tragic for every one involved. Who is "responsible" will always be the first and last question -- too often settled in court.

His experience in the birth of a baby born brain dead is a perfect representation of all aspects of birth in our society that are being debated about not only WHERE is a baby safe, but what care provides safety while respecting the mother's body, choices, decisions, and responsibility. How can this society develop the best and safest care for the baby and respect the needs of all parties, including the physician and midwives.

My intent is to engage women, obstetricians, nurses, psychologists, malpractice attorneys, educators……anyone who wishes to contribute to making birth safer wherever a woman chooses to give birth -- home, birth center, or hospital. This effort to reform birth practices and develop partnerships between midwives and physicians is so that our society focuses on the well being of humans from conception on. It is so babies are not only born alive, but that they are conceived, gestated, labor, and are born with the least drama and trauma possible.

In order to facilitate what I have proposed here -- a beginning of coming together of all parties to dialog -- in order to heal birth, I invite you, whoever you are, to respond to the following correspondence from a second year resident in an obstetric residency program in an inner city Chicago hospital.

This story is about a woman who comes to the hospital wishing to claim her body and birth and be without interventions. To do so in a hospital, a woman must come to that place very defensive and resistant. It is very eerily similar to many homebirths that result in fetal death -- the mother's wishes are supported and the need for emergency care happens fast and too late. This story is likely to have ended the exact same way if the mother had chosen to birth at home.

In our society, regardless of the best efforts by a mother and her medical caregiver, clearly some babies will die. The attitude prevails that “someone has to pay” and there are plenty of malpractice lawyers to take up the cause. For damaged, but living human beings there is a huge cost on many levels for the family. Our society does pay to support their care and treatment, often life long services. A myriad of social service programs and therapists will be paid by taxpayer money to provide for the child, often for decades. The resident's heart-felt questions about this, "who will take care of the brain dead child" are touching. This baby's birth and death, while trying to "do birth right" was a turning point situation for this resident -- he stepped out the "between a rock and a hard place" and into the medical machinery. The pressure from all sides -- family, legal teams, attendings, etc -- is too much. Living with the questions of self-doubt and losing a baby is life changing for a physician (or nurse or midwife.)

How can we give women power over their bodies and choices in birthing their babies, and support those caregivers -- physician, nurse, or midwife -- to also be cared for and supported?

This is an opportunity to express your concerns and needs, either personally or professionally, but it must be done with respect and regard for the differences of others and their choice, especially the mother, baby, and family, and resident. I am looking for sincere answers as this story demonstrates what I believe are big issues.

1) Doctors are disproportionately responsible for birth outcomes ;

2) Legal liability of any caregiver - physician or midwife allowing the mother to make the choice and how to personally live with the consequences; because

3) Sometimes babies will die regardless of where, or with whom, the mother and baby give birth.

Remember the FOCUS is the HUMAN BABY in relationship to the mother and family, and what a baby needs to be safe and supported, nurtured, and to be born according to his or her own biological impulse (physiological science tells us the baby begins labor).

Rules of engagement

1. Use “I” statements and refer to people in general as "one" as "you" often creates misunderstandings.
2. Express your perspective as your own
3. No personal attacking of individuals or groups
4. I reserve the right to not publish those that are offensive or attacking
5. Consider the Four Agreements by Miguel Ruiz as a guide
-- Be Impeccable with Your Word (say what you mean, mean what you say and don't gossip)
-- Don't Take Things Personally (love you or hate you -- others project their beliefs)
-- Don't Make Assumptions (what you assume is more about yourself and your beliefs)
-- Do Your Best Everyday (and acknowledge others doing their best are as well)



Last night I had a woman who was at the hospital as she was in labor. Her family did not want to take her home and when in pain after offering her different methods of pain relief she refused. Then she continued to labor very slowly (doing it all on her own) after rupturing her membranes on her own earlier in the morning. She only allowed us to examine her a few times and by the way she was progressing I knew that it was going to be a long night. The baby's heart rate was now in the 180's and she would not allow us to intervene. At 1230 yesterday night I got a call from the nurses to perform a stat c-section for absence of fetal heart tones. I was in the operating room at 1231 and tested the mom’s stomach for adequate anesthesia. She screamed in pain, but after 6 minutes she was under general anesthesia and I made the first incision and had the baby out in 40 seconds. When I pulled the baby’s head out it appeared limp and when I pulled the rest of the body out it appeared lifeless with no pulse in the cord which I clamped. I placed the lifeless infant in the isolette and after fifteen minutes they were able to revive the infant but had to place it on a ventilator. Both its pupils were already fixed suggesting massive hemorrhage in the brain.

After the neonatologist informed the parents of the baby’s condition they both hugged one another and started to cry. Later they both asked the staff and me what went wrong?
If you want to labor on your own no one should stop you. Yes, it was the right of the woman to refuse anesthesia/epidural, and to refuse monitoring; but now she has a brain dead infant and is looking for answers which only God has the answers to and it is God who would have predicted the outcome. But who is standing up for the baby who is now going to be in a vegetative state.  

Who is going to pay for it? Which one of the women who supported this woman in her decisions is going to give her comfort? Which one is going to pay her expensive medical bills and who is going to help her raise child that is possibly going to be in a vegetative state for a long time, if not forever?

The middle ground exists in other countries where they have home births, birthing rooms, and hospitals. Some women have good outcomes and some women have bad outcomes in all populations those in a hospital setting to those in a home setting.

Fight the good battle which ever side you’re on but make sure that you’re there to support your side when the going is bad.