I recently talked to a Certified Professional Midwife about her experience with home births. Due to the current climate, with many still unsupportive of home birth, she's asked not to be identified but supplied a brief bio below.
In this interview, I propose a variety of scenarios to her: what if…? And she explains when (and in some cases, how often) she has run into this scenario during her 40-year career as a midwife, as well as what the outcomes were. I've read plenty of studies and talked to midwives at length and I was still surprised by some of the amazing stories she told me!
The midwife sent me this brief biography: I have been in practice for over 40 years and have attended almost 1,000 births. I am a Certified Professional Midwife (CPM) with current CPR and NRP certifications. I was an advanced EMT for 10 years. I am a midwifery educator and have done midwifery work on a local, statewide, national and international levels.
So she's pretty experienced. Here's our interview:
1) Out of all the births you have attended, approximately how often do you transfer a mother to the hospital?
Approximately 15% of all clients transport to the hospital.
2) What is the primary reason for transfer?
The vast majority of that 15% are first time mothers who choose to go to the hospital for pain relief (an epidural) or because they are exhausted (and want an epidural so they can sleep.) I try to caution each first time mother (even if they are not my client) to eat, drink and rest in early labor. The problem is that most first time moms are so excited (and feel like they have waited so long for labor to begin) that they get a rush of adrenalin making sleep difficult or impossible. Having never experienced labor before, they often believe that the mild, early labor contractions they are feeling must surely be "active labor." Sometimes, they are even afraid that if they sleep, they may miss the birth. I assure them that this will not happen. If labor begins in the daytime, I urge them to go about their normal activities and try to ignore the contractions as long as possible and nap, if possible. With the growing popularity of water labor (using a deep tub of warm water) there are fewer first time mothers who feel they need an epidural for pain relief. Still…I urge them to avoid getting in the tub too soon, as it can slow or stop early labor.
3) How often do emergency transfers happen?
True emergency transports are really quite rare…perhaps 1% of all clients. And even so, many of those arrive at the hospital with both the mother and the baby in good shape, because I would rather err on the safe side and regret an unnecessary transport later than wait too long and risk arriving at the hospital with either the mother or the baby in trouble.4) Have you ever lost a mother or baby? If so, what were the circumstances? Do you believe that this would have been different if they had been in the hospital?
I have never lost a mother. Over the years, however, I have lost a few babies. Most of these were for inoperable birth defects. These deaths could not have been prevented no matter where the baby was born.
Interestingly, I have had two babies born with a diaphragmatic hernia. This is a defect in the baby's diaphragm which occurs at approximately 10 weeks gestation. The diaphragm fails to close during development and the intestines fill the space above the diaphragm. Thus, the lungs do not have adequate space to develop.
The first of these two babies was born at home. His heart rate was always normal during labor, but when the cord stopped pulsing (providing oxygen) after birth, he became blue and limp. I used a mask and bag with oxygen to breathe for him and took him to the hospital. There they performed surgery to move the intestines back where they belonged and close the hole in his diaphragm. They then placed him on ECMO (similar to a heart/lung machine) which oxygenated him while his lungs were given an opportunity to develop adequately so he could breathe on his own. About a week later they were able to remove him from ECMO. This was many years ago and one of the first times ECMO had been used to resolve this problem, so he was followed for 9 years (the last I heard) and always demonstrated normal development and no brain damage at all.
The second of these two babies was supposed to be born at home, but both the mother and I felt we should go to the hospital. I cannot explain why as labor was progressing normally and there were no signs of distress. My best explanation is that our intuition knew it was time to go. The baby was born in a metropolitan hospital and much like the first baby, her condition worsened shortly after birth. The baby had the same surgery and treatment, but died a few days later. Although the cord was clamped and cut immediately at birth, I doubt this was the cause of death. I believe the difference in these two cases was that the first baby's lungs were further developed at the time of birth than the second baby's lungs and her lungs simply could not make the transition.
So here is an example of two babies with nearly identical problems and the one born at home survived and the one born in the hospital did not. I suspect the outcome would have been exactly the same regardless of where they were born.
5) Have you dealt with cord prolapse? What happened?
I have only seen a cord prolapse once. In that instance, I felt a loop of cord in the bulging membrane. In this particular instance, the fetal heart tones were normal and it was still early in labor. We transported the mother to the hospital in a knee-chest position to keep the baby up off the cord. (If fetal heart tones had been affected, I could have transported her in that position using my hand to push the baby's head up off the cord.) The physician who met us at the hospital, prepped her for a cesarean and then used a tiny needle to put a small leak in the membrane. This allowed the fluid to leak out slowly (instead of in a gush) and as the fluid leaked out the loop of cord slowly slipped back up above the baby's head. She delivered vaginally without incident.
For the full interview, visit Babble.
MORE ON BABBLE:
5 things we never knew before becoming pregnant
Room to breathe: 6 great sandals for achy feet
5 things my wife found endearing ... before she was pregnant
"How I delivered my own baby": An accidental freebirth
Happiest families have two girls, most miserable have four!?