Although rare, it is unfortunate for moms, their families and their midwives that sometimes bad
things happen, even with low-risk clients. We, as midwives, try our best to prevent complications
and bad outcomes. But, they still occasionally happen, even with the best of care.
Childbirth, although we all try to make it as safe as possible, does have it's potential dangers, regardless of
where the birth occurs and who is attending the delivery. However, when a death occurs in a hospital
setting attended by a medical team, it usually becomes a statistic and is rarely mentioned or even
investigated. Whereas, if it occurs in a home setting, it becomes front page news with possible serious
legal and medical complications for the midwife in attendance, regardless of how well she handled the
situation and no matter what her skills are and what steps she took to prevent complications. Sometimes,
even with proper management by a midwife and a successful transfer ensues, the medical facility is the
one that drops the ball (usually from poor communication between medical staff members, delayed
or inappropriate treatment and possibly complicated by medical animosity towards a homebirth client) and the
bad outcome and blame comes back on the midwife, even though she had successfully completed her part
of the care properly.
It is also sad that the medical community tries to prevent midwives from obtaining valuable skills
and experience beyond basic emergency training (such as CPR training) that could help prevent or treat
the rare occurrence of a serious situation, such as being able to start an IV for fluids or using
appropriate medications in an emergency to prevent or treat hemorrhage, as an example. The further
away from a medical center the client lives, the longer it takes to transport and those few minutes
could be the difference between life and death in some situations.
We, as midwives, are protectors of the "normal" and practice preventive care with our clients primarily
with proper nutrition and healthy lifestyles. We try to learn as much as we can to prepare for the
unexpected, but on rare occasions something happens that we are not prepared for. This happens with
both the best trained midwives and medical health care providers. We all try our best to read the
signs and symptoms and obtain help when it is needed. We also try to keep our services within our own
scope of practice and refer those clients on that fall outside our guidelines.
We often cover clients that have little or no medical coverage, sometimes do not speak English,
and are unable to afford or live too far away from a medical facility to make the commuting feasible,
especially during a fast labor. Most medical health care providers no longer provide any form home
care. I have done my share of deliveries that were 100 miles from the nearest medical facility with
only a volunteer ambulance service available several miles away with much less obstetric experience
than the usual midwife (my EMT training was taught by a fire chief that had only delivered
1-1/2 babies in his entire career and thus allowed me to present the childbirth section to the class).
Most health care providers and obstetricians would be lost delivering a baby in
a log cabin with no running water and no electricity in a snow storm and without their staff to do
most of their work for them and their gadgets and machines that go "ping" (reference to a Monty
Python movie about childbirth) and without a surgical team standing by with a various assortment of
drugs available. Obstetricians are trained in the abnormal (the pathology) of childbirth and find
it very difficult to sit on their hands during a normal, healthy delivery. However, they are very
useful during a high-risk pregnancy or an emergency situation that needs immediate attention.
Instead of preventing midwives from getting valuable education, experience and support, the medical
community should be encouraging and providing these services to their community midwives as a form of
continuing educational training, especially those traveling into remote areas or providing services
to families unable to afford standard medical care (which, by the way, the medical professionals
do not want to provide service to because of their inability to pay for them... free care only goes
so far - standard uncomplicated vaginal hospital birth runs about $6,000 and a cesarean delivery
runs about $12,000 - midwife delivery at home averages about $1,000).
Unfortunately, all this type of support from the medical community for midwives is still not happening
here in the United States to this date. Fortunately, even without the support from the medical community,
we still maintain excellent statistical outcomes, here in the U.S. and worldwide.
Although these recommendations below probably will not change the outcome of a situation like a suspected
maternal (or infant) death, here are some basic guidelines, regardless of the cause:
1. Any life-saving measures should be performed. Cardiopulmonary Resuscitation (CPR) started and Emergency
Medical Services (EMS) notified.
2. Continue CPR until EMS arrives and takes over.
3. Document all events, actions, and decisions.
4. Whenever possible, speak to all personnel only in the presence of a reliable witness or your attorney.
Keep only to the facts and avoid emotional responses to the situation. Be professional, but safeguard
yourself in the process. Regardless of the cause of the death and the expected outcome of the situation,
expect a great deal of finger-pointing and blame, not necessarily from the client's partner or family,
especially if they were present at the birth, but more so from the medical and legal community.
5. Contact an attorney for consultation and be prepared for a coroner's inquest and a backlash of
publicity. Do not release any statements, documents or sign any papers without consulting with your
attorney first.
May you never have to experience this problem and always listen to your midwives' intuition while
attending a birth. Learn as much as you can about everything you can and however you can. Be aware
of any danger signs that something is happening. Listen to your client. She knows when something is
not right with herself. If it don't feel right, recommend getting it checked out before it progresses
to something more serious. It is better to have a false alarm than a serious situation.
SOME INTERESTING LINKS
Cost of Hospital Birth Far Outweighs Risk of Employing Midwives
Pregnancy Plus Birth Equals $$$
Maternal Death After Homebirth - UK
Death in Birth
Midwives Fight AMA To Provide Black Maternal Care
BMJ: Outcomes of Planned Homebirths With Certified Professional Midwives
Home Birth Research Summaries
Midwife Attended Birth At Home - Dispelling Myths
MoonDragon's Birthing Guidelines - Variations of Postpartum
