Homebirth Advocate Dies at Homebirth

2 Feb

Re: Inquiry into Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills

I write to express my concern about the above bills. I understand that these bills will enable Medicare funding, access to the Pharmaceutical Benefits Scheme and professional indemnity premium support for midwives providing care for women to give birth in hospital. Medicare funding for midwifery care is long overdue. It is not acceptable, however, to exclude homebirth from this funding and indemnity arrangement…

On a personal note, I am quite shocked and ashamed that homebirth will no longer be a woman’s free choice in low-risk pregnancies… I feel the decision to outlaw homebirth’s is contrary to women’s rights … Please find a solution for women and babies who homebirth after this date as their lives will be in threat without proper midwifery assisstance. And as a homebirthing mother I will have no choice but to have an unassisted birth at home as this is the place I want to birth my children.

Yours sincerely,
Caroline Flammea, Nick Lovell and daughter Lulu Lovell.

*****
Caroline Emily (Flammea) Lovell

LOVELL (nee Flammea). – Caroline Emily 15.07.1975 – 24.01.2012 Passed away suddenly after giving birth to a beautiful baby girl. Beloved daughter of Jadzia (Jade), loving wife of Nick and exceptional mother of Lulu and Zahra. You taught us how to love Always in our hearts

*****

Does anyone know any new Mums in the Melbourne area?? Please share this post:

“Are there any mothers in the Melbourne area, who could be part of a milk tree? A woman named Caroline died this week while giving birth to her second daughter, Zahra, at home. And the family is seeking donated milk to help bubba along.

If you can help or know someone who can, please contact Eve …
.
And please send your love & thoughts to Carolines family 3yr old Lulu, 5day old Zahra & husband Nick.”

****************************

This is the 4th maternal homebirth death that I’ve heard about in the past 4 years:

A mother bled to death at homebirth in the UK in 2008 and the midwife didn’t know how to start an IV.
A mother died in California.
A mother died in Florida last year apparently from a ruptured uterus while attempting a home VBAC.
And now this tragedy.

We are awating further details on what actually went wrong, but newspaper reports suggest that it happened within 2 hours of the birth, since she was well enough after the birth to hold her baby and since the midwife did not call for an ambulance until 2 hours later.

The likely causes:

massive postpartum hemorrhage
amniotic fluid embolus
seizures due to eclampsia
hemorrhage secondary to HELLP syndrome (a variant of pre-eclampsia)
stroke from elevated blood pressure
previously undiagnosed arterio-venous malformation in the brain

In other words, it is most likely to be a complication of childbirth, although it is possible that it is unrelated.

Homebirth advocates are now scrambling to overcome the cognitive dissonance of having one of their own die at a homebirth. This “claim” from Homebirth Australia is, unfortunately, typical:

… Sadly many women died in Australian hospitals in childbirth last year – should we ban hospital births, too?” Michelle Meares, Homebirth Australia spokesperson said.

Yes, women do die in the hospital, too. Some people who wear seatbelts die in car accidents, but that doesn’t mean seatbelts don’t prevent deaths. Hospitals are like seatbelts. There is no guarantee they can save your life if one of the above six complications occurs in the wake of your baby’s birth, but we can guarantee that you will die if they happen outside of the hospital.

Other homebirth advocates pointed out that more maternal deaths (20) occurred in the hospital in the past year, compared to one maternal death at home. Apparently they think that 20 is a bigger number than one so hospital birth leads to more deaths than homebirth. They don’t seem to understand that comparing absolute numbers is inappropriate. The only valid comparison is that of rates. Yes, there were 20 maternal deaths in the hospital last year. Since nearly 300,000 women gave birth in Australian hospitals, that’s a death rate of 6.6/100,000. There was only 1 maternal death at homebirth, but there were only 750 homebirths. That’s a death rate of 133.3/100,000, a maternal death rate for homebirth more than 20 times higher than the maternal death rate in the hospital.

We can refine the calculations further. Most maternal deaths in the hospital are due to pre-existing medical conditions or serious complications of pregnancy. The maternal death rate for low risk women is probably in the range of 1/100,000 or lower. According to homebirth midwives, this is the first maternal death in 15 years, making a homebirth death rate of 9/100,000. Obviously, that is 9 times higher than the hospital death rate for low risk women. Any way you look at it, homebirth is more dangerous for mothers than hospital birth.

The “argument” advanced by Homebirth Australia doesn’t show that hospital birth is more dangerous than homebirth, but it does make the case that people who can’t even do grade school arithmetic should not be entrusted with the lives of pregnant women and their babies.

Cross posted at The Skeptical OB.

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7 Responses to “Homebirth Advocate Dies at Homebirth”

  1. blue4butterfly February 2, 2012 at 5:45 pm #

    Excellent point about the maths – can’t comment effectively on anything if you can’t first understand it!

  2. Babs February 3, 2012 at 6:51 am #

    Caroline didn’t die giving Birth, she died the next day!!!!

    • Amy Tuteur, MD February 3, 2012 at 12:11 pm #

      She died the next day because she was resuscitated by EMT’s and supported by medical technology when she arrived at the hospital. Unfortunately, when your heart stops outside the hospital (because of blood loss, oxygen deprivation, seizure, etc,) the odds of recovery are extremely low.

      Had she not been resuscitated by EMTs when her heart stopped at home, she surely would have died within a matter of minutes.

    • Anda February 5, 2012 at 10:46 am #

      Sorry, but even if the final verdict is yet out, it is highly likely that Caroline dies of birth-related complications.

      If that is the case then “when” is irrelevent. It’s the cause that counts.

      Plus, if indeed she died of birth related complications, the next question would be if those complications could have been treated successfully at the hospital.

      The large majority of birth related complications that lead to maternal death CAN be diagnosed and successfully treated at the hospital, but not at home (e.g. major Post Partum Hemorrhage requiring blood transfusion, Eclampsia).

      I suspect she DID die of a birth related complication and that, if she HAD given birth at the hospital instead of at home, she would still be alive.

      Why?

      Because if you firmly believe that the patient suffers from something that CAN’T be treated at the hospital, you usually don’t bother to call the paramedics.

      But the paramedics WERE called. Unfortunately, by then, it was too late.

      I hope she still had time to say good-bye to her family.

  3. Theo Bromine February 9, 2012 at 11:09 am #

    I think homebirth is a bad idea. I would not do it myself, and would strongly recommend against it to anyone who asked my opinion. But I am a bit worried about the implications of legislating against an activity on the basis of its riskiness. People are allowed to jump out of airplanes and parachute to the ground even though it would be much safer to land in the plane (or not go up at all). Pregnant women are allowed to choose to terminate their pregnancies, and are not legally forbidden to engage in activities that would risk their lives or the health of the fetus.

    It is clear that the statistics are being abused by the home-birth advocates, and it is clear that women are being unnecessarily put at risk by being provided with mis-information about home birth. I’m not a medical practitioner, nor an expert in public health – for all I know legislation may be the best of the alternatives, despite the downside, and I would appreciate more information. (It’s a completely academic point for me – I have had 2 hospital births (one with minor complications which would certainly have been major if at home), and (unrelated to either birth) I no longer have a uterus).

    • Amy Tuteur, MD February 9, 2012 at 5:03 pm #

      No one is suggesting legislating against homebirth. What I hope will happen is that there will be acknowledgment of the increased risk to babies and mothers at homebirth. Homebirth advocates insist that homebirth is safe, but all the existing scientific evidence, as well as state, and national statistics shows that homebirth increases the risk of preventable death.

  4. MC August 10, 2012 at 1:32 am #

    Excellent article, couldn’t have said it better myself!

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