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Entries in Midwife (3)

Thursday
Feb022012

Death After Home Birth Raises Questions

Comstock/Thinkstock(NEW YORK) -- Before hospitals became the go-to places for giving birth, having a baby at home was considered the norm. Now, with celebrities including Giselle Bundchen and Jennifer Connelly publicly announcing they opted for a home birth, the method is increasingly becoming more popular.

Recent studies show that home births are up 20 percent. But even with this renewed interest, less than one percent of babies in the United States are born at home.

However, the death of a respected home birth advocate in Australia as she herself gave birth at home resurrects the question of how safe home births are.

Caroline Lovell, 36, once advocated for midwife funding and legal protection in Australia. But in January, Lovell died of a heart attack just one day after giving birth at home to her second daughter, Zahra, the Australian newspaper Herald Sun reported.

One of the main appeals of home birth is the woman’s comfort from being in her own surroundings, according to Brad Imler, president of the American Pregnancy Association.

“The families that tend to elect home birth favor a natural birth,” said Imler.

The report sparked a burst of comments among mothers and mothers-to-be on online chat boards -- some of whom strayed further from the idea.

“Just one reason why I would never feel comfortable planning a home birth,” one mother commented on the online community BabyCenter.com “Nothing against those that choose to, but this is too scary to convince me.”

Imler said that he found cardiac arrest an extremely uncommon complication, and it should not be attributed to the fact that Lovell had a home birth.

“Having birth at home or at a hospital does not trigger the heart attack itself,” said Imler. “We don’t really know that the home birth brought it on.”

A majority of mothers who commented on BabyCenter.com agreed.

“Things can go wrong in childbirth regardless of where you give birth,” one mother wrote.

But the difference between home birth and hospital birth lies in having quick access to care should an unforeseen complication emerge.

“The question would be: Had she been in the hospital, would there have been ample time to resuscitate and save her life?” said Imler.

The American Pregnancy Association doesn’t advocate a mother choose one birthing method over another, as long as a mother is educated about the risks and benefits. The Lovell case certainly doesn’t change its stance.

However, Imler said, there are many women who choose birthing centers that try to recreate the full home birth feel but are more medically equipped with staff and services.

“Labor and delivery is not a condition, and that tends to be one of the connotations of the hospital,” said Imler.

Many hospital maternity wards are starting to provide a more comforting feel to the birthing process.

According to the American College of Obstetricians and Gynecologists (ACOG), hospitals and birthing centers are the safest places to have a baby.

Evidence suggests home births carry a two- to three-fold increased risk of newborn death compared to planned hospital births, ACOG said in a public statement.

Copyright 2012 ABC News Radio

Monday
Sep192011

Newborn's Death Revives Debate over Mandatory Midwife Licensing

Photodisc/Thinkstock(EUGENE, Ore.) -- Oregon's thriving midwife community has long operated outside the bounds of state regulation, but a recent increase in safety reports combined with the highly publicized death of a Eugene, Oregon newborn during a homebirth this July has revived debate over whether midwives should have to be licensed to practice in the state.

Among the 40 states that allow midwifery, the laws regulating them vary greatly.  Oregon and Utah, however, are the only states that have optional licensure of midwives.

It was to one of the unlicensed midwives, Darby Partner, that Eugene resident Margarita Sheikh turned to this summer when preparing to give birth to her son.

But tragedy struck as Partner and her assistant, Laura Tanner, were delivering Sheikh's son Shahzad.  He was born not breathing and attempts to revive him failed.

Sheikh said Partner initially ignored her requests to be taken to a hospital and that Partner and Tanner panicked when her infant was not breathing, arguing over how to perform infant CPR.  They eventually took Sheikh to a nearby hospital shortly after her son's birth but it was too late to save him.

Though Partner has more than a decade of experience, according to her online midwife profile, she does not have the optional state licensure nor certification as a professional midwife (CPM) that is offered by the North American Registry of Midwives.

Because unlicensed midwives are not regulated by the state, Sheikh cannot file a complaint against this midwife.

Now, Sheikh is calling for mandatory licensure of all midwives so her baby's death is not "for nothing."

Many midwives and advocates of midwifery contest the notion of mandatory licensure, arguing that it will not change the safety of home births.

"We're not in favor of mandatory licensure," said Susan Moray, press officer for Midwives Alliance of North America.  "We don't see that it makes a difference in birth outcomes.  It doesn't create more safety."

The alliance supports the CPM training, but hesitates to say that midwives need even that training because there are many qualified midwives with years of experience that have neither.  Instead, Moray said, women should look to standards of care set by the midwife community.

"We do peer reviews several times a year and ask the midwives how many births they've delivered, what complications they've handled, and which medications they can use," she said.  "I would encourage any woman seeking a midwife to ask the same questions."

Copyright 2011 ABC News Radio

Thursday
May122011

Mothers Support Midwife Who Pleaded Guilty to Negligence During Delivery

Jupiterimages/Thinkstock (ALEXANDRIA, Va.) -- Karen Carr has won the thanks and praise of many moms by delivering more than 1,200 babies during her 25-year career as a midwife.

But last week Carr, 44, pleaded guilty to two felony charges in an infant death that she attended during a home delivery in Virginia last September. The state of Virginia argued that Carr was negligent during the home birth after the baby's head became entrapped for more than 20 minutes during the delivery. The baby died two days later.

Despite the charges and Carr's guilty plea, her fans still stand by her -- even raising money for her on a Facebook page created by In Service to Women, a group that supports midwifery and now hopes to help pay for Carr's legal fees.

Carr faced several charges, including involuntary manslaughter, according to the Washington Post. By pleading guilty, Carr accepted that her negligence contributed to the baby's death that and she was not licensed to attend a delivery in Virginia, the state that brought the charges against her.

It was the state of Virginia, not the parents of the baby who died, that brought the charges against Carr. The parents filed a request for confidentiality throughout the trial.

John Zwerling, Carr's attorney, said the parents were well aware of the risks involved with a vaginal breech home birth, but the mother was "desperate not to have a c-section."

Carr is a licensed midwife in Maryland but not in Virginia, which technically made it illegal for her to deliver the baby there.

"The hospital brought it to our attention, and we filed charges, brought by the Commonwealth," said Krista Boucher, chief deputy commonwealth's attorney in Alexandria, Va. "We were delighted that she acknowledged that she was criminally negligent in open court."

During the pregnancy, the baby was in a breech position, and the parents hired Carr to attend the home delivery. In the breech position, babies enter the birth canal feet -- or buttocks -- first, not head-first.

The baby boy's head was stuck for nearly 20 minutes before it was pulled out. Carr performed CPR, but the baby was soon transferred to Inova Hospital in Alexandria and died two days later, according to court documents.

"Breech deliveries, in general, are done by Caesarean section for exactly the reason that happened in this case," said Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York City. "The chance of head entrapment is small, but when it happens, it is devastating."

Moritz was quick to note that breech births can be difficult in hospitals, too, but "there are more things you can do in a hospital" to fix it.

"I'm as midwifery-friendly as they come, but a breech home delivery is just stupid," said Moritz, who was featured in the pro- midwifery documentary The Business of Being Born.

When head entrapment does occur, Dr. Manuel Porto, professor and chairman of obstetrics and gynecology at the University of California Irvine Medical Center, said there are a series of procedures available.

Patients interested in midwifery are informed of the benefits and risks before deciding on a home birth. Licensed midwives are trained in normal patterns of labor, Moray said, but if something becomes abnormal during the delivery, the midwife transfers care to physicians.

Had the mom in Carr's case been in a hospital, Moritz said, doctors probably would have performed a C-section to take out the baby, or, if the head was stuck while trying to deliver vaginally, special forceps could have been used to pull the baby. Midwives do not have such tools available to them.

When asked whether the outcome would have been different in a conventional hospital setting, Porto responded, "Yes, with little doubt."

Despite it all, Carr's backers still sing her praises. The Facebook page contains messages that express thanks and support from mothers who hired Carr as their midwife.

"Karen was such a blessing in my first pregnancy and birth that I went on to have 2 more homebirths," one woman wrote. "The peace and words and knowledge she shared with me -- I continue to share with other expectant mothers."

Copyright 2011 ABC News Radio 







ABC News Radio