Planning a Safe Homebirth- The Midwife

This is written by my good friend Jane Hall, who happens to also be a homebirth mother::

Planning a Safe Homebirth

For women with full term, head down singleton babies where mom and baby are both healthy, home birth with a qualified attendant can be a safe choice to make.  However, because of the basic risks involved with not being in a hospital settings if serious complications occur, there are some critical issues to look at when planning your home birth, both in terms of choice of midwife and in terms of how to plan your birth in ways that minimize risk.  As a mom planning a 4th birth at home, here is how I make sure that I am planning home birth in the safest manner possible.

Midwife:

Bottom line: if your midwife doesn't cut it, you are not safe at home.  End of story.  If you cannot find a good enough midwife, hospital birth is the safest and most responsible choice even if it's not the setting you prefer.  Keep an open mind and high standards, and remember that a solid attendant matters more than being in the home setting.  Here are things to consider:

1.  Education:  Education matters.  It does.  All of the studies demonstrating that home birth is a reasonable option are from countries where midwives have university education and are able to practice in either home or hospital settings.  If your midwife is not educated enough to be able to practice in any other first world country, look elsewhere.  This is the person you are entrusting your life and your baby's life to;  it's ok to say that the person responsible for safety in your birth should at least have a bachelor's level of education in midwifery.  You don't feel guilty about expecting college education from your child's teacher, and shouldn't feel guilty or unreasonable about expecting it from the person you are hiring for your birth.

2.  Experience:  Without a high enough volume of births, your midwife will not have seen enough to recognize complications before they have the chance to spiral out of control.  You don't want to be your midwife's first placental abruption or first encounter with respiratory distress in an infant.  I take this a step further and will not choose a midwife without extensive hospital based experience.  Women with complications are rightly in hospitals, and I want a midwife who has seen the worst that nature can throw at birth so that she has a better chance of recognizing a pattern of a complication that leads to an emergency when minutes are brain cells and can be the difference between life and death.  

3.  Practice:  How your midwife practices will tell you a lot about whether she is a safe attendant for you to plan home birth with.  For example:

* Does your midwife carry malpractice insurance?  If not, there needs to be a very good, verifiable reason. 
* How many clients is your midwife willing to take on in any given month?  Too few births and she maybe out of practice, too many and she could be so exhausted and burned out that she could miss the early signs of problems or could miss your birth entirely.
* How smoothly does her practice run?  Are appointments timely?  Lab results readily available to you?
* Who else attends your birth?  Do not under any circumstances give birth with a midwife who is willing to attend you without a second trained set of hands in case both mother and baby are experiencing complications at the same time.  My preference is for the assistant to be a registered nurse, and the midwife and assistant should know eachother and work well enough together as a team to provide seamless care in emergency situations.
*  Does your midwife have oxygen, IV fluids, antibiotics to treat for Group B Strep, medications to treat bleeding, and other equipment necessary in an emergency?

4.  Integrity and Professionalism:  Your provider's good character is your defense against unethical care.  Here are things to consider:

*  What do other medical professionals in your area think about your midwife?  Do they feel comfortable collaborating with her when clients need more advanced care outside her scope of practice, or refer patients seeking home birth to her?
*  Is your midwife willing to lie or violate professional standards of care in her care?  Is she willing to lie about performing tests or about their results? 
*  Verify that your midwife's license is in good standing, and that she participates in peer review.
*  Find out what continuing education your midwife participates in.
*  Google your midwife and see what people are saying about her online.  Many more cautious midwives can be unfairly described online as "medwives," and it's worth raising any complaints you find that concern you with your midwife to gauge her response.  
*  Look at your midwife's social media presence and how it lines up with HIPAA requirements.  Your protected health information should stay protected and not be spread all over your midwife's Facebook page.  

Planning a Safe Homebirth- The Midwife

This is written by my good friend Jane Hall, who happens to also be a homebirth mother::

Planning a Safe Homebirth

For women with full term, head down singleton babies where mom and baby are both healthy, home birth with a qualified attendant can be a safe choice to make.  However, because of the basic risks involved with not being in a hospital settings if serious complications occur, there are some critical issues to look at when planning your home birth, both in terms of choice of midwife and in terms of how to plan your birth in ways that minimize risk.  As a mom planning a 4th birth at home, here is how I make sure that I am planning home birth in the safest manner possible.

Midwife:

Bottom line: if your midwife doesn't cut it, you are not safe at home.  End of story.  If you cannot find a good enough midwife, hospital birth is the safest and most responsible choice even if it's not the setting you prefer.  Keep an open mind and high standards, and remember that a solid attendant matters more than being in the home setting.  Here are things to consider:

1.  Education:  Education matters.  It does.  All of the studies demonstrating that home birth is a reasonable option are from countries where midwives have university education and are able to practice in either home or hospital settings.  If your midwife is not educated enough to be able to practice in any other first world country, look elsewhere.  This is the person you are entrusting your life and your baby's life to;  it's ok to say that the person responsible for safety in your birth should at least have a bachelor's level of education in midwifery.  You don't feel guilty about expecting college education from your child's teacher, and shouldn't feel guilty or unreasonable about expecting it from the person you are hiring for your birth.

2.  Experience:  Without a high enough volume of births, your midwife will not have seen enough to recognize complications before they have the chance to spiral out of control.  You don't want to be your midwife's first placental abruption or first encounter with respiratory distress in an infant.  I take this a step further and will not choose a midwife without extensive hospital based experience.  Women with complications are rightly in hospitals, and I want a midwife who has seen the worst that nature can throw at birth so that she has a better chance of recognizing a pattern of a complication that leads to an emergency when minutes are brain cells and can be the difference between life and death.  

3.  Practice:  How your midwife practices will tell you a lot about whether she is a safe attendant for you to plan home birth with.  For example:

* Does your midwife carry malpractice insurance?  If not, there needs to be a very good, verifiable reason. 
* How many clients is your midwife willing to take on in any given month?  Too few births and she maybe out of practice, too many and she could be so exhausted and burned out that she could miss the early signs of problems or could miss your birth entirely.
* How smoothly does her practice run?  Are appointments timely?  Lab results readily available to you?
* Who else attends your birth?  Do not under any circumstances give birth with a midwife who is willing to attend you without a second trained set of hands in case both mother and baby are experiencing complications at the same time.  My preference is for the assistant to be a registered nurse, and the midwife and assistant should know eachother and work well enough together as a team to provide seamless care in emergency situations.
*  Does your midwife have oxygen, IV fluids, antibiotics to treat for Group B Strep, medications to treat bleeding, and other equipment necessary in an emergency?

4.  Integrity and Professionalism:  Your provider's good character is your defense against unethical care.  Here are things to consider:

*  What do other medical professionals in your area think about your midwife?  Do they feel comfortable collaborating with her when clients need more advanced care outside her scope of practice, or refer patients seeking home birth to her?
*  Is your midwife willing to lie or violate professional standards of care in her care?  Is she willing to lie about performing tests or about their results? 
*  Verify that your midwife's license is in good standing, and that she participates in peer review.
*  Find out what continuing education your midwife participates in.
*  Google your midwife and see what people are saying about her online.  Many more cautious midwives can be unfairly described online as "medwives," and it's worth raising any complaints you find that concern you with your midwife to gauge her response.  
*  Look at your midwife's social media presence and how it lines up with HIPAA requirements.  Your protected health information should stay protected and not be spread all over your midwife's Facebook page.  

The Impact Of Negative Midwives

In 2001, one of my good friends found out she was pregnant and planned on a homebirth. We talked and talked about it. I thought it sounded incredible. At that time, I fell for the romanticized notions of it. I did no research. Course, I couldn't get my husband on board anyway, so it didn't happen for my next two pregnancies. When I got pregnant with my fifth, we hit a rough patch in our marriage and I decided that I didn't care how my husband felt, I was going to have the birth I wanted. I looked at studies from other countries and saw how safe homebirth was. Did I know the difference between here and other countries?? Nope. When I interviewed Brenda, I was incredibly impressed with this woman. She was very sweet and caring. Her numbers were phenomenal with just 1 stillborn out of 2500 deliveries. I had found my midwife and was going to have the birth I wanted. Course, I had an easy labor and delivery, baby was perfect. So, when I got pregnant with Mary, we decided since all went well before, we would do it again. I was low risk and had never had any problems. My kids had all been born healthy (minus the oldest who was resuscitated due to a cord around his neck and then diagnosed with a CHD, which he still has). Between pregnancies, Brenda and I remained friends. I truly loved and trusted her. I knew she cared about not only the baby and I, but my entire family. So, when Mary was born, it was easy for me to believe Brenda when she told us our baby was healthy and the little things I had questions about were just typical newborn things.  We all know what happened next. That afternoon, when we left the hospital I called Brenda to tell her, but the police had already been to her house. The next day at some point, Brenda came over and brought me a locket that she had had engraved with Mary's name. The day of the funeral, between the burial and luncheon, was when we came home to her sitting on our steps pissed because OTHER midwives were discussing the possibility of her being arrested. Days later she showed up begging me not to be angry with her. She talked about her cancer and that she would hold my baby for me in heaven. She sat and cried over my anger because she was my friend and loved me and didn't want us mad at her. There was another day that she came and just sat with me outside and talked about having our families get together for a pool party because our kids loved hanging out. Shortly after this is when we got the infamous emails from her. Six months after Mary's death is when I learned about her past. By then, it was too late. 

Now, you may wonder why I have shared all of this. With Lisa Barrett being in the news, I feel that I need to address some things and it's hard to address them if you don't get a background on where I am coming from.

I see people talking very flippantly about the babies that have died under Barretts watch. These were loved and wanted babies, not just some ratty old tee shirt. They aren't disposable. These were real little babies that never got a chance. Barrett is why they didn't get a chance. She behaves as though she is above reproach and she's just fighting for women's rights. It's infuriating. SHE wants to do what SHE wants regardless of the costs to others she may harm

In talking about Women's rights, let's really look at this. The premise of this is that women have the right to birth how they want with whomever they want. Fair enough. It's also said that trying to regulate and get rid of negligence infringes upon women's rights. Can anyone explain this to me?? When abortion clinics began, did THAT infringe upon rights or was this a way to ensure safety in those seeking the procedure? That furthered women's rights and gave women a safe option. Considering childbirth is more dangerous than abortion, we must ask why safety in childbirth is so abhorrent. Isn't it a good thing to have a provider who actually knows their stuff, has a real education, and values your baby too?? Why is that such a bad thing??

Now, this leads me to my last point. IF any provider is practicing negligently, we NEED them not practicing. If you have a homebirth provider whose negligence and/or rogue behavior is leading to death upon death, do you really want them practicing?? If an OB was negligent and repeatedly caused deaths, the pitchforks would be out. It's bad enough that there is no recourse for families who lose babies due to negligent non-CNM's, but to have the homebirth community support them is even worse.

Stories, like the ones about Lisa Barrett, are going to continue piling up until the homebirth/midwifery community stands up and says "This isn't ok". Our camp continues to say "There needs to be safety measures. There needs to be accountability. These deaths aren't ok.". I feel like we are begging and pleading for this community to do something, anything and we are hitting a brick wall.

 As a mother who has lost a child due to a serial negligent midwife, I am angry as hell. You are essentially telling me that this midwife is more important than my child. My child's life didn't matter to you. No child's life matters. Really?? It's ok to continue to let these babies die PREVENTABLE deaths? It's ok to put families like mine through hell? My children have lost a sibling. Infant death is a reality to them and something they discuss with other children and adults. This is something they shouldn't have to deal with. I know I have said it before, but if somebody, anybody had stopped Brenda from practicing, I wouldn't of found a midwife and would of continued using an OB and had that happened, my daughter would be here.