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Her Survival Was a “Christmas Miracle,” but the Disaster Was Man-Made

Many of you will have read the story of the woman laboring on Christmas Eve who suddenly went into respiratory and cardiac arrest in front of her horrified husband. She recovered shortly after her son was delivered by emergency cesarean, and the baby, too, was successfully revived. As the MSNBC article tells the tale:

After their miraculous recovery, both mother and the baby, named Coltyn, appear healthy with no signs of problems, Martin [the obstetrician who responded to the Code Blue and performed the emergency cesarean] said. She said she cannot explain the mother’s cardiac arrest or the recovery. “We did a thorough evaluation and can’t find anything that explains why this happened,” she said. Mike Hermanstorfer credits “the hand of God.”

However, an ABC video interview with Tracy and Mike Hermanstorfer and Dr. Martin provides details that call into question the hospital’s failure to find an explanation. I have transcribed the relevant section.

Tracy: [Tracy was being induced for her third child because membranes ruptured.]The pains [with Pitocin] were a lot harder than I remembered. We decided to go ahead and do the epidural for the very first time. . . .

ABC: Mike, you were holding her hand as Tracy got the epidural. . . . When did you start to notice that there was a problem occurring?

Mike: Well, we had her sitting up when they were doing the epidural and afterwards she lay down and said that she was tired and that’s when the whole nightmare started.

ABC: What happened?

Mike: She started going numb and everything in her legs . . . and she laid down to close her eyes and take a little nap . . . and she wasn’t waking up.

ABC: When did you notice that her breathing was shallow or her color was blue?

Mike: Well, I felt her hand—I was holding her hand—and it started getting cold and I looked down at her fingertips and her fingertips were blue and one of the nurses noticed that the color in her face was completely gone. She was as gray as a ghost.

ABC: Code Blue was declared, a scary thing in any hospital. [Dr. Martin arrives in response.]

Dr. Martin: . . . When I ran into the room, the anesthesiologist had already started breathing for Tracy. There were preparations already being made to start a resuscitation should her heart stop. About 35 to 40 seconds after I got in the room, her heart did stop and we started making preparations to do an emergency cesarean delivery right there in the room in the event that we were not successful in bringing Tracy back. Unfortunately, in most of these situations, despite the best efforts of the team, Mom is often not able to be revived, so we anticipated that possibility and when it became clear that Tracy was not responding to all the work that the team was doing on her, we had to make that difficult decision to do the cesarean section, primarily in an effort to give Coltyn the best chance at a normal survival and also hoping that it would allow us to do a more effective resuscitation on Tracy, and fortunately, she cooperated and we got a heartbeat back immediately after delivering Coltyn.

So, according to Dr. Martin, Tracy is an example of how things can go suddenly and horribly wrong for no discernable reason in a healthy woman having a normal labor. All I can say is that Dr. Martin must have slept through the class on epidural complications. Tracy’s story is the classic sequence that follows what anesthesiologists term an “unexpectedly high blockade,” meaning the anesthesiologist injected the epidural anesthetic into the wrong space and it migrated upward, paralyzing breathing muscles and in some cases, stopping the heart. High blockade happens rarely, and even more rarely does it result in full respiratory and cardiac arrest—one database analysis of 11,000 obstetric epidural blocks reported a rate of 1 in 1400 women experiencing a high block and 1 in 5500 requiring intubation, and no woman experienced cardiac arrest. It does happen, though, and I am willing to bet that high blockade and its sequelae happened to Tracy.

The moral of the print version would be: have your baby in a hospital where you can be saved should this happen to you. The video interview, however, reveals a different picture. The real moral of the tale is that the safest and healthiest births will be achieved by avoiding medical intervention whenever possible. Induction of labor is by no means always necessary when membranes rupture and certainly not immediately. If Tracy had been allowed to start labor on her own, which, considering that this was not her first baby, she would likely have done within a few hours, she probably wouldn’t have wanted the epidural any more than she did for her first two children. Tracy almost certainly would have gone home the day after Christmas after another uneventful, unmedicated vaginal birth. Instead, she is recovering from surgery, and she and her husband have the emotional trauma of her and her son’s near miss experience to deal with. Along with the Hermanstorfers, we can thank God for the prompt actions of the hospital team, but the safe money says they were rescuing her from a disaster they themselves had caused.

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  1. January 2nd, 2010 at 10:56 | #1

    Not to mention that the use of pictocin ALSO carries a risk of cardiac arrest!!

  2. January 2nd, 2010 at 12:12 | #2

    “High blockade happens rarely, and even more rarely does it result in full respiratory and cardiac arrest—one database analysis of 11,000 obstetric epidural blocks reported a rate of 1 in 1400 women experiencing a high block and 1 in 5500 requiring intubation, and no woman experienced cardiac arrest. It does happen, though, and I am willing to bet that high blockade and its sequelae happened to Tracy.”

    Hmmm. So in that study epidural has a mortality rate of zero, yet you seem particularly concerned about high block (if that’s even what happened.) Can you explain why you focus on the risk of rare complications of interventions, but ignore the dramatically higher rate of death associated with homebirth, not to mention the inherent dangers of childbirth itself?

    It doesn’t make sense to me that you would blithely accept the far higher rate of neonatal death at homebirth while simultaneously highlighting the trivial risk of epidural.

  3. avatar
    IsntItIronic
    January 2nd, 2010 at 12:37 | #3

    LOL. Leave it to Dr. Amy to spout her anti-homebirth agenda on an article that has absolutely nothing to do with homebirth. Cute!

  4. avatar
    Kim Plummer Wallace
    January 2nd, 2010 at 12:45 | #4

    For God’s sake, Amy, where in this article was home birth even mentioned?

    While epidurals and induction have their place in birth, there are risks to them, and you know this as well as I do! I’ve seen high blockade complications during births at which I was the RN, and they’re a true emergency, there is a very real risk of death to the mother and baby, and in the absence of our general cultural mistrust of a normal low-risk process, and dependency on trying to make the unpredictable timetable of labor fit into a medically prescribed box, this scenario might have been avoided altogether. Had the “standard of care” that said go straight to augmentation with pitocin not been blindly, (I might even say blithely) instituted, there is a very real potentiality that this mother, who had delivered before without an epidural would have kicked into labor on her own, and avoided use of the epidural at all.

    Even though I am an advocate for non-interventive birth methods, I will be the first to acknowledge that birth is not so much to be “trusted” as respected. I /know/ that things can go quickly wrong, even in the healthiest of prior situations…but, if birth, as you believe, is /inherently/ dangerous, why then, do we in the medical profession continue to add procedures and protocols to the care standards that increase that danger in normal pregnancy? I can see the place for some of these interventions in a high risk pregnancy, but not normal…and I think that is where we fail the American public…by not distinguishing between normal pregnancy and high risk pregnancy, normal labor and an emergency complication.

    And I’m still out there on the front lines practicing…have you gone back to work yet? You might try it…could be a lot more fulfulling than trolling the web looking for places to get attention. You’re beginning to pop up in the most amusing places…and starting to look more than a little pathetic. Your methods belie your stated intentions, and the attention you are garnering is anything but support for your message…I’d dare to say you are damaging your own message by your methods. Perhaps it’s time to move on now to more productive work?

  5. avatar
    Anita
    January 2nd, 2010 at 12:50 | #5

    Thank you for the complete picture, Henci. I had heard this dramatic story and wondered whether it was some sort of embolism. I appreciate you!

  6. avatar
    Sam
    January 2nd, 2010 at 12:52 | #6

    What has homebirth got to do with it?

    ince it’s been raised: in the UK, we are encouraged to birth at home, although it is still a minority choice. Official advice is: for a woman of low-moderate risk within a certain radius of a hospital, there is no evidence to show that birthing in a hospital is safer.

    I wonder if there are some women in America who birth at home when a HB would not be advisable….. because they mistrust the medical profession. Given that a hospital full of qualified staff don’t seem to know the risks of the drugs they are peddling, the high rate of interventions (and in particular C-sections) AND the fact that a woman in the US is 3-4 times more likely to die in childbirth than in any other developed nation (despite the fact that most are hospitalised for birth)… I am not surprised if they don’t trust the profession. I wouldn’t either. The more I discover about the health service over there, the more I think, maybe our NHS ISN’T so bad after all.

  7. avatar
    Anonymous
    January 2nd, 2010 at 12:54 | #7

    @Amy Tuteur, MD Any reason why you are refraining from discussing this particular case and attempting to lead the conversation away to a subject that is not even raised here?

  8. avatar
    ms. michel
    January 2nd, 2010 at 12:56 | #8

    Dr. Amy, you really do amaze me. Homebirth is not the focus of this article. Interventions that happened immediately prior to this poor women turning blue and becoming unresponsive are the focus of this article. Why would the interventions not be called into question? Are you really that fearful of your own body? Our world would not be as overpopulated as it is if birth didn’t work.

    Please list the studies you have read that show these frightening homebirth statistics. They seem to contradict most recent studies that say homebirth is *at least* as safe as hospital birth for low risk women. It also contradicts our country’s high infant mortality rate compared with those countries where midwifery care is standard.

  9. avatar
    Betelgeuse
    January 2nd, 2010 at 12:59 | #9

    “The real moral of the tale is that the safest and healthiest births will be achieved by avoiding medical intervention whenever possible.”

    Nobody ever said anything about homebirth.

  10. avatar
    Guggie Daly
    January 2nd, 2010 at 13:07 | #10

    1 in 1400 is rare?

    And that’s only the incidence in one collection of studies for ONE complication. Reported incidence. This story is an excellent example of how an incident tied to needless intervention goes UNDERreported.

  11. avatar
    Betelgeuse
    January 2nd, 2010 at 13:15 | #11

    Y’all do realize what Amy did right? She threw out the bait. And we all bit. Hard.

    Now she has a platform here–rebutting all the crazy “natural” birth advocates who have opened the door for her and put out the welcome mat.

  12. avatar
    Birth Love
    January 2nd, 2010 at 13:15 | #12

    Amen to that, Kim. Well said.

    No one can or should ignore the risks involved with pregnancy. Any of them. Every health care provider – doctors, nurses, midwives, obs – everyone – should try to make birth better and safer, not more complicated.

  13. January 2nd, 2010 at 13:16 | #13

    “Leave it to Dr. Amy to spout her anti-homebirth agenda on an article that has absolutely nothing to do with homebirth.”

    The article is about risk. Ms. Goer would like to smear the use of epidurals as an “unnecessary” intervention by highlighting the risk of a high block. (We can leave aside for the moment the fact that Ms. Goer actually has no idea what happened, but is hoping that she can use this as a cautionary tale about interventions. For all we know, the patient had an underlyng cardiac defect that lead to her reported arrest.)

    One of the most serious problems in discussing risk with in relation to childbirth is that “natural” childbirth advocates have a tendency to grossly overestimate the risks of “interventions” and grossly underestimate the risks of avoiding interventions. That’s exactly the problem with this article. To read it, you would never know that the risk of a high block is trivial compared to the inherent risks of childbirth. Indeed, the risks of a high block are trivial compared to the risk of avoiding interventions by choosing homebirth.

    In other words, if the risk of a homebirth is considered acceptable, why write a post about an event that is far less likely to occur? The only reason, in my view, would be to unjustly imply that epidurals are both dangerous and unnecessary, and neither implication is true.

  14. avatar
    Birth Love
    January 2nd, 2010 at 13:19 | #14

    @Sam – be careful, you will NEVER hear the end of it when talking to Dr. Amy about home birth. She will NEVER compromise, make any attempt to see your side, she will call you foolish, dumb or uneducated…she’s outrageous. Just wanted to warn you.

  15. avatar
    emjaybee
    January 2nd, 2010 at 13:26 | #15

    Thank you Ms. Goer; I wanted to add, didn’t the video GMA interview also state that she went into labor *early*? Which made me wonder, again, why they could not let this poor woman labor in peace. I would add another layer of suspicion here; she came in on Christmas Eve. And induction/csec rates always rise before major holidays when the staff wants to go home. Wonder if that played a part in the decision to use Pit as well?

    In short, I agree with you that I smell a rat here, and a hospital PR department trying to spin a bad outcome into a feelgood story about a “miracle” to cover up their own incompetence. I hope I’m wrong of course, but I am certainly suspicious.

  16. January 2nd, 2010 at 13:38 | #16

    My problem with this is all the risks they took and when asked they had no idea why this happened! Did they fail to read the handouts that they give out or did they not bother to read the risks themselves? How could they not know the cause when the risks are printed in black and white for us all to see?

    My problem with this and stories like this is that certain risks are acceptable for doctors because they are “calculated” but when you add them up, they out weigh the risks for ‘normal’ birth. Add up all the risks individually to pitocin, to cervadil, to epidurals, to spinals, to stadol, to demerol then add up the VBAC risks… then I’d like someone to tell me which is truly riskier!

  17. January 2nd, 2010 at 13:46 | #17

    I fail to see what home birth has to do with this at all, but the more I read from “Dr. Amy” the more I see she cannot leave it at the door and talk about the real issue.
    Amy, is there a reason home birth needs to be brought into every post you make?
    Because a post like this has nothing to do with Home birth…

  18. January 2nd, 2010 at 13:54 | #18

    ‘My problem with this and stories like this is that certain risks are acceptable for doctors because they are “calculated” but when you add them up, they out weigh the risks for ‘normal’ birth’

    No, they don’t. That’s my point. Articles like this deliberately imply that the “risks” of interventions are high and the risks of not intervening is zero. That’s entirely untrue. Childbirth is inherently dangerous; in every time, place and culture, childbirth is a leading cause of death of young women, and usually the leading cause of death of babies.

    The ONLY places that have low rate of perinatal and maternal mortality are countries where interventions are routine. Only interventions have the power to save lives: interventions ranging from routine prenatal care to detect complications, C-sections (the only surgery that can save two lives at once, pitocin for hemorrhage, Mag sulfate for pre-eclampsia, induction to reduce stillbirth; the list goes on and on.

    Without routine interventions, childbirth kills babies and mothers.

  19. avatar
    Kate
    January 2nd, 2010 at 13:58 | #19

    Amy Tuteur, MD :
    “High blockade happens rarely, and even more rarely does it result in full respiratory and cardiac arrest—one database analysis of 11,000 obstetric epidural blocks reported a rate of 1 in 1400 women experiencing a high block and 1 in 5500 requiring intubation, and no woman experienced cardiac arrest. It does happen, though, and I am willing to bet that high blockade and its sequelae happened to Tracy.”
    Hmmm. So in that study epidural has a mortality rate of zero, yet you seem particularly concerned about high block (if that’s even what happened.) Can you explain why you focus on the risk of rare complications of interventions, but ignore the dramatically higher rate of death associated with homebirth, not to mention the inherent dangers of childbirth itself?
    It doesn’t make sense to me that you would blithely accept the far higher rate of neonatal death at homebirth while simultaneously highlighting the trivial risk of epidural.

    Where are you getting your figures from? The studies I’ve seen on homebirth vs hospital birth for low-risk women is the same for fetal and maternal outcomes, with the home-births have lower rates of interventions.
    Scare tactics. The doctor and hospital did not ‘save’ this mom, she probably would have bee happy and healthy without any of the interventions they used on her.

  20. avatar
    Sarah Dubé
    January 2nd, 2010 at 13:59 | #20

    “Amy, is there a reason home birth needs to be brought into every post you make?”

    My guess? Because women are informing themselves and normal childbirth is becoming popular as a result…it’s good for her business to be at the forefront of the opposition. It’ll get her booked on talk shows and get her a book deal. Like most doctors, it’s all about the money.

  21. avatar
    Anonymous
    January 2nd, 2010 at 14:12 | #21

    @Amy Tuteur, MD
    Are you playing dim on purpose. Those are NOT routine interventions.

  22. avatar
    Robbin
    January 2nd, 2010 at 14:19 | #22

    Amy seems kind of scared of childbirth. I hope you’re not peddling your fear of birthing babies to the women you know. “Routine” interventions are a major problem. Interventions should not be done routinely. They should only be done when they’re necessary on a case-by-case basis.

    I haven’t read anything about this childbirth miracle, but it seems to me that those doctors should be thankful they could solve a problem they caused – even though they did so much harm to mother and babe in the process. I had a hospital birth with “routine” (unnecessary) intervention that was pretty disastrous, too.

  23. avatar
    Gretchen
    January 2nd, 2010 at 14:31 | #23

    @Amy Tuteur, MD
    Here’s a comment I would expect from a dr. I had my first child nearly die from a dr. in a hurry to deliver me, and spend 10 days in NICU and another 2 months paralyzed from Herbs Palsy…and my 3rd child almost died because my dr didn’t believe me when I said something was wrong, the baby had stopped moving – my placenta had died. Thank GOD he hurried up and c-sectioned me 3 days later, when it was too late to have a vag. birth and my son had been living on his own body fat for a period of time. Dr’s medical degree’s go straight to their heads and then they pull crap like this and ‘can’t figure what happened’. I’ll tell you what happened…..DRS!

  24. avatar
    JSS
    January 2nd, 2010 at 14:47 | #24

    Honestly, it really shouldn’t matter what this Dr. Amy thinks or believes, what matters is the evidence, and the evidence is clear that home birth is as safe, or safer than hospital birth, for the right woman with the right caregiver. We have done the studies here in Canada and have the numbers to prove this. Also, you will find that the Canadian College of Family Physicians have recently released a statement supporting home birth as a safe option, and have given their members the green light to participate in home births if they have/get the necessary training. a GOOD doctor would know about these stats and a GOOD doctor should give her patient unbiased, non-judgemental info so that the PATIENT can make an informed choice.

  25. avatar
    Renne
    January 2nd, 2010 at 14:48 | #25

    Amy, darling, do you have any child laboured by your own? Are you a mother?))) Whet gives you a right to write all that nonsense? Do you know, though approximatelly, real risks of normal labour process??? Why do you offer to make emergency interventions for everyone?

  26. avatar
    Rachel
    January 2nd, 2010 at 14:48 | #26

    Actually, Amy, the leading cost of infant lives worldwide is diarrhea from a lack of clean water, misinformation about bottle feeding and breast feeding. Not birth.

  27. avatar
    JSS
    January 2nd, 2010 at 14:51 | #27

    Since when did childbirth become INHERENTLY DANGEROUS? Surely our species would not have survived for so long if it were. Afterall, Dr. Amy, you will recall that doctors have only been meddling about in birth for but a blink of time relative to the length of time women have been giving birth without them. If doctors and interventions have made birth so safe, why has the USA such an abominal mortality and morbidity rate???

  28. avatar
    Guggie Daly
    January 2nd, 2010 at 15:13 | #28

    Oh patooey! The doctors in the article know what happened! It’s call CYA (cover your arse). Of course they need to invoke God’s name and pretend it is all a mystery. What are they supposed to do, admit their mistake, admit they didn’t give the patient informed consent and risk a huge lawsuit or penalty for acting unethically and recklessly?

    LMAO

  29. January 2nd, 2010 at 15:33 | #29

    I just want to chime in quickly here, with a comment that has nothing to do with Henci’s article per se, but is quite relevant to the current discussion. I have administrated, moderated and participated in many many online communities and forums and there we have learned over the years one very helpful rule:

    “Don’t feed the Trolls”

    ….even if, or maybe I should say: especially if they have upper case letters after their name.

  30. avatar
    terry
    January 2nd, 2010 at 15:41 | #30

    @Amy Tuteur, MD
    can you provide documentation to this alleged “high mortality rate” for home births?

    i am also a doctor and i have researched this area thoroughly before having 2 babies at home without issue.

  31. avatar
    terry
    January 2nd, 2010 at 15:47 | #31

    @Amy Tuteur, MD

    once again – no sources for your statements

  32. avatar
    terry
    January 2nd, 2010 at 15:50 | #32

    @Amy Tuteur, MD

    wow!…i cant even comment. thats truly amazing

  33. avatar
    Copy and Paste, MD
    January 2nd, 2010 at 15:52 | #33

    Copy and paste, copy and paste, must find time to copy and paste.

    RH Reality Check banned Amy for spamming, which was essentially copying and pasting the same comment on every birth related post.

    Watch out, JSS… here comes the copied and pasted crap about perinatal versus neonatal mortality.

    The U.S. maternity care system and all of the doctors in it are PERFECT. Everything is perfect just the way it is and there are no problems. Why can’t you silly twits just be grateful, asks Amy.

    She got you. She tried to make it Henci’s fault for pointing out a glaring medical error and shifted attention away.

  34. January 2nd, 2010 at 15:56 | #34

    There isn’t a higher rate of death with homebirths. The maternal death rate in the US is increasing due to hospital interventions, not homebirths. Do you research first!

    Less than 1% of births in the US occur at home, and I highly doubt all those women have died.

    In Europe over 70% of births are attended by midwives, and 1/3 of those midwifery assisted births are planned homebirths. Europe has a lower maternal death rate than the US by far. The US ranks 44 out of 45 countries when it comes to maternal death, it has gotten lower in the past 10 years, you used to be at 33 out of 45. Places that promote homebirths, and midwives are a lot higher on that list.

    Epidurals run the risk of death with mother and even higher rate in baby. Everything you put into your system when you are pregnant directly affects the baby, no matter what you are told. Sometimes babies die, and being in a hospital likely won’t save your baby (unless the reason your baby is in stress if due to something they have done to “help” your labour. ie; Pitocin) and I don’t know of a single woman in who has died in a hospital birth in my city. My midwives have never lost a mother and have never had to transfer to a hospital for an emergency.

    You should really watch the movie “The Business of Being Born” you might learn something.

    To the author:
    Glad to know people are aware that this was a hospital mistake and had nothing to do with a normal birth. Womens hearts don’t just stop in labour or natural childbirth unless she has a heart condition. This is utter nonsense. One report from the hospital said all the tests have been “inconclusive” but we know what happened. She had a nearly fatal reaction to the Epidural. I just hope this family can move on with their lives.

  35. January 2nd, 2010 at 15:57 | #35

    Wait that should say “I don’t know of a single woman in my city to die in a home birth” not hospital birth. My mistake.

  36. January 2nd, 2010 at 16:00 | #36

    I wrote about this story also: http://realityrounds.com/2009/12/29/crash-c-section-on-dead-mom-with-miraculous-result/.

    The story seemed fishy to me from the beginning. I have no idea why this hospital would want this story splashed all over the news. It did not seem like a happy miracle from where I sat, but a very traumatic experience. Women (in general) do not just go into cardiac arrest in labor without a reason. It just does not happen. To portray the story as if this mom just dropped dead one minute, then completely recovered the next after the section, does not add up.

    This story will go in my “Code Bullshit” pile of medical media reports that gloss over the realities and turn tragedies (such as 25 week quintuplets, or a mom coding and getting a section in a labor room) into feel good “miracle” stories.

  37. January 2nd, 2010 at 16:00 | #37

    @Amy Tuteur, MD

    Didn’t I say NORMAL birth? So by adding in pitocin to a NORMAL birth is far riskier than letting birth progress. Adding CERVADIL into a NORMAL birth is riskier than letting birth progress. Adding an epidural into a NORMAL birth is far riskier than letting it progress. Is there a reason you purposely misused my statement?

    Where your statistics say that interventions are safe the backs of the bottles and the FDA in black and white show that they are not. Where you say that routine interventions are safe, I will show you the manufacturers websites which show that they are not to be used ROUTINELY but to used upon medical necessity. No one is arguing medical necessity but the routine augmentation of labor. You said it yourself, “Without routine interventions, childbirth kills babies and mothers.”
    And that is PRECISELY my problem… the routine augmentation of labor.

    Want to dance with statistics, go right ahead but I get to make the choice for my body and my baby. I’m sorry but where do you get to make the decision for me and my baby? Where is your opinion more valid than mine because last time I checked, isn’t it my body? Isn’t it my baby? Trolling around looking for a swing vote in your quest against home birth is absurd and very unbecoming. Its one thing to provide information but I can tell you, as a pregnant woman looking for information, you are driving me more towards a home birth by your statements and actions.

  38. avatar
    j. conner
    January 2nd, 2010 at 16:04 | #38

    I think the author of this article was jumping to conclusions about what actually happened. How do they know there wasn’t something chemically wrong with that particular dose (or lot) of the medicine? What if it was administered into a vein accidentally? He also said basically, that the medical personnel were taking credit for a disaster THEY created. Did THEY create it? Didn’t she ASK for the epidural? I don’t think the article implied in any way that one should give birth in a hospital, in order to save lives…….(even if it does). I think he’s stretching his imagination a bit with this article, and the responders are scrambling all over EACH OTHER for some ridiculous reason! She chose an epidural; she had a bad reaction; she was revived; the baby was saved and it happened on Christmas. Thank God or the gods (whatever you believe) but seems they are ok,despite the mistakes that may have been made by all.

  39. January 2nd, 2010 at 16:19 | #39

    “what matters is the evidence”

    That’s right, and the evidence shows something very different from what you believe. The evidence shows that homebirth with an American homebirth midwife (CPM or LM) is the most dangerous form of PLANNED birth in the US.

    Consider:

    1. Childbirth is INHERENTLY dangerous. It is and has always been one of the leading causes of death of both young women and babies.

    2. The best study of American homebirth midwifery (Johnson and Daviss, BMJ 2005) actually shows that homebirth with a CPM has triple the neonatal death rate of hospital birth for comparable risk women. The authors hid this by failing to compare homebirth in 2000 with low risk hospital birth in 2000.

    3. The CDC statistics for linked birth infant death show that homebirth with an American homebirth midwife is the MOST DANGEROUS form of planned birth in the US. Planned homebirth with a homebirth midwife has triple the neonatal death rate of low risk hospital birth.

    4. The recent publication of the Dutch and Canadian studies is bad news for American homebirth. The studies shows that homebirth with an American direct entry midwife has more than triple the death rate of homebirth with a Canadian midwife or a Dutch midwife. The central lesson of both studies is that homebirth can only be safe when practiced by highly educated, highly trained midwives under rigorously controlled conditions, a position in direct opposition to the philosophy of American homebirth.

    5. The Colorado Midwives Association reported its own mortality statistics. Colorado LICENSED midwives have an appalling rate of perinatal mortality of approximately 8/1000 (and rising), far exceeding the perinatal mortality rate for low risk births in Colorado.

    6. Homebirth advocates like to quote US infant mortality statistics, but infant mortality is a measure of pediatric care. According to the World Health Organization, the correct measure of obstetric care is PERINATAL mortality and according to the World Health Organization, the US has one of the LOWEST perinatal mortality rates in the world, LOWER than Denmark, the UK and The Netherlands.

    7. American homebirth midwives have less education and training than any midwives in the industrialized world.

    8. The Midwives Alliance of North America (MANA) the organization of certified professional midwives has been collecting extensive safety statistics since 2001. They have offered the statistics to those who can prove they will use them to support homebirth, but refuse to release their own safety statistics to the public, suggesting that their own data show that homebirth increases the risk of neonatal death.

    That’s what the evidence shows.

  40. January 2nd, 2010 at 16:20 | #40

    “Amy, darling,”

    Why do “natural” childbirth advocates favor sexist put downs when they cannot come up with scientific evidence to support their claims?

  41. January 2nd, 2010 at 16:27 | #41

    “Surely our species would not have survived for so long if it were.”

    That betrays a basic misunderstanding of evolution, as well as a complete misunderstanding of childbirth.

    In order for a population to grow, every set of parents would need to leave (on average) more than two children. From the point of view of population growth, there is no difference between having 10 children, 7 or whom die in childbirth, or having only 3 children that live. Massive population growth is perfectly compatible with astronomical rates of neonatal and maternal mortality.

    Moreover, wastage is common is human reproduction. Each woman born with millions of eggs that will never be ovulated. Each man produces billions of sperm that will never fertilize an egg. The miscarriage rate in established pregnancies is 20%. The fact that the inherent rate of neonatal death is in the range of 7% and the inherent rate of maternal death is approximately 1% is perfectly compatible with our current population size.

  42. January 2nd, 2010 at 16:28 | #42

    “Didn’t I say NORMAL birth?”

    You don’t seem to understand. Neonatal and maternal death are normal results of childbirth, just like miscarriage is a normal result of pregnancy. They may not be the ideal results, but they happen so often that they are surely normal results.

  43. January 2nd, 2010 at 16:32 | #43

    Guggie, my thoughts exactly. When about 85% of women giving birth get an epidural, 1 in 1400 is fairly frequent in my mind.

  44. avatar
    Maree
    January 2nd, 2010 at 17:05 | #44

    Ah Dr Amy. The triumph of doctor speak over reality. At least she makes for a good laugh. Is she real? No idea. I’d like to see a study into that though!

    Thanks, Henci. Factual, well supported statements as per usual. Unlike some. *lol*

  45. January 2nd, 2010 at 17:12 | #45

    “Don’t feed the trolls”. Exactly. I humbly beg those of you who understand and respect birth to spend your time working for the positive. I’m afraid that Amy is just bad for our blood pressure and will never change her opinions. I suspect she has been severely damaged by some of the things she has seen in her work as a doctor.

    I suspect she no longer practices for this reason, as she surely wouldn’t have time to work with patients and spend the time she so obviously does blogging and spamming every normal childbirth website on the internet.

    There are some ‘natural childbirth’ advocates who are equally vociferous and evangelical. Let’s stay unbiased, true to the spirit of what women want and instinctively know is safe for themselves and their babies (whether that is hospital or homebirth; medicated or unmedicated)and work for true informed choice. Please don’t take the bait. There are many MDs who have similar views to Amy who would relish a real debate – in the spirit of both sides learning from the other.

  46. avatar
    Kamilla
    January 2nd, 2010 at 17:13 | #46

    Well, from a labor and delivery nurse’s opinion:

    The point is that possible complications of an epidural were not addressed in the interview. They ran every test on Tracy and revealed that they could find nothing wrong, but why did they not investigate a possible problem with the epidural migrating or entering a blood vessel, or even the previously mentioned “bad lot” of medication, how about the pump that was delivering continuous medication (if that was the case), there are lots of possibilities.

    Yes, Tracy did ask for the epidural, but I’m sure under the pretense that it will not affect her or the baby. . . as all seven hospitals I’ve ever worked in (and still work in) claim fervently. We know all too well the cascade of events that occur after the epidural: blood pressures drop- despite IV fluid boluses, increased risk of C/S etc.
    Physicians don’t tell the truth regarding the risks vs. benefits of epidural and make patients feel ridiculous if they don’t get one. I see it every day. Where do we draw the line in regard to informed decision.

    It’s a complicated web that involves MD’s, hospital management, insurance companies, etc.

    The only real answer is to trust God in prayer with each labor and delivery I am a part of. That’s my opinion!

  47. avatar
    Sam
    January 2nd, 2010 at 17:22 | #47

    @Amy Tuteur, MD

    Amy:

    Why was your ENTIRE last post about homebirth? There are plenty such discussions in existence on the net already – go and find one and copy and paste the same boring homebirth tripe there. Alternatively, try addressing the issue:

    //Childbirth is inherently dangerous; in every time, place and culture, childbirth is a leading cause of death of young women, and usually the leading cause of death of babies.//

    “Childbirth” is simply too broad a term. If we are interested in CHANGING this state of affairs, rather than relishing it because it is lining our pockets, it’s useful to get specific. There are a number of things which can make childbirth dangerous, depending on where you are. In some cultures, it might be risk of infection. In the US, it might be heavy use of unnecessary interventions (case in point). In the UK, it might be related to the national midwife shortage.

    So – please: what is it about a normal, low-moderate risk birth, following a smooth pregnancy, is so inherently dangerous? Please be precise and offer useful, solid facts, rather than unhelpful fear-mongering, and protracted posts about homebirth (which is not the topic of the article, which I am beginning to suspect you didn’t bother to read).

    //The only reason, in my view, would be to unjustly imply that epidurals are both dangerous and unnecessary, and neither implication is true.//

    Um – are you REALLY a doctor, or is it just a screen name? Epidurals DO carry risk, as do ALL anaesthetics. ALL medications and medical procedures carry risks. To imply that they are A) ALWAYS safe and B) ALWAYS necessary is the most facile statement on the thread so far.

    Of course, disdaining any and all medical assistance is foolish – its advent in recent years has saved many lives. On the other hand, treating all births like a dire emergency or a problem that needs to be fixed is hardly mature or helpful, yet that appears to be your approach.

    Try directly addressing the article under discussion. Do you think the mother just dropped dead for no reason at all? What condition may have caused it? Do you insist that there is no possibility at all that the epidural is, or may be, the cause? Do you think the hospital did the right thing by intervening in this instance, and why? Do you think ALL interventions are completely OK, risk free, and if the mother or baby suffers further complications (up to and including death), well, it’s nothing to do with *US*.

    Why might this woman have been induced, then loaded with pitocin (so that her chance of coping without further intervention were remote) – rather than allowed to progress naturally? I mean OTHER than the impending holiday season, obviously. And why do you think these reasons have not been reported? It would seem a wise move for the hospital to explain why these procedures were necessary, so that those viewing the story do not lose trust in the medical profession. So – any ideas why they haven’t? You appear to oopose the article, so I assume you believe they were correct in their actions – I’d be interested to know why, and on what basis.

  48. avatar
    alia
    January 2nd, 2010 at 17:24 | #48

    OK–assuming the discrepancy between the canadian and american homebirth midwives are correct, there is still a failure to acknowledge something here.
    a large chunk of women, with HIGHLY TRAINED med personal around them, can labor safely without the following: pitocin and epidural. If hospitals and doctor didn’t push it on you (YES THEY DO, experienced it first hand), more of us would labor in a hospital. Because we are given so little choice–basically a rather paternalistic “if you want to labor here you do what I say” attitude–we have to find environment with more flexibility. If you are not in a large city with a birthing center, sometimes the only place is home.

    I know you MDs all want to get home in time to watch american idol, but no more pitocin, thanks. Luckly I had a nurse smart enough to shut mine off when my baby started to stress out, rather than raise the c-section alarm.

  49. avatar
    rozepyle
    January 2nd, 2010 at 17:26 | #49

    @IsntItIronic
    looks like your one of the many money hungry Dr’s this country is polluted with. Anyone that knows a damn thing or two about birth would know that medical intervention isn’t necessary thus making home birth IDEAL. I suppose your anti breastfeeding too if you have this mindset. young healthy women would not be dying during birth if NATURAL safe pregnancies and birth information was readily available, if doulas were not considered a luxury but a normalcy and if people like you who think with their wallets didn’t exist.

  50. avatar
    Mom of Six
    January 2nd, 2010 at 17:54 | #50

    I was sent this link by a friend and found the article and the comments interesting.

    But I just cannot completely agree with the writer of this article. I along with this writer thank God for the prompt actions of the doctor but we are “almost certain” of nothing about this case and for this writer to speak with such near certainty only does a disservice to the author.

    Avoiding medical intervention whenever possible is a good principle during labor (I have six children born with and without medical intervention) but to use this story to promote that message is misguided and unfortunate.

    IF mistakes were made that is something that should come from the father or mother directly and not from “Monday morning quarterbacks” who speculate for their own purposes. Currently, the father has decided to publicly thanked God and the doctors for a wife and child who are alive today. He has his wife and child and chooses to focus on their blessings and provide an inspiring example for me and many others.

    By all means speak out boldly strongly for normal/natural childbirth. The medical community is often too quick to action and healthy debate will benefit everyone. But advocates of “natural” childbirth are often too quick to blame the medical intervention when all the facts are not known and may never be known to them.

    The moral of this story has nothing to do with medical intervention but a family whose faith in God and love for each other allowed them to thank God for their very breath and move past the birth experience and get on with life. We should all do the same.

Comment pages
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  1. January 2nd, 2010 at 12:35 | #1
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