I had a homebirth this past fall. I absolutely loved my midwife in every way. We got along well, she took a lot of time with me at each appointment, and she cared about me personally as well as medically. As far as safety precautions, she was very reasonable: she was strict about who she took, offered proper screening (ultrasound, the same routine tests they do at an OB appointment, GBS test, etc.), and recommended we have readily available transport in case of transfer. She was extremely well trained both through midwifery school and through internships in Africa and the Phillipines. She also was a former EMT and had a back up doctor for me. It seemed like the safest homebirth scenario possible, and I would have another homebirth with the same midwife in a heartbeat.
Recently, however, I’ve heard a couple terrible homebirth stories with sad endings, and they have made me question what exactly went wrong. Let me be clear with my statements on this. I know that in some cases when a baby dies at a homebirth, he may have died regardless of location. I also know that there are some rare, but serious, complications that constitute true emergencies. These require fast action to be taken and sometimes could be better solved in a hospital. However, the birth stories that I read were neither of these situations.
The most frightening “homebith gone wrong” stories I’ve heard were the result of negligence or incompetence on the part of the midwife in attendance. For example, in one story, the midwife glossed over a maternal fever, contractions right on top of one another, and bright red blood clots- all of which are signs of a placental abruption, requiring immediate transfer to the hospital. This is completely alarming to me- even I know about placental abruptions, and I have no official training in any of this! How in the world is it that a midwife, in good conscience, could ignore these warnings and not take the mother to the hospital immediately, at the very first signs?
This story is not isolated. Preventable deaths at the hands of an inept care provider is always tragic, whether it be at the hospital or home. Whenever I tell people that I support homebirth under the right conditions, I now have to add that if they want to do it they have to find a good, competent midwife. Credentials are sometimes a good indication of her knowledge and abilities, but I think it’s best to look at her individual training and experience. (For example, a DEM that follows evidence based practices and has had many years of experience might serve you better than a CNM fresh out of school. Of course, there are also times that a CNM would be the better choice.) Look into her history, the school she went to, make sure she brings the right equipment with her, and know how she handles a situation that requires transfer.
I don’t think that all midwives are equal in their practice any more than I think all OBs are equal. Both are prone to error at times, sometimes more drastically than others. I recommend that you research your individual midwife, just as I would hope that you research your individual obstetrician. Check out Birth Sense’s article, “Ten Ways to Spot an Incompetent Midwife” for excellent questions to ask a midwife before birthing with her.
Be it clear that I am pro-competent midwifery, pro-sensible obstetrics, and an advocate for homebirth under the right conditions. It is imperative that mothers research their midwife extensively when planning a homebirth to ensure safety and know that the right actions will be taken in case of unexpected scenarios. The safety of homebirth (and hospital birth too, I might add) strongly depends upon qualified and watchful attendants.