11/25/2016
Truth.
WHAT IS A “FAILED HOME BIRTH”?
Over my 30-plus years as a midwife, I have on more than one occasion encountered the words “failed home birth”, both in conversation and in print. It seems that some clarity is in order, because the implication in these words is that failure and home birth are inseparable, probable, obvious.
I’m an old midwife. I’m no longer so idealistic or naïve as to claim that birth never fails. Nor am I so un-accusing as to say that the mother or provider are never to blame. Truth is that sometimes (although rarely) birth just doesn’t work, and other times it really is the people involved who screw it up.
But that said, why do we never hear the words, “failed hospital birth”? If you check the statistics, the infant mortality rates of home and hospital births are about the same.
“Failed home birth” typically means an attempted home birth in which a complication arose, requiring transport to a hospital. BUT THIS IS NOT A FAILURE. This is usually an appropriate and wise choice made by the midwives and the parents, who recognize the legal and personal limitations of a safe delivery in the home. Good midwives and reasonable parents are not anti-medical. We believe there is a time and place for sensible medical care. We also believe that most births can be experienced naturally and beautifully, without intervention, and in the comforts of the family’s home.
Responsible home birth is one which has been preceded by continuous risk screening and thorough prenatal education. A trained and professional midwife works with an informed and healthy mother, honoring the natural process of pregnancy and birth while simultaneously observing for anything out of the ordinary. Midwives have traditionally been called the “Guardians of Normal”. Plans to deliver at home are ruled out if and when specific risk factors arise.
Under these circumstances, a transport from home to hospital is no different than a transport from a small rural hospital to a larger medical facility. Does this mean that a responsible family should opt for the larger facility to begin with? Not necessarily. It only means that an unforeseen complication has been professionally identified, limits in the scope of care have been (humbly) acknowledged, and plans have changed accordingly. The patient / client is triaged and relocated to a more technologically advanced care center. This is not a failure; it’s just common sense.
Success happens when all involved are working methodically together towards one goal. Cooperation and respect are key.
The public applauds those life-flight EMT’s and nurses, the ones who accompany patients as they are air-lifted to medical centers. Their work is indeed heroic and honorable. And yet, the midwife and laboring mother who show up at a hospital are referred to as participants in a “failed home birth”.
Even among midwives, the status of one’s transport rate is often used as a measuring stick for competency. Some midwives evaluate themselves or their peers based on how many times they transfer care to a more specialized provider. Other midwives take great pride in claiming that they stay at home with their laboring clients, no matter what. I want to say that both views are foolish. Transports do not indicate failure. Transports indicate prudence and humility, both essential virtues of moms and midwives alike.
“Failed home birth” becomes a reality when prenatal risk screening is too lax or not done at all. Failed home birth occurs when mothers are uninformed or unwilling to take responsibility for their own health and that of their child. Failed home birth happens when midwives are uneducated, ill equipped or too prideful to let go of the controls.
I want to add here that the trend toward unassisted birth is an example of people functioning outside of their personal limitations, and often results in a truly “failed” home birth.
A midwife who appropriately transfers care is a blessing to her community, knowing her limits and protecting her clients. This is a midwife who will be welcoming babies into the world for many years to come. The mother who experiences a home-to-hospital transport is not a failure. She is a wise and courageous woman who has placed the safety of herself and her baby above her original birth plan, and above the inevitable criticism which will undoubtedly follow.
So please … be aware of your words. Be cautious about using inaccurate and hurtful terminology as you communicate about a new mother's birth experience. The things you say can make an enormous difference in that mom’s confidence as a mother. It can also make or break a midwife's heart.
~by Pat Schwaiger, RN, CPM, Mountain Midwives, Billings, MT
