Home Births and Hospital Privileges

A guest blog post for you today by Anj Fabian, highlighting the importance of correct maternity care. Thank you Anj for letting me share this:

Here is my simple, three step guide to having a responsible home birth:
1) Get standard prenatal care throughout your pregnancy. Do not improvise, do not opt out of anything.

2) Have a documented transfer plan, including hard transfer criteria and preregistering at the destination hospital.

3) Only use a midwife who has hospital privileges at your designated hospital. If she doesn’t have privileges, her back up OB/CNM should have hospital privileges. If you have not seen her back up with your own eyes, met them and have their contact information on hand – it doesn’t count.

Here’s the reason for the PSA:

It’s been a record week. I know people who know people in the home birth world, in the crunchy world and in the medical world. We keep track of home births that don’t end happily ever after. There’s usually a trickle of documented stories, a handful a month. July has seen a flood. It’s appalling to see so many preventable tragedies.

One baby transferred in severe distress after a traumatic birth to hospital. One woman transferred to hospital in time to have her baby delivered by emergency cesarean section. Both babies were put into cooling therapy to minimize brain damage from loss of oxygen. One has passed. Another is in the hospital and still critically ill.

One woman tested positive for group B strep. Her midwives didn’t transfer her to a hospital to get IV antibiotics during labor as is the standard protocol. Her son developed respiratory distress soon after birth and was taken to the hospital. He was diagnosed with strep B pneumonia. He responded well to the IV antibiotics in the NICU and after some days was discharged. His mother would have rather gotten the antibiotics herself, if she had been given that choice.

One baby was stillborn after his mother chose to do her own pregnancy care, including prenatal care and birthing at home. The family is devastated.

A woman transferred from a home birth with eclampsia. The mother is recovering. Her baby died in utero due to an placental abruption. High blood pressure is a known risk factor for abruption and hers was sky high when she was admitted.

A woman transferred to hospital after a long attempted home birth. Her baby girl was stillborn there.

It is simple to argue that all of these were preventable tragedies. No prenatal care. Transfers to the hospital that were too late to undo any damage. A woman whose blood pressure was so high that someone thought her diastolic reading was her systolic. Midwives who could have transferred a woman to the hospital in time to prevent her baby from acquiring a potentially deadly infection.

These incidents aren’t the result of standard, boring obstetric care. If they were, someone would be investigated for providing incompetent and/or negligent care. In a hospital, that’s what would happen. In the wild world of home birth, nothing at all may happen.

That’s why I emphasized “hospital privileges”. It’s shorthand for “accountability”.
There isn’t much accountability in home birth.

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