Do you have any experience with homebirths? Midwives? Planned unassisted births?

abckidsmom

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An acquaintance recently had quite an experience with a planned homebirth, a prolapsed cord, some really excited firemedics, and a c-section without any anesthesia at all.

It all led me to wonder what the community experience with interacting with people who planned homebirths is.

What would you do if you were called to assist a midwife caring for a woman with complications during labor/birth? Would you take over for the midwife? Would you let her ride along?

What if the baby was crowning, and you couldn't hear fetal heart tones with the doppler?

What would you do if the midwife had her hand inside the vagina, holding pressure off of what she said was a prolapsed cord? What about if she was not physically tall enough/agile enough/able to keep up with the stretcher as you crossed the yard to the ambulance?

What other complications have you seen when called to assist with births, planned or otherwise?

What's your plan for communicating what you have to the hospital?
 

Aidey

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I think what I would do would depend on the midwife.

We were called for a newborn not breathing and when we arrived the midwife was bagging the baby. I don't remember the exact APGAR, but the baby's color wasn't great, pulse was over 100 and he wasn't very active. Midwife told us he was agonal when born.

She was freaking the f out. It was a HUGE pain in the arse dealing with her, and then after the baby started crying and everything seemed ok she talked the parents out of transporting! She told them that if they took the baby to the ED the doctors there would force them to admit the baby and wouldn't let them take it home that night, even if nothing was wrong. Said it was "impossible" to get the baby out of the hospital once it was brought there.

We did everything we could to try and talk the parents into transporting, but they listened to the midwife. In retrospect we should have asked her to leave, and then made her leave very early on.

It is essentially like any other provider on scene. If you are helpful you can stay, if you are not you're going, even if I have to get the police to make you go.
 

Aerin-Sol

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Can you legally force control from a midwife? I can see making the case for a lay-midwife, but wouldn't a certified nurse-midwife be considered a more advanced level of care? Could you have the police help you take over a RN's patient? I'm not being snarky.
 

firecoins

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Call medical control and put the MD on with the parents.
 

Aidey

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Police don't care about level of certification. In most places it is illegal to interfere with EMS, period. If I tell the police officer that the midwife is preventing me from administering appropriate care that is all there is to it. In my case there were multiple paramedics on scene who disagreed with the midwife, which I think matters in these cases.
 

JPINFV

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It is essentially like any other provider on scene. If you are helpful you can stay, if you are not you're going, even if I have to get the police to make you go.

Can you demand that a provider who the patient wants present to leave just because their advice is conflicting with yours? If you're at a doctor's office, for example, can you demand that the physician leave his own patient and exam room? Would this not put the other provider at risk for patient abandonment as well?
 

JPINFV

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Police don't care about level of certification. In most places it is illegal to interfere with EMS, period. If I tell the police officer that the midwife is preventing me from administering appropriate care that is all there is to it. In my case there were multiple paramedics on scene who disagreed with the midwife, which I think matters in these cases.


Is the patient actually preventing you from administering appropriate care, or advising the patient on what they believe is appropriate care? Ultimately, isn't it the mother's choice to determine what care is actually appropriate?

Are you going to seriously consider putting your education and experience with childbirth up against a certified midwife?
 

the_negro_puppy

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I have had one bad experience with a home birth/midwife.

We were called lights and siren to a house in a semi-rural area (40 mins from hospital) initially for a home delivery gone wrong. The job description was a birth with the baby's shoulder stuck, and midwife on scene. We got halfway there before the midwife called back and tried to cancel us. But our supervisor told us to proceed and do a quick checkup.

When we arrived i noticed a large car in the driveway, with political midewife bumper stickers all over it such as pro breast feeding and pro home birth.

We went inside and found mum and baby, both doing ok. Baby APGAR 10 and this was mum's 5th child. She still had minor bleeding but the midwife was very defensive and by her demeanour didnt want us there or near the patients. We checked mum and baby quickly before leaving. I couldnt help but notice the midwife had no resus or other gear just some oxytocin injections.

We drove the 20 mins back to station only to be called back to the house, due to the mother continuing to bleed. By the time we got back, the mother was pale, diaphoretic, BP 90 systolic, HR 120, increased RR. All the signs of hypovolemia. We ended up oxygen, loading, IV access, small amount of fluids and driving code 1 to hospital with the shocked mother on the stretcher, the father on the spare seat in the back holding the 1 hour old baby, and the placenta swishing around in an icecream tub on the floor.

In this case we nearly had 2 patients die (baby from shoulder dystocia, mother from primary post-partum haemorrhage. All in the name of homebirth. This was particularly bad in that the midwife had no resus gear, and failed to recognise the signs of post-partum haemorrhage early on. Her oxytocin injections and fundus massages didnt really do the trick.


I am against homebirths, and there are recent studies indicating the mortality of infants is much higher born in home than hospital. It is of my opinion that the mother is putting her own comfort ahead of the possible risks to the baby. There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.
 

bstone

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It wasn't long ago that 100% of humanity was a product of homebirths. Our rates of survival weren't too great back then. Midwives, as they existed then, were trained by apprenticeship. If the master (mistress?) was good then the future midwife might also be. They weren't really good at emergencies.

Modern midwives are usually RNs with specific midwifery training. Some states view them as Nurse Practitioners/Advanced Practice Nurses. They can write prescriptions. They have graduate degrees. That's more than what we EMT and medics have.

When called to a homebirth gone wrong don't assume you'll immediately take over care and push the CNM (certified nurse midwife) out of the way. Work *with* with CNM, keep the patient comfortable, say 'you have a beautiful baby'. Things like that will keep tachycardia down. 'Offer' the CNM a ride to the hospital in the back of the bus. She'll likely refuse and want to follow in her car. 'Suggest' she does not tailgate the bus but instead ensure the CNM you'll take very good care of mom and baby and see her at the hospital whenever she can safely make it there.

Do the above and you'll find your patient and CNM much happier.
 

Aerin-Sol

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I am against homebirths, and there are recent studies indicating the mortality of infants is much higher born in home than hospital. It is of my opinion that the mother is putting her own comfort ahead of the possible risks to the baby. There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.

So do you think home birth should be criminalized?
 

lightsandsirens5

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There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.

This is an excellent statement. I wholeheartedly agree. The vast majority of births go off s a hitch. However, when something does go south, you need help and you need it yesterday. 40 mins away from the ER via amb is just too long.

I am all for people having kids outside of the hospital if that is your thing. But common sense must be exercised. Not only that, aren't there clinics where a midwife can deliver the kid s going to the hospital?
 

Linuss

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When I was at AMR we got called to a Midwife after the mom lost a crap load of blood.


The midwife completely overloaded the patient with NS and skyrocketed the BP, and looked at me like I was an idiot when I shut off the IV.
 

usalsfyre

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Don't speak for anyone else, but as a husband standing at bedside for two somewhat complicated vaginal births, I think the thought of homebirth is insane. Find a hospital that will honor whatever cultural/religious/completely made up rituals you want and have the kid there. But for God's sake, have some people who know what to do when things go bad close at hand. At home, an hour away from an L&D department is NOT the time to find out you CNM is an idiot.
 

Aerin-Sol

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Don't speak for anyone else, but as a husband standing at bedside for two somewhat complicated vaginal births, I think the thought of homebirth is insane. Find a hospital that will honor whatever cultural/religious/completely made up rituals you want and have the kid there. But for God's sake, have some people who know what to do when things go bad close at hand. At home, an hour away from an L&D department is NOT the time to find out you CNM is an idiot.

As opposed to being in the hospital and finding out that your OB/GYN swears by pitocin & c-sections regardless of what the patient actually wants? Going by horror stories of bad practitioners as a way to declare something "insane" is in itself insane.
 

usalsfyre

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As opposed to being in the hospital and finding out that your OB/GYN swears by pitocin & c-sections regardless of what the patient actually wants? Going by horror stories of bad practitioners as a way to declare something "insane" is in itself insane.
Why did I figure you were a rabid home birth person :rolleyes:

If you had taken the time to READ my post, you'll see I indicated to find somewhere that will honor your wishes. It's not a couple of horror stories, it's the thought of having a complication that requires a section/blood/hysterectomy/complicated resus to prevent fetal and/or maternal demise in the boonies without help available that is insane to me. It's a personal opinion. Someone being willing to put their own and their kids life on the line for what essentially amounts to a personal statement doesn't sit well with me.

If your hell bent on no pit/drugs/sections/touchy-feelly natural birth stuff, perhaps the time to discuss that with you OB is PRIOR to being in a delivery situation.
 

Aidey

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Can you demand that a provider who the patient wants present to leave just because their advice is conflicting with yours? If you're at a doctor's office, for example, can you demand that the physician leave his own patient and exam room? Would this not put the other provider at risk for patient abandonment as well?

Is the patient actually preventing you from administering appropriate care, or advising the patient on what they believe is appropriate care? Ultimately, isn't it the mother's choice to determine what care is actually appropriate?

Are you going to seriously consider putting your education and experience with childbirth up against a certified midwife?

Honestly, it depends on the situation. The provider could end up riding in. The chance of something like that happening is very very small. We are talking about situations were the other provider's actions go directly against the standard of care. We aren't talking about the difference between 2lpm of O2 and 4lpm of O2, more like giving someone in anaphylaxis 3mg of epi rather than .3.


In the case I posted I looked up the midwife later, and that is all she was. She was not an ANP, or RN for what it is worth. In a case like that one, where the baby was not breathing and she is scaring the parents into thinking the hospital is going to steal their child, yes I would be willing to go up against a midwife.


Why did I figure you were a rabid home birth person :rolleyes:

If you had taken the time to READ my post, you'll see I indicated to find somewhere that will honor your wishes. It's not a couple of horror stories, it's the thought of having a complication that requires a section/blood/hysterectomy/complicated resus to prevent fetal and/or maternal demise in the boonies without help available that is insane to me. It's a personal opinion. Someone being willing to put their own and their kids life on the line for what essentially amounts to a personal statement doesn't sit well with me.

If your hell bent on no pit/drugs/sections/touchy-feelly natural birth stuff, perhaps the time to discuss that with you OB is PRIOR to being in a delivery situation.

Something I think is a happy medium are birthing centers. They tend to have a number of options for delivery and multiple midwives/staff on site. I would be WAY more comfortable giving birth in a birthing center than at home. There was actually a VA hospital where I used to work that had a birthing center attached, totally separate from their normal OB floor. It was very popular, and if anything went wrong they were in the hospital.

I don't really have a problem with home births, but there was a reason mortality rates were high. If parents are going to elect to do a home birth they need to be aware that there is no way to be 100% sure before hand it is going to be an uncomplicated birth, and that there is risk involved. I think OBs end up in a sucky situation because they get blamed for so much more than any other doctor. Their insurance rates are the highest in the industry. I think if more people realized not every birth is going to go 100% perfectly, and not every kid is going to be 100% healthy things would go a lot smoother.


Besides, who doesn't think it would be a huge mess to set up a birthing pool in their living room? Blech.
 
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usalsfyre

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Something I think is a happy medium are birthing centers. They tend to have a number of options for delivery and multiple midwives/staff on site. I would be WAY more comfortable giving birth in a birthing center than at home. There was actually a VA hospital where I used to work that had a birthing center attached, totally separate from their normal OB floor. It was very popular, and if anything went wrong they were in the hospital.


Besides, who doesn't think it would be a huge mess to set up a birthing pool in their living room? Blech.
I'm good with this. Just some sort of site. Not at the far south end of my district, in a part of your house we can't get you out of, on a night where it's raining cats and dogs.
 

the_negro_puppy

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So do you think home birth should be criminalized?

Definitely not. I like living in society with many freedoms, but im not so sure we should suddenly outlaw home births.

At least in Australia:

http://ama.com.au/node/5275/

"A retrospective population-based study has added to previously published evidence showing that planned home birth in Australia is associated with a higher risk of intrapartum related perinatal mortality (death during labour or after birth owing to problems occurring during labour).

...Prof Keirse said that while the data showed that planned home births had a perinatal mortality rate similar to that of planned hospital births, they had a sevenfold higher risk of intrapartum death and a 27-fold higher risk of death due to intrapartum asphyxia (lack of oxygen during childbirth). This was despite the finding that women with recognised risk factors, such as nulliparity, Indigenous status, lower occupational status, and residence outside metropolitan areas, were less likely to plan a home birth.

I am personally against home births but respect peoples choices to have them. Why take the chance? For the sake of some temporary comfort and one midwife with little to no gear/drugs vs a team of neonatal specialists (if required) I know which i'd prefer to have nearby.
 

fortsmithman

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I have no experience with home or planned unassisted home births. I do however have experience with midwives. The midwives here in town work at our local hospital where midwife assisted births are common. As well the midwives also train and certify us in Neonatel Resuscitation.
 
OP
abckidsmom

abckidsmom

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I think what I would do would depend on the midwife.

We were called for a newborn not breathing and when we arrived the midwife was bagging the baby. I don't remember the exact APGAR, but the baby's color wasn't great, pulse was over 100 and he wasn't very active. Midwife told us he was agonal when born.

She was freaking the f out. It was a HUGE pain in the arse dealing with her, and then after the baby started crying and everything seemed ok she talked the parents out of transporting! She told them that if they took the baby to the ED the doctors there would force them to admit the baby and wouldn't let them take it home that night, even if nothing was wrong. Said it was "impossible" to get the baby out of the hospital once it was brought there.

We did everything we could to try and talk the parents into transporting, but they listened to the midwife. In retrospect we should have asked her to leave, and then made her leave very early on.

It is essentially like any other provider on scene. If you are helpful you can stay, if you are not you're going, even if I have to get the police to make you go.

Perhaps she had education in newborn assessment, and the baby, slow to start but now crying and pink, really didn't need to go to the hospital? Choosing to treat midwives like interference could influence them to be more hesitant to call EMS next time. Y'all got the baby going, but you didn't mention being concerned about his breathing afterward, or being suspicious of a murmur, or whatever.

If the baby had a healthcare provider at home to monitor for any issues, why would he need to go to the hospital?

She was a healthcare provider, hired by the family, providing care to them in their own home. I would be extremely hesistant to involve police with kicking her out if she was just having a different opinion than you.

If you really felt that strongly, I think the medical command talking to the parents option would be the one I would go with.

Maybe the parents really wanted to have their baby in their arms, and not feel like criminals from a homebirth transfer with a baby who
 

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