Homebirth controversy

Akrasia

http://www.rte.ie/news/2013/0731/465665-homebirth-court-aja-teehan/

Aja Teehan is currently sueing the state for the right to give birth to her second baby at her home despite the current best medical advice that it is safer to deliver in a maternity as her first delivery was via cesearean section.

Do people have 'the right' to deliver their baby in the manner of their choosing?

Obviously, the state can not force people to come into hospital to deliver their baby but there are professional guidelines for Midwifes that they are legally obliged to follow. These guidelines are based on the current best practice and are there purely for the safety of the women and the babies.

Should the state be forced to cater for a woman's birth plan by changing the guidelines against the medical advice of the medical council?

In most of the world, pregnancy is still associated with a very high risk of infant and maternal mortality. Luckily, Ireland is a very safe place to give birth, but does this mean that there is a risk that some people won't take the risks seriously enough?

I tried to research the medical evidence around 'vbac' (vaginal birth after cesearean) and 'hbac' (home birth after cesearan) but the internet is infested with special interest sites promoting 'natural and alternative lifestyles' with all of the top search results linked to advocacy groups who are not necessarily the most unbiased sources on this issue.

One of the biggest problems with the research is that it is very very easy to manipulate in favour of 'natural' forms of birth

Advocates of home birth point to statistics showing reduced complications and shorter recovery times. However, the statistics are very heavily skewed by the different studies methodologies.

If there are complications during a home birth, these women are usually rushed to a maternity hospital where they are recorded as complicated pregnancies in the hospital statistics making hospital delivery look bad, when it was the hospital that most likely saved the mother and child (or had to deal with the more negative outcomes)
http://www.thelancet.com/journals/lancet/article/PIIS0140673610611658/fulltext?rss=yes

One study in the Netherlands shows that 40% of women who start labour at home, end up delivering in a hospital. So the outcomes recorded for home birth may only reflect 60% of home births and not include the 40% where there was already an elevated risk of injury to the mother or baby.

Of all the 'First world problems', respecting a mothers 'birthplan' has to rank amongst the most upsetting. Millions of women and babies die every year during pregnancy and delivery. Even in Ireland, where it is relatively safe, babies are lost and severely injured with depressing regularity despite all the best efforts of the maternity services. Should we really be taking steps that increase the risks associated with childbirth on the basis that some women like the idea of a natural birth?

Frank Black

Sorry, stopped reading after 'vaginal'.

Love2love

The midwives don't want to be sued and if something does happen they're left open to be sued so if you want a home birth don't expect help.

FatherLen

I don't understand what's going on here.

The HSE has told Ms Teehan she has the right to have her baby at home.

What is she complaining about?
The fact that because she chooses to not give birth in a hospital, she wont be given the same support as someone who does?

She can't have it both ways.

Akrasia

Frank Black wrote: »

Sorry, stopped reading after 'vaginal'.

Your lucky I didn't post up any pictures

My wife makes me watch 'one born every minute', it's a good form of contraception as it completely puts you off sex for the night

She has a right to have the baby at home if she wants.

The HSE also has the right to not be held responsible in case something goes wrong in that situation.

F35

Akrasia wrote: »

Your lucky I didn't post up any pictures

My wife makes me watch 'one born every minute', it's a good form of contraception as it completely puts you off sex for the night

hehehh

Akrasia

Love2love wrote: »

The midwives don't want to be sued and if something does happen they're left open to be sued so if you want a home birth don't expect help.

There are some independent midwives who are totally in favour of home births (that's how they make their money) but they are prevented from 'HBAC' deliveries because of the medical council guidelines (which are legally binding)

If Aja Teehan wins her case she'll have no problem finding a Midwife

Smiles35

Deleted User wrote: »

She has a right to have the baby at home if she wants.

The HSE also has the right to not be held responsible in case something goes wrong in that situation.

Yeah but I think the thing is that for her to get a registerd midwife you need go-ahead from the HSE.

January

The problem is that although the HSE are saying she is entitled to the birth she wants she won't find a midwife to attend to her at home because of the MOU guidelines which will prosecute a midwife if they attend to a homebirth outside of the guidelines.

kneemos

Is it a hippy thing or something?surly going to a hospital would be the responsible thing to do.

Czarcasm

This is it in a nutshell really-

The HSE respected Ms Teehan's right to disagree with it but she could not come to court to compel the HSE to provide, support or finance a practice it did not believe was safe.

3DataModem

Your mortality rate is NEVER higher then it is in the moments after birth.

3DataModem

[Deleted User] wrote: »

The HSE also has the right to not be held responsible in case something goes wrong in that situation.

Alas, they don't. They have a duty of care to both child and mother that they can't ignore.

Leroy42

I really don't get this either. The HSE is telling her that the C Section last time increases the risks in this pregnancy.

She seems to be suggesting that she knows better and that she should be allowed to make that call (despite the doctors being qualified!).

While she may feel she has a Right, surely the safety of her baby comes first. Even if the increased risks are very small, why even put any additional risks when it can be removed by going to the hospital.

This story reeks of a person more concerned about her rights than the rights of her child.

She evens says herself that she would be the first to cal lthe ambulance if something started to go wrong, so at that stage she accepts that the HSE as best placed to get her out of the situation, just they are qualified enough to make the initial call?

Celly Smunt

I really don't see why the HSE should entertain her,she's been warned by profressionals not to go for a home birth but disregards their advice and expects aid for what they advise against.

MurdyWurdy

I had a baby recently and just don't get this - the HSE have told her they don't believe it is safe and they're not comfortable providing home birth services to her because of this and she still wants to put herself at risk and demand that they assist her to do so? I'm sure she believes that it is safe for her to have a home birth but I can't undersatnd women who put themselves and their unborn child in danger like this against medical advice. I would have done anything the professionals told me I needed to have a safe delivery - and as a matter of fact, I did. I understand women want to control what happens to their bodies and want to have the birth experience that feels right for them but you have to have a bit of sense as well.

I bet if they had agreed to provide midwifery services to a woman in this situation, against their better judgement and something happened to her that woman's family would be up in arms that they were negligent in their care. They can't win.

josip

3DataModem wrote: »

Alas, they don't. They have a duty of care to both child and mother that they can't ignore.

But neither the mother nor child is "in their care" if the mother decides to go ahead and give birth at home against medical advice. It's not the faceless HSE that's makeing this policy/decision. It's one or more doctors with a lot of experience.

The mother has every right to go ahead and give birth at home. Evolution will ultimately determine who is right. Those type of genes will either thrive or die off.

Uriel.

FatherLen wrote: »

I don't understand what's going on here.



What is she complaining about?
The fact that because she chooses to not give birth in a hospital, she wont be given the same support as someone who does?

She can't have it both ways.

The HSE provide an indemnity for midwives when operating within the HSE's policies and regulations.

Due to the risks involved in this particular case, the HSE policy does not cover a homebirth and so a midwife assisting the birth will not be indemnified (as such might be mad to go ahead, in the event that something goes wrong).

Risk factor (there is argument between the parties as to the significance of the risk) but as far as the HSE is concerned the risk factor is outside of the limits of their policies and will not provide the indemnity.

I guess that effectively stops the midwife in question from proceeding. I think the woman will lose her case and rightly so. The HSE, despite its controversies has more experience and expertise than this woman has and they have a duty to protect the taxpayer in the event of one of the risks being realised.

Perhaps the woman (not sure of the legality of this) could waive her comeback against the state in the event that something go wrong.

Stavro Mueller

And of course if it goes all wrong and the baby's brain damaged as a result, we will all be picking up the tab for its lifelong care.

Celly Smunt

cymbaline wrote: »

And of course if it goes all wrong and the baby's brain damaged as a result, we will all be picking up the tab for its lifelong care.

She should be put away for negligence if the baby is disabled due to her stupidity.

Uriel.

Akrasia wrote: »

There are some independent midwives who are totally in favour of home births (that's how they make their money) but they are prevented from 'HBAC' deliveries because of the medical council guidelines (which are legally binding)

If Aja Teehan wins her case she'll have no problem finding a Midwife

She might have a problem finding one that is suitably indemnified. If she wins her case and God forbid something goes wrong with the birth, I just she doesn't come looking for compensation from the state.

Grumpypants

Leroy42 wrote: »

This story reeks of a person more concerned about her rights than the rights of her child.

She evens says herself that she would be the first to cal lthe ambulance if something started to go wrong, so at that stage she accepts that the HSE as best placed to get her out of the situation, just they are qualified enough to make the initial call?

Yip wants to ignore the best medical advice put herself and child at risk and on top of that has no problem calling on the hse to send an ambulance to collect her wasting a valuable resource.

kunst nugget

3DataModem wrote: »

Your mortality rate is NEVER higher then it is in the moments after birth.

I would have thought being shot in the chest or when you're just about to be hit by a truck might pip that one.

Smiles35

I think hospitals are pox ridden places. If I was told I 'd have to attend due to a technicality I'd be annoyed aswell.

bringupthebook

Is there any information on why she is so adament to give birth at home? Has she had a bad experience in hospital on her first birth? Having had a section myself I don’t think I would be going against doctors/HSE advice. Surely she needs to put the safety of her baby and herself first. If she wins who pays costs? If she loses having a home birth will be the least of her worries

Beruthiel

Akrasia wrote: »

Do people have 'the right' to deliver their baby in the manner of their choosing?

Women have decided where to have their baby since the dawn of humanity.
Only in the last 5 seconds of humanities lifetime have we had them in hospitals.
Like all women through the millennia, this woman has the right to decide.

Immaculata

Akrasia wrote: »

http://www.rte.ie/news/2013/0731/465665-homebirth-court-aja-teehan/
Do people have 'the right' to deliver their baby in the manner of their choosing?

Yes!

And I think you might want to look at your pronoun use there.

Celly Smunt

Beruthiel wrote: »

Women have decided where to have their baby since the dawn of humanity.
Only in the last 5 seconds of humanities lifetime have we had them in hospitals.
Like all women through the millennia, this woman has the right to decide.

The right to decide,yes.The right for aid for what is advised against,no.

joebloggs32

Uriel. wrote: »

The HSE provide an indemnity for midwives when operating within the HSE's policies and regulations.

Due to the risks involved in this particular case, the HSE policy does not cover a homebirth and so a midwife assisting the birth will not be indemnified (as such might be mad to go ahead, in the event that something goes wrong).

Risk factor (there is argument between the parties as to the significance of the risk) but as far as the HSE is concerned the risk factor is outside of the limits of their policies and will not provide the indemnity.

I guess that effectively stops the midwife in question from proceeding. I think the woman will lose her case and rightly so. The HSE, despite its controversies has more experience and expertise than this woman has and they have a duty to protect the taxpayer in the event of one of the risks being realised.

Perhaps the woman (not sure of the legality of this) could waive her comeback against the state in the event that something go wrong.

She could waive her comeback, but not that of the unborn child.

Think about it, every time you hear a case reported about medical neglect during birth, it is the child who sues the hospital/HSE.

Also if the child were to suffer a brain injury from a lack of oxygen etc at the end of the day it is the HSE whom will end up providing the expensive services for a lifetime of care, and the parents will get a carers allowance too.

This woman needs yo get out of cloud cuckoo land.

Ms2011

Not completely the same thing but I had a section on my first & because of this I won't be able avail of the midwife led scheme if I have a second pregnancy(although I would choose to give birth in hospital) which really upsets me as I had it on my first & felt really comfortable & reassured through out my pregnancy. I found consultant led care to be more pushy & listened to less.
Someone else dictating such a personal choice can be frustrating, a mother being comfortable with her choice of birth can play a major part on how the labour goes I feel. The more happy & content the mother the better the outcome imo.

Lando Griffin

And if baby begins to get stressed during this home birth, an Ambulance with 2 crew will have to be dispatched and probably a doctor.
Then A&E will have to cater for her and end up stressing the baby even more which can have serious consequences for baby.

Instead of what we did when we were having our first.

Our consultant advised us when she was going on holidays and booked us for a certain date.
We arrived at the hospital that morning and booked in, went to our room and settled in.
I remarked to herself that is was something akin to booking into a fine hotel.
I went off and got the paper and read it while the missus was being cared for by the mid wives.
Unfortunately I had decided to grab a coffee and sandwich and when I got back she was nearly giving birth, and I had to throw away a perfectly good sambo.
Baby started to get stressed so off to the operation table and an hour later a fine healthy Baby Lando:).

Uriel.

joebloggs32 wrote: »

She could waive her comeback, but not that of the unborn child.

Think about it, every time you hear a case reported about medical neglect during birth, it is the child who sues the hospital/HSE.

Also if the child were to suffer a brain injury from a lack of oxygen etc at the end of the day it is the HSE whom will end up providing the expensive services for a lifetime of care, and the parents will get a carers allowance too.

This woman needs yo get out of cloud cuckoo land.

I concur.

Funnyonion79

I've had a hospital birth and a home birth and without a doubt, I got much better care and attention with the home birth.

You see your own personal midwife every 4 weeks, then every 2 weeks and then every week, as your due date draws closer. You are allowed to labour at your own pace, walk around the house, have a bath, lie now, sit up, be as uninhibited and vocal as you feel you need to be and then afterwards you get to see your midwife every day for 14 days if you so wish, to check that you and baby are keeping well. The aftercare also allows the midwife as much time as is necessary to get breastfeeding established and ensure there are no problems with latch etc. The post natal visits are such a support, at a time when you are at your most vulnerable and can help to spot PND at an early stage.

I had a good hospital experience but I was one woman out of hundreds having a baby in the hospital. I saw a different doctor/midwife each time and really at times, it was like we were a herd of cattle being led from one end of the hospital to another to get various checks done. I had to repeat myself to each medical professional that I saw, to ensure certain personal things were adhered to - despite these being mentioned in my file. Also, once the baby was born, you were pretty much left to your own devices, there was nobody available to spend time showing you how to breastfeed - it was a case of "this is a rough idea of how to do it - off you go" - from a young midwife who had never given birth herself.

The MOU was only introduced in 2008. Previous to the introduction, women were allowed to have a homebirth despite having a c-section before. The HSE appear to be making it more difficult to have a homebirth these days, despite our maternity hospitals being stretched to capacity as it is.

The demand for homebirths is there but there arent enough independant midwives available to meet it. If more women (naturally only those who are having complication-free pregnancies) were able to have homebirths, it would free up valuable space in the maternity hospitals.

anto3473

Akrasia wrote: »

.

Do people have 'the right' to deliver their baby in the manner of their choosing?

Yes she has every right to have the baby at home if she want's to. It's up to her but her idea is going against medical advice. nobody is stopping her from having her baby at home. If she wants to take the risk of uterine rupture and death it's completely up to her.

As for the midwife (s)he can't break the guidelines set up by the medical council while working as a midwife. The guidelines absolutely should not be changed as they were made on the basis of evidence based medicine and not to accommodate peoples decisions to act against medical advice.

The midwife is totally overstepping the mark on this. They are not qualified to give a patient medical advice on matters like this they and they are NOT doctors.

If the midwife wants to deliver the baby at the patients home against medical advice and without insurance they can, from once they call themselves a "home birth witchdoctor" or "homeopathic baby catcher" or whatever else they might want to call themself. From once they does not administer prescription drugs or do anything that requires midwifery qualification, or refer to him/herself as a healthcare professional then they can.

They should not advertise themself as a midwife (which is a protected title) if they are going out there with the intention of breaking best medical practices.

Also i don't pay too much notice to the "clinical judgement" of midwives in cases like these. I've worked as a Medical Scientist in a maternity hospital and I've heard some very very worryingly stupid things said by midwives ("Keep the surgeon away, a tear heals better than a cut"). Don't get me wrong doctors say plenty of dumb stuff too, as I'm sure I do sometimes, but that's advantage of having a multidisciplinary team in hospital is nobody oversteps their own training or ability and sticks to their own job.

Akrasia

According to the Lancet study I linked to in the OP, the risk of stillbirth can be up to 3 times higher for homebirth compared to hospital birth.

The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment.
http://www.thelancet.com/journals/lancet/article/PIIS0140673610611658/fulltext?rss=yes

While on a case by case basis, the risks are still low, the HSE needs to make their policy based on statistical outcomes and if the risk is higher at home than in a hospital, then they have to choose the policy that will save more lives.

tritium

Beruthiel wrote: »

Women have decided where to have their baby since the dawn of humanity.
Only in the last 5 seconds of humanities lifetime have we had them in hospitals.
Like all women through the millennia, this woman has the right to decide.

True, but not to expect to ask someone else to accept foolish additional risks

anto3473

In relation to professional practice guidelines, the longer I've practiced for the more important they seem. I've always followed them to the letter with the best of my ability even if I thought some were unnecessary.

I remember during my training in my 1st job and as a student often thinking "Ah heyor, leave it ouh!!... Do we really have to do all this extra work to prevent something so unlikely"

Weeks later "Oh crap, good thing I actually done the extra work event X actually happens"

Years later "Event X seems to happen all the feckin time"

Murphy's law applies in medicine too, probably more than anywhere else. Always assume anything that can go wrong will go wrong. Clinical guidelines are written by much smarter and more experienced scientists/clinicians than me. There's nearly always a "method to the madness".

I'm in a different job but the principle is the same, the midwife should know better (and probably does, they probably have to have a lot of experience to do home births).

She's putting her patient at unnecessary risk for a few quid. Plain and simple.

When a decision goes beyond what me (or my pay grade) is qualified to make, regardless of whatever I think I know it gets passed on to the person who does know. In this case the guidelines which were written by experts and have been tried tested and honed over the years.

Saying "No thats beyond my scope of practice" can be a blow to your ego sometimes, but it is the professional thing to do and the most important rule of working in a hospital. Cynics may call it the CYA or "cover your ass" rule but i've seen it is in the best interest of patients, time and time again. The biggest danger in healthcare is a know-it all. I'd take a doctor that will admit they are in over their head any day over one that is over confidant.

I've seen a patient die one time because a nursing home doctor went against a consultant's advice and tried to treat something he was incapable of treating in the nursing home instead of calling an ambulance. His big head cost a patient her life.

Akrasia

Akrasia wrote: »

Luckily, Ireland is a very safe place to give birth,

Mostly because they fiddle the stats, I hear

Akrasia

bluewolf wrote: »

Mostly because they fiddle the stats, I hear

Really?

It wouldn't necessarily surprise me, but I haven't heard this before

Pumpkinseeds

I think it's typical of the sense of entitlement that exists in Ireland now. You can bet that if the HSE did accomodate her wish for a home birth she'd be suing the arse off them if something went wrong, she wouldn't be long saying they shouldn't have let her have a home birth then:rolleyes:

josip

Akrasia wrote: »

Really?

It wouldn't necessarily surprise me, but I haven't heard this before

I have heard it recently but can't remember exactly why or how they differ from the EU norm.

mikom

Fast forward a few months.........


"Aja Teehan is currently sueing the state because an ambulance was slow to get to her house"

Not beyond the realms of possibility.

pickarooney

3DataModem wrote: »

Your mortality rate is NEVER higher then it is in the moments after birth.

The moment after death is pretty high up there.

seamus

The two main problems with her argument as I see them:

She has carried out extensive research and believes the risks of uterine rupture are miniscule in her case because of her level of physical fitness and absence of complications.

Did I miss the part of the article that stated that this woman is a doctor of obstetrics? Nope, cos she's not.
She doesn't even have any kind of expert backup. I would support her argument if she had the backing of someone with actual qualifications in this area, but she doesn't.

She has decided on one hand to dismiss modern medicine because she thinks she knows better while on the other hand demanding that modern medicine facilitates her. It's like a homeopathist demanding that they are supplied with a nurse to assist them during "procedures".

Mr Kelly said the discretion of midwives to make decisions on home birth suitability had been taken away.

Since when are midwives qualified to make this decision? My experience of being the man in the pregnancy thing is that they're really good at the part about getting the baby out, but for everything else midwives can be hit-or-miss, often full of superstition and strong personal opinions. I would absolutely not trust a midwife to make a call on whether my wife is suitable for hbac. Her opinion would be based almost entirely on her personal experience and not on clinical research.

I've no issue with homebirths and I can totally understand the reasons behind it in many cases. But often I get the feeling that the goal of the homebirth is to make the woman feel better about it, it's not done with the baby's wellbeing at the forefront.

seamus

seamus wrote: »

Since when are midwives qualified to make this decision?

A midwifery degree...?

General General

Ireland needs more midwife-led/managed birth centers/centres.

I think the odour of entitlement often reeks to those who either don't want that entitlement or cannot qualify for it & it'd be a lot more fragrant tomorrow to any of those who found sudden benefit.

HSE have an obligation, I'm not sure what it is... but I am sure that it's possible that some would lie through their teeth about what it is, trying to save money that they've effectively already ear-marked for some bullsh!t or other.

Let the judge decide... that's all any of us can do.

Qualitymark

Pity the hospitals don't have homey birth options - back in the day, some nuns in Galway had a setup in a hospital where there were apartments where the whole family could go and stay, and you could have a water birth in calming, non-clinical surroundings, but because the hospital building was right next door, you could be rushed in if there were a medical problem. I wonder if this still exists. Best of both worlds, really.

Gatling

We have an amazing low child birth death rate ,
Now that's going to change because its been insisted that when recording child birth mortality that the records show
Deaths caused from road traffic accidents, suicide ,cancer ,lung disease, gerenal accidents and so on ,
So yes the last quoted will make it look like a sudden increase in child birth mortality rates not because of the books been fiddled but because the parameters have been changed

pickarooney

It would be interesting to cross reference this thread with the cotton wool thread in a few pages and see how consistent people are on the subject of children and overstated risks.

josip

General General wrote: »

Let the judge decide... that's all any of us can do.

Let Darwin decide.