bearing blog

More birth stuff.

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3 comments on More birth stuff.

Remember that news story just after Christmas, with the birthing mother and baby both nearly dying and being revived?  Christy sent me a link indicating that a poorly administered epidural was probably at fault:

 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.

I was particularly interested to read this just now because of a conversation I had on Saturday evening.  We were dinner guests,  and the women were swapping childbirth stories.    One woman described her experience with her first epidural during childbirth:  it was an awful experience, she said, because the epidural paralyzed her arms as well as numbing her lower body.  She didn't find out until giving birth (with an epidural) a subsequent time, at a different hospital, that this shouldn't have happened, and the staff at that second birth told her she was lucky she hadn't had worse problems.  I'm guessing that this was a less serious example of the same complication.

We had been discussing in a previous post whether the risk to babies is greater or lesser in home births in the U.S. (studies from other countries being more or less applicable) — I'll tell you one thing, I am pretty well convinced that mothers at least are safer at home.

ADDED — Christy posted a comment in the previous post, where I asked what sources she was using in her classes with med students to demonstrate the safety of homebirth.  The main article she cited, "Outcomes of planned home births with certified professional midwives:  large prospective study in North America" (Johnson KC et al, Brit. Med. J. 2005;330:1416) has the full text online for free.

One detail from that study which I found extremely interesting:  19% of planned low-risk hospital births turn out as Cesarean sections; 3.7% of planned low-risk home births turn out as a Cesarean section in a hospital.  Among those who planned a home birth and then transferred to hospital — one would surmise this to be a group for which things are not going smoothly, and for whom one might expect the risk to be higher — the risk of Cesarean section is 30%, only fifty percent higher than the low-risk hospital group.  I find this a pretty damning indictment of hospital Cesarean policy.  I reiterate that the biggest advantage to home birth is the avoidance of unnecessary Cesarean section.

Comments

3 responses to “More birth stuff.”

  1. Kate Avatar
    Kate

    I had the same thought reading that story, that it sounded like a physician caused complication. What bugs me is that the take away a lot of women get from this sort of news story is that birth is unbelievably dangerous, which just feeds in to the tendency to medicalize it.

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  2. Mike (the lantern crossword dude in that cartoon physics class) Avatar
    Mike (the lantern crossword dude in that cartoon physics class)

    You can avoid an unnecessary c-section in the hospital: Just say no. Under circumstances where your consent would no longer be required, you’re probably in a place where you’d want to have the c-section anyway.
    It seems pretty obvious that home births will have a lower incidence of c-sections. (warning! bad analogy coming!) While you can do a lot of repairs on a vehicle using the emergency kit someone who tinkers with cars keeps handy in their car, you would only do many of those repairs at home, unless you are forced to because the car won’t move. Similarly, while there may be births that would have less risk from a hospital-based c-section, the risk presented by transporting a woman in labor to a hospital for a c-section may be higher than the risk of a vaginal delivery. Simply put: home to hospital transport for a c-section risk > vaginal delivery risk (irrespective of location) > hospital c-section risk.
    I know, I lack the equipment to weigh in with what some consider a valid opinion, but there are some car repairs I will make myself, there are some I will let friends who are more knowledgeable about cars make for me, there are some that I will let any qualified mechanic do, and there are some that I would only trust a dealer’s mechanics to handle properly. You can make a hospital-birth as natural as you want! When my son was born, by the time my wife acceded to receiving medication, she was told “sorry, honey, but it’ll be party time before we could even get you prepped!”

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  3. Kate Avatar
    Kate

    It’s not exactly true that you can make hospital birth as ‘natural’ as you want. Many hospitals have policies that make a comfortable physiological birth more difficult – constant monitoring, for example, which limits movement, slows labor, and can make it harder to use natural pain management techniques. Limits on food intake (long labors are a lot harder to bring to a successful conclusion if you’re only allowed broth and jello). I could go on, but it’s late and I’m tired. 🙂

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