What if Something Goes Wrong?

Birth Anarchy reader, Karla and baby having an herbal bath following their homebirth.

Birth Anarchy reader, Karla and baby having an herbal bath following their homebirth.

** Trigger warning: birth trauma, birth injury **

What if something goes wrong at a homebirth?

What if the woman hemorrhages and there’s no one there to attend her? What if the baby shows signs of distress and they can’t transfer in time?  What if they live far from a hospital?  What if the weather’s bad?  What if the baby gets stuck?  What if the cord prolapses?

What if mom dies?  What if baby dies?

We should consider these implications for 1% of birthers.

 

But what if something goes wrong in the hospital?

What if a woman is tangled amongst wires to machines and medications that increase her chance of a surgical birth and a bad outcome?  What if the robotic voice holds more weight – more validity – than the signals of the woman and her baby?

What if her water bag is snagged open and she’s brought to her knees in defeat and surrender?  What if her baby’s cord rushes down between her legs – her peaceful labor turned emergency in one plastic-hooked swoop?

What if her contractions, fueled by the IV line, crush her baby between the walls of her uterus, and his sweet body, meant to dance to the rhythm conjured between him and his mama, loses the beat and falls tired, beaten down, compromised?

What if the numbness that seeps into her body from the cord in her back keeps her from the force of the electric current within?  What if she must be rescued from her labor?  From herself?  How can you undo the first step that led to the second – the one that left bruises and scratches and bleeding on the brain?

What if his pulsing lifeline is squelched too soon?  Or she’s pumped full of medications no one asked her consent for?  What happens when her doctor is impatient and tugs on her placenta, leaving chunks and hunks clinging to the banks of a gushing river of blood?

What if the intimately connected unit is pried apart – mother left longing, reaching; baby screaming, cold and frantic on a hard, bright table?  What if he’s poked, pried, handled roughly?  And given things that his parents haven’t consented to?  What if all this fuss confuses baby?  Confuses mom?  Confuses the entire family?  What of attachment?  What of breastfeeding?

What if the surgery was unnecessary?  Or the episiotomy leaves her unable to sit comfortably for months?  What if his gloved hand thrust into her vagina leaves her feeling powerless, violated, confused?

What if most women receive care that increases risks to them and their babies?  What if many women describe their births as traumatic? If some of them go on to develop clinical PTSD?  How about the multitudes of women who have trouble navigating the waters of new motherhood amidst the residual physical and emotional trauma?

What if despite the fact that the U.S. spends the most money on maternity care and that most women birth in hospital, women and babies die at alarming rates?

What if we considered these implications for 99% of birthers….

 

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Comments

  1. says

    Fantastic article – it’s motivating and powerful. Where is the statistic to back up that 1% located at so I can use it in my arsenal as well. I am in awe of this post and will probably be referencing it my self on my blog. You rock!

  2. simon says

    It’s an interesting point of view, but I’d be interested in knowing:

    1) Frequency of above listed problems during home birth
    2) Practical implications of said problems during home birth
    3) Frequency of above listed problems during hospital birth
    4) Practical implications of said problems during hospital birth

    I may be wrong, but my educated guess is that while a few hospital births encounter problems due to the fact of it BEING a hospital birth, the implications thereof are minor, with nearly none of them result in the death of mother or child.

    On the other hand, many of the potentially fatal problems that are encountered during a hospital birth are often readily rectified, which might prove terminal in a home setting.

    In other words, I think that the “what-if’s” listed above are uncommon and insignificant in comparison (re-read “in comparison”) to the primary goal of childbirth, which is to end up with a live and healthy mother and baby. I’d prefer to end up with the emotional trauma of a rough hand in the vagina than the emotional trauma of a dead mother or child.

    (Full disclosure – my wife’s vaginal canal was severely torn during our hospital birth, and the doctor indicated that she would likely have bled out in the course of 15 minutes, had we not had immediate access to emergency treatment.)

    • says

      Without getting too deep into it (just because I don’t have time! :) ) I think your premise falls apart when you consider the severity of what happens in hospitals. One very quick example is that the risk of death to the mother and baby are higher in a C-section. Death in childbirth is still rare, yes, but it’s higher. So, if we have half a million unnecessary C-sections every year due to inept care and hospital practices (which is the rough estimate of 1.1 million Cesarean surgeries a year at double the threshold at which we start to see more harms than good), there are real lives lost. The U.S. also has an astonishing number of so-called “near misses,” where someone doesn’t die, but has a really serious complication or injury. Wish I had time to grab all these stats, but maybe someone else will for me.

      I also don’t want you to discount the way women are treated in the hospital. The term “birth rape” exists for a reason. Simon, I thought it was a totally ridiculous phrase when I first heard it, and then I started hearing the stories from women. That term is not an exaggeration. To expect someone to return to the “scene of the crime” where they have been raped or sexually assaulted in order to give birth is inhumane. I completely understand why some of those women would rather give birth under a tree in the backyard than subject themselves to that kind of treatment again, and place their baby’s safety in the hands of people have assaulted them.

      I encourage you to take a look at the actual data about the safety of homebirth. Could someone post something? I have a crying child over here……

    • Profile photo of Kathi Valeii says

      Hey Simon,

      Thanks for your comment. The fact is that 9 out of 10 women receive care that increases rather than decreases risks to both them and their babies. Our c-section rate is one example of that. The U.S. has a c-section rate in excess of 33%, and the World Health Organization states that for the rate to be “safe” it should not exceed 10-15%. We are at least double – in some areas, triple – that recommendation.

      In addition, the U.S. spends the most money on maternity care than any other country in the world. And yet our infant and maternal mortality rates are higher than almost any developed country in the world. I know it is hard to believe, but unfortunately, women and babies are dying in greater numbers in the U.S. than 45 other countries across the globe. In fact, in the past 25 years our mortality rates have doubled.

      I have been birth worker and activist for almost a decade, making my lens into the situation pretty unique. I routinely see non-evidence based practices carried out in hospital. Practices that are based on cost, convenience and liability concerns – or “just they way we do things” – and not based on what is proven safest for women and babies.

      I’m sorry to hear about your wife’s close call. The fact is, it is really impossible to compare what would have or could have happened if the birth would have happened elsewhere. That is because the way that birth is managed within the two locations is entirely different – thus the outcomes would not always be the same. Often what becomes an “emergency” in the hospital is the direct result of a model of interventive management.

      How do I know that the problem lies in the hospital and not at home? Our mortality rates tell us this. We know because despite the fact that only 1% of women birth at home, we still rank around 45th in maternal and infant mortality. We don’t all have to agree on which place is “best” to give birth. The point of this piece isn’t to do that. On the contrary, the point is to raise awareness of the lack of scientifically sound practices that are carried out as routine in MOST births – in the place where most women give birth. If we have a dysfunction in the system, we should focus our efforts toward reforming where 99% of the problem lies.

      We owe it to all the women who will birth after us to make sure that the system is set up to be as safe as possible.

      Here are some links that support the information, above:

      http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf
      http://www.childbirthconnection.org/article.asp?ClickedLink=748&ck=10396&area=27
      http://www.childbirthconnection.org/article.asp?ck=10450
      http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf

      • Wendy says

        The last two posts did an excellent job of responding to your response Simon but I would like to add one more thing. You do NOT have a vagina so how DARE you say that a little trauma is a small price to pay for a healthy baby and healthy mother. After you have experienced multiple people shoving their fingers

        • Wendy says

          I’m sorry my boys just entered that for me. If you ever experience birth trauma YOURSELF then feel free to act like its no big deal. I would also like to point out that with proper care its quite possible that your wife may not have torn. Just like with proper care my first son would not have been vacuumed out leaving me with an episiotomy that did not heal for months and destroying our initial bonding period.

          • simon says

            Well, Wendy, you’re right, I don’t have a vagina. But I do have an anus, and males have been raped there (including a friend of mine who is still, years later, having great difficulty coping). So although I don’t have a vagina, I am certainly able to imagine the trauma of actual rape. Besides, I’ve been to the proctologist. I’m no stranger to a brusque man putting his fingers in me. And I DO understand, from direct experience, traumas of other types.

            My statement was not to imply that the trauma of rape is not damaging, or that an episiotomy is not a horrible thing to endure, but rather to state that the potential of emotional trauma of any sort – rape or otherwise – is not as bad as the emotional trauma and genuine tragedy of a dead mother or child.

            (By the way, try not to throw around the phrase “how DARE you” too easily – save it for when it really matters.)

            In terms of “proper care,” my wife was very well taken care of by a tender and experienced doctor and a wonderful staff of nurses in a hospital with an excellent birthing center. The fact is, our son was born with very long, sharp fingernails, and they were pretty sure that this was the cause of my wife’s internal bleeding. So the fact remains, if she’d birthed at home, I’d be a widowed father of one instead of a happily married father of two.

            Again, my point was not to diminish the fact that many women have traumatic experiences during birth. I get that. I have friends who have gone through horrible situations. Rather, I was pondering what the statistics are in terms of number of problems that arise as a DIRECT result of a hospital birth, the actual real-life consequences of those problems, and the comparative cost.

            I maintain that although there very well may be birth traumas that are a direct result of the hospital setting, there are also problems that are a result of home birth, and only by comparing the real-world consequences of each can one decide which birth method is right for any individual family.

    • Madalena S. says

      I wonder if your wife’s vaginal canal would be torn if she was having a relaxed childbirth at home… It seems to me that most problems that arise in hospitals are caused by the way they treat the mother.

      • Profile photo of Kathi Valeii says

        Just a reminder about the social media policy of Birth Anarchy. I love a lively discussion, but PLEASE keep it respectful.

        “These topics are deeply personal, and can be emotional for those engaged in the conversation. As always, I welcome thoughtful discussion in this forum. Disagreement is a springboard for productive conversation. A basic ground rule that I will follow, and that I expect from all of my readers and commenters is RESPECTFUL dialogue. All comments are moderated, and those not adhering to that basic guideline will not be published. This holds true for Birth Anarchy’s facebook page, as well. Disrespect in the form of name-calling, banter, or generally rude comments will be deleted. There are plenty of forums out there with an interest in mud-slinging, slander, and childish behavior. This is not one of them.”

  3. Meagan says

    I watched my mom have 3 home births. The 3rd one almost killed her. She started to hemorrhage and was rushed to the hospital. There are too many things that can go wrong. I am sure that most incidents with at home births go unreported. Plus, 99%?!! That would mean that I would have to have problems with at least a few of the 4 children I delivered in the hospital. The last one was delivered naturally. They allowed me to do whatever i wanted. I could walk, stand, take a bath or shower. It all depends on having a doctor you can trust. My doctor always worked with me. In fact, my baby was facing sideways and he turned him gently as i pushed him out naturally. All of my births have been extremely peaceful, luckily. Plus, I never felt forced to do anything I did not want too. I find this post to be completely one sided and incorrect. Find a doctor you can trust, voice your opinions and you will be fine.

    • Profile photo of Kathi Valeii says

      Hi Meagan,

      Thanks for your thoughts. Certainly emergencies can arise in any setting. My point wasn’t to suggest that they can’t or don’t occur at home, but rather to explore the question of why are we always focusing on the teeny tiny 1% of women who choose to birth at home when we consider risk analysis? I just doesn’t make sense.

      I intentionally laid this piece out with more elaboration on the risks of hospital birth because not enough attention is paid to it. We’re so caught up in the idea that surely the hospital is the safest place, and surely it would be risky to choose otherwise, that we often turn a blind eye to the place that 99% of women in this country choose to birth – the hospital. (And that’s the 99% figure — not that 99% of women suffer egregious complications, but simply that 99% of women birth in hospital.)

      I’m glad you had a peaceful hospital birth and a supportive doctor. The fact remains that most women receive care in the hospital that is not evidence based; and most women are not respected as the ultimate authority when it comes to choices about their care in pregnancy, labor and birth. I’m not suggesting all women birth at home – that’s silly. I am advocating for better care in the hospital. I want all women – regardless of their place of birth – to have access to the kind of care that is proven safest for women and babies AND that honors them as the decision-makers about their care.

      • simon says

        “Risk analysis” and “evidence-based” are the key phrases here.

        It just struck me – is there any evidence that home births are more likely to be attended to by doulas who actually practice evidence-based practices? Someone could very well choose not to go to the hospital because they fear non-evidence-based practices will be used, and end up with a doula who is even less aware.

        (I probably sound like the total anti-home-birth dude, but please don’t think less of me. I’m just interested in a good debate on these issues.)

        • Profile photo of Kathi Valeii says

          I think what you are asking about is midwives rather than doulas, right? I’ll just assume that’s the case in this reply, because a doula’s role does not allow for her to offer any kind of care to a woman outside of comfort measures and physical and emotional support.

          So, to answer your question – yes. There are two well-known distinct models of care, known as the medical model and the midwifery model. (You can probably guess who follows which – usually, though not always… I’ve known a handful of doctors who practice the midwifery model and vice versa.) As a general rule, OOH providers adhere pretty closely to normal physiological management (which is proven safest for mom and baby).

          Countries who have a well-integrated system with midwives providing most of the prenatal care – referring out to OB-GYN’s when there is a true medical condition – have the best outcomes. There was recently published article that addresses that issue, in particular, but I’m having trouble locating it at the moment. (Maybe someone can help me with that…)

          And then there’s this amazing article, which was just published in AMA Journal of Ethics. The piece is authored by 2 physician professors and tackles the very issue of non-evidence based care practices in hospital settings by maternity care providers. http://virtualmentor.ama-assn.org/2013/09/msoc1-1309.html

          I believe you aren’t necessarily anti-homebirth; I, too, am not anti-hospital birth. I just know we can do way, way better. I know that women and babies deserve the very best care – regardless of where they choose to give birth.