Maternal death after homebirth

TallPoppy · #1 (**permalink**) 15-May-2008, 13:46

A young mother who developed complications during a home birth died after a midwife lacked the confidence to inject her with fluids, an inquest was told.

There was also a delay in giving Joanne Whale treatment that could have saved her life in hospital after another midwife failed to pass on information to the doctors there.

Dr Peter Dean, the Greater Suffolk Coroner, said that lessons must be learnt from her death and that women should be made more aware of the dangers of home births. He also demanded better communication between midwives and doctors.

Miss Whale, 23, gave birth to a healthy boy at home in Ipswich last September. But she died hours later after a severe haemorrhage.

When Ms Whale began to lose blood she needed an injection of fluids. Julie Bates, a midwife, said that she had been trained in the process but had never had to use it. “I’ve got the theoretical knowledge but not the practical knowledge,” she said. “I felt uncomfortable having to do that in this situation.” She added: “Knowing the ambulance was only a few minutes away I thought it was better to leave it for the proper paramedics.”

Read more ...

http://www.timesonline.co.uk/tol/new...cle3934513.ece

We have been debating this on the student site - whats your view?

Shoshana · #2 (**permalink**) 15-May-2008, 13:54

copy and pasted from StudentMidwife.NET:

How very sad.

I commented on another thread recently that I think midwives should gain confidence and experience in the hospital setting, before going out in community. It is for just such a situation that the midwife needs to have the experience behind her.

NICE guideline have made it clear that whilst homebirth is safe in the majority of cases, when problems occur the consequences can be far more severe, for both mother and baby, due to the distance and time it takes to get medical help.

LotusEater · #3 (**permalink**) 15-May-2008, 15:11

Not sure of the details, did the woman die after several hours in the hospital, following the homebirth? This is the one with the inverted uterus? I wonder if active management of the third stage was done - again a hospital management that really shouldn't be done in a homebirth context.

Personally, if I had a woman haemorrhaging at home, and I was alone, I would be more concerned about emptying the bladder, getting the placenta out, administering the ecbolic and applying external BMC rather than faffing about with getting a line in. If I had someone else there, then of course let's get a line in but as indies, we are not licensed to carry fluids anyway so except for flushing it, there is nothing else we can get into the line until the paramedics arrive.

indiemidvic · #4 (**permalink**) 31-May-2008, 09:15

I'd be interested to read what the members of the student site said about this.
It needs to be said that a lot of PPH cases are a direct cause of the 'management' of birth and subsequent interventions.

I don't necessarily feel that NHS experience prepares students/midwives in the handling of homebirth cases...those who are used to hospital birth with policies and protocols would be more inclined to promote active third stage, routine VE's, ARM etc... which are practices that have no place in the home unless medically indicated...it is these hospital practices transferred into the home that can cause such devastating outcomes.

Therefore, the comment about having hospital experience before going out onto the community..I have to disagree. Working alongside an experienced community/independent midwife in the home is far more beneficial to the aspiring homebirth midwife than spending time on hospital wards.

Not trying to S**t stir...

Vicky x

smwife · #5 (**permalink**) 31-May-2008, 16:57

I replied on the student site that it is very sad, and a blow to homebirth promotion, another scare story.

and that the details are vague. I agree with regards to hospital based midwifery having protocols and guidelines, and these have no place in the home. I'd like to think as a community midwife in years to come that I would not perform VE's unless necessary etc...

I think it is a terrible pity that this happened and that the real facts of the case are unlikely to emerge.

I do feel as a student that I don't gain much experience of normal labour and birth, and are mainly taught in uni about normality and the promotion of it, without gaining the opportunity to see it in practice.

Kentish Spitfire · #6 (**permalink**) 31-May-2008, 17:47

I agree SMWife, we ought to be able to have some experience within a low risk, midwife led unit at some point during our training.
KS x

angelina · #7 (**permalink**) 01-Jun-2008, 15:58

It is very short sighted IMVVHO to single out 'homebirth' as the root cause, in cases with a bad outcome. The question to be addressed is - did the homebirth - in itself - cause the untoward outcome?
Sometimes it is the 'team working' that needs to be addressed. i.e. when a woman transfers in from a home birth, the support that is available for that midwife and that woman; that the communication is good, and the time during transfer is used to the best advantage.

It seems to me the case that events OUT of the control of the homebirth midwife affected the outcome to a great degree.

The focus should be on accomodating women`s choice, and ensuring that there is the back-up to support this, rather than denying the women that choice in the first place.

jm2p
Angelina

Shoshana · #8 (**permalink**) 02-Jun-2008, 10:54

Originally Posted by indiemidvic

Therefore, the comment about having hospital experience before going out onto the community..I have to disagree. Working alongside an experienced community/independent midwife in the home is far more beneficial to the aspiring homebirth midwife than spending time on hospital wards.

We're all entitled to our opinions.

The impression that I got from the write-up about this case was that the midwife simply didn't know what to do. It seemed as though she was so used to everything going well and straight forward that, given an emergency situation, she felt out of her depth. So, for this reason, I stand by my initial comment that I do think it is important for midwives to have gained experience in a hospital setting first, to give them the confidence to act in an emergency.

Not all hospital based midwives are pro-intervention. I for one am very reluctant to intervene in labour. I will give the woman every opportunity I can to labour in a calm, supportive atmosphere, within the hospital setting where I work.

JuanitaFanjita · #9 (**permalink**) 02-Jun-2008, 22:19

Shoshana

I am getting the impression from this thread and another I read that you are definitely a fan of gaining hospital experience before either working independently or in community. With particular reference to this thread, you seem to feel that working in the hospital would have prepared you better in dealing with this said emergency. We really have not been given an awful lot of details about this case so I am reluctant to speculate on whether the insertion of a cannula at home would have saved the life of this woman but I do think that working in the hospital would certrainly prepare you in the power of speech and communication and the ability to give your colleagues an adequate handover of the relevant information about the clinical picture of this woman. This appears to have been lacking in this case and I do wonder if her lack of experience in hospital would be contributory to poor communication skills??

With reference to your comments about hospital work preparing you for working in community - can you tell me where the red button is in the home?

TallPoppy · #10 (**permalink**) 02-Jun-2008, 23:01

Originally Posted by indiemidvic

I'd be interested to read what the members of the student site said about this.
It needs to be said that a lot of PPH cases are a direct cause of the 'management' of birth and subsequent interventions.

I don't necessarily feel that NHS experience prepares students/midwives in the handling of homebirth cases...those who are used to hospital birth with policies and protocols would be more inclined to promote active third stage, routine VE's, ARM etc... which are practices that have no place in the home unless medically indicated...it is these hospital practices transferred into the home that can cause such devastating outcomes.

Therefore, the comment about having hospital experience before going out onto the community..I have to disagree. Working alongside an experienced community/independent midwife in the home is far more beneficial to the aspiring homebirth midwife than spending time on hospital wards.

Not trying to S**t stir...

Vicky x

The students were basically saying that it made them think about the experience you need as a CM/IM, its hammered into us that the hospital setting is where you learn the craft - hence why all our placements are hospital based with a handful of community placements. Ive made my views very clear that I personally feel we'd learn alot from placements with IMs particularly, and that students are loosing out because we dont get that experience and exposure. The closest Ive got is with a CM and in all honesty I feel I learnt more from her than I have anyone else because she just seemed to know everything, predominantly because she has been in difficult situations, thinking on her feet, more often than not on her own and as juanita says, with no red button to press.

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Maternal death after homebirth

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