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(part 2 of 2)

My client was an informed consumer who sought out a midwife once she discovered she could not have a vaginal breech birth at the hospital, where she had been receiving her care throughout pregnancy. At our initial interview, I was impressed with the vast amount of research that her and her partner had done on the safety analysis of vaginal breech birth vs. planned Cesarean. Had she been able to find a qualified provider at the hospital to provide her with a trial of labor for a vaginal breech birth, I doubt she would have sought out other options.  

We transferred from home to hospital appropriately and in a timely manner. She had a healthy baby via cesarean. This is not a "homebirth gone bad" but an appropriate homebirth transport.

In my opinion, here is what a homebirth gone bad is:  A situation where transport IS needed, but doesn't happen because the midwife and/or the family are fearful of the treatment they will receive upon arrival to the hospital.  I'd like to work together to ensure that true homebirths gone bad don't become a reality here in Oregon, as they have in other states.  I know that the midwifery community as a whole has been meeting and striving to find ways to bridge these relationships with hospitals.  We are eager to work toward the same goal of effective and appropriate transfer of care.   

I again would like to invite you to meet with me to review the case of this transport.  If you would be willing to proceed with a conversation regarding these issues, you have my contact information.  

Jesica Dolin, BSM, LDM

PS.  The conclusions of the Term Breech Trials (cited by most doctors as a major study showing breech birth is not safe vaginally) were retracted because the study was found to be so flawed. Please google "Five years to the term breech trial: the rise and fall of a randomized controlled trial" for more information.

posted 4 years ago
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TO DR. KAREN ADAMS FROM THE LICENSED MIDWIFE OF THE BREECH BIRTH TRANSPORT

As you know because of our communication through email, I was listening to the show when you started to talk about an example of a "homebirth gone bad."  I recognized that the scenario was a transport for which I was the midwife.    I was surprised by the vast discrepancy between the story you told on the radio, and my perception of the events that I witnessed.  For example, you stated that the mother's blood pressure had been taken once in the prior month.  The chart reflects that her BP had been taken 4 times in the month preceding the transport (and was normal on every occasion). 

You have indicated to me that you do not think women should have the right to choose a vaginal breech birth. I believe in a woman's right to choose where and how to have her baby. I recognize that vaginal breech is outside the scope of practice for most hospital based providers now.  My understanding from the obstetricians and CNMs who have taken the time to talk to me about such important issues, is that this is partly the result of malpractice insurance restrictions (as are many non-evidence based hospital practices), partly the result of the Term Breech Trial study (the conclusions of which have been retracted: see my post script below), and partly due to a snowball effect: As fewer doctors do these births, fewer doctors are able to train new doctors on how to do them, resulting in even fewer doctors with the knowledge, training, and experience to handle breech vaginal birth.   There are still a significant number of informed consumers who demand this option.

(part 1 of 2)

posted 4 years ago
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