We can blame OBs but we cannot blame midwives.
In a hospital: interventions, inductions, c-sections --> fault of the
Yes, a mother must give consent for an epidural. Yes, a
mother has to give consent for an induction. Yes, a mother has to give consent
for a c-section. But it's still the OB 's fault. They
offered. They unrightfully scared the mother. And so on.
On the flip side....
At a home birth: death, brain damage, injury --> fault of
the PARENT
Yes, you read that correctly.
Sorry, parents, but this is something you need to understand
up front. You need to take responsibility for your decision to have a
home birth if something goes wrong. Regardless of the details, people in the
home birth community will ban together and bail out the midwife and do whatever
they need to do to protect her. It has happened and continues to happen over
and over and over again. Expecting accountability = persecution or a witch
hunt!
If you have a home birth loss and if it was due to
negligence on your midwife's behalf, you may be met with comments such as these...
these are actual comments made to (or referring to) home birth loss moms. I
have cut and pasted them. These are, sadly, just a very small sampling of the
types of parent-blaming comments I have read!!
"at any time she felt it was needed, she could tell them she wanted to be transferred... I am sorry for the parents who lost their precious child, but they made the choice to have the child there (at a free-standing birth center), and they made the choice to stay even when complications arose." (the mom she is referring to actually had no idea complications had come up… so much for informed consent!)
"What's abhorrent is the need to carry malpractice insurance because we are such a sue happy country because no one can take responsibility for their choices. There is NEVER any guarantee that things would have turned out differently if other choices had been made no matter what the "professional" people claim."
"They weren't hostages. They could have called an
ambulance themselves, right? Just asking."
"I find it disheartening that the parents are not accepting any accountability themselves for the decision they made."
"I truly feel bad for the [family]. However, with all the resources we have at our finger tips, doing research on something so important only after a tragedy happens is somewhat negligent in itself."
"When we can let go of the blame in a child's death, we heal!"
**
So let’s turn those comments around for mom’s who have had what they believe to be an unnecessary c-section:
“When we can let go of the blame in a c-section, we heal!”
"I truly feel bad for the [family]. However, with all the
resources we have at our finger tips, doing research on something so important
only after a c-section happens is somewhat negligent in itself."
"I find it disheartening that the parents are not
accepting any accountability themselves for the decision they made to consent
to have a c-section."
"They weren't hostages. They could have told the
OB that they will not consent to a c-section, right?
Just asking."
"What's abhorrent is the need to carry malpractice
insurance because we are such a sue happy country because no one can take
responsibility for their choices. There is NEVER any guarantee that things
would have turned out differently if other choices had been made no matter what
the "professional" people claim." (sweet!! OB ’s, just
ask your patients to own up to the outcome 100% and you no longer need to pay
thousands and thousands of dollars for your malpractice insurance!!)
"at any time she felt it was needed, she could tell
them she refused a c-section... I am sorry for the mom that she had to
have a c-section, but they made the choice to sign the form.”
Harsh, huh?
B/c most home birth midwives do not carry malpractice
insurance and b/c they really don't have a governing body (like a medical
board), there really is no recourse if a midwife practices negligently here in
the USA. Even if she does so multiple times. She can keep right on
practicing. So your chances of being able to have any justice in the shape of a lawsuit or such is slim to none. And to top it off, you have people that will back your midwife regardless of her actions and tell you to basically suck it up and take responsibility.
I cannot even imagine what it would feel like to not only
lose your baby due to a negligent care provider, but then on top of it, having
to read about how people are blaming them - the parents. The PARENTS are
negligent when death happens at a home birth. The PARENTS didn't do enough
research. The PARENTS didn't speak up. The PARENTS should know when things
become dangerous - even if they are being assured by their PROFESSIONAL CARE PROVIDER that
it is not dangerous.
You can only complain about informed consent in a hospital setting. Not at a home birth. A midwife is infallible, basically. Parents - be prepared to 100% own your home birth outcome!!
You can only complain about informed consent in a hospital setting. Not at a home birth. A midwife is infallible, basically. Parents - be prepared to 100% own your home birth outcome!!
Does this sound fair? No. But it’s the sad reality of the
situation and something that was so shocking/horrifying/heartbreaking for me to see in the home birth community. Blame your OB and you'll find an entire community that has your back, that will share in that blame you cast on your OB, that will coddle you and love on you and "empower" you by telling you "it's not your fault, shame on that doctor of yours!!" But if things go wrong at your home birth and you again want to blame your care provider - your home birth midwife - well, don't expect that same community to stand behind you. B/c they are behind the midwife.
**
Please note: The point of this blog post is not to say that OBs are never at
fault and that women are never mistreated in a hospital. The point
is, if negligence happens on behalf of a
care provider, there should be recourse and accountability. A woman is not
expected to know as much as her professional care giver, no matter where she
chooses to give birth. Responsibility falls on the care giver to act ethically,
in the best interest of the patient. This is why every health care professional
in the United States
is required to have malpractice insurance… except home birth
midwives.
Excellent post with commendable clarity Dani, thank you.
ReplyDeleteJust a note ... health care providers are not always legally required to have malpractice insurance (it is not required by law in some states). HOWEVER, they are ethically required to carry it by many professional organizations of which they are members as a standard of care, and they sure as heck are required to carry it in order to have hospital privileges, or be board certified, etc., etc.
ReplyDeleteThank you! I made the edit and removed the word "legally."
DeleteThis is so very very true. Thank you for telling it how it is.
ReplyDeletehttp://community.babycenter.com/post/a44305270/stillbirth..._guilt
ReplyDeleteSo sorry for your loss. Stillborns do occur, even after pregnant women were just seen by their doctor or midwife. You should take time to seek help through counseling with family, friends, or professional help and use coping mechanisms and meds as appropriate for this loss.
Without trying to point fingers for responsibility, some questions must be asked and answered to determine if any possible contributing factors may have impacted this pregnancy that may be prevented next pregnancy. Don't be mad at your family for asking questions. Everyone should be asking questions to evaluate the care you got. Every sentinel event in a hospital has a root cause analysis to evaluate the care and determine if any measures can be done to improve care or provide different or additional care for next time.
In all best practice Homebirth studies, such as from the Netherlands, UK, or Canada, FTM were risked out for a reason. I wish your Homebirth midwife explained that to you.
You mentioned the placenta was small and only in the third percentile. What was your baby's weight? Was your baby IUGR? Was your fundal height measurements right on? A late trimester ultrasound could have detected oligohydramnios, IUGR, or an overly mature placenta.
You mentioned you always thought you had decreased fetal movement. Did you Homebirth midwife perform NST, AFV, BPP, or CST? This might have detected failing baby reserve. Especially since you were 41 weeks and 4 days along. Were you getting NST and BPP for being past 40 weeks? Umbilical artery dopplers could have been performed if there was any doubt. I know you were not past 42 weeks, the traditional post dates, but doctors now perform these tests after 40 weeks since the stillborn incidence increases with each week past 39 weeks.
You mentioned infection as the primary cause. What was your GBBS culture result? What was the bacteria that causes the chorioamnionitis? Decreased movement is one characteristic of infection.
It sounds like you had a 41 week 4 day pregnancy in a FTM that had undiagnosed IUGR trying for a Homebirth. I hope you did not refuse the GBS screen. If you had the GBS screen, I hope the Homebirth midwife performed it correctly by inserting it vaginally than rectally. Omission of the rectal screening will sometimes miss detection.
My recommendations for you next pregnancy is to start NST and BPP weekly at 32 weeks, then twice weekly after 36 weeks. Umbilical artery dopplers as appropriate. Keeping a strict fetal kick count at home. Serial ultrasounds every month to rule out IUGR. Weekly urine cultures to rule out presence of GBS bacturia after32 weeks. CBC testing can even be performed weekly at term to monitor the WBC. Elective induction of labor at 39 weeks in a hospital is appropriate in this case. I have even seen some parents have their doctors perform an amniocentesis to document lung maturity at 38 weeks, and then induce if mature. Losing a baby is difficult. Even with all this preventive surveillance a stillborn can still occur. But I believe these prenatal fetal surveillance measures will give you some piece of mind that your healthcare provider and you have done everything you could have.
Whatever the parents end up choosing, both the OB and the midwife should hold responsibility of the mother's and child’s safety. In the case of the midwife, she should make sure that she is competent enough to carry on with the birthing process. And should there be unforeseen circumstances that is out of her expertise, she should quickly inform the parents, so that they could go to the proper medical facilities as soon as possible. Trying to salvage the situation and prolonging the inevitable would only result in more problems.
ReplyDeleteSabrina Craig @ Medical Attorney