The Current State of Home Birth and Emergencies

Reader Contribution by Jeremy Galvan
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In emergency medicine, OB calls are thought by most paramedics to be a Basic Life Support skill. Firefighters and EMT-B’s who receive basic level emergency training are taught how to catch a baby in an out of a hospital setting.  Paramedics who receive advanced training get to go watch a few babies get delivered in local hospitals. We can do IV’s and give drugs, intubate and many more advanced skills. Generally a birth is not problematic. There is a very small chance that the situation is going to become an emergency. Events like hemorrhages and babies born not breathing are very rare and many times, either in the hospital or at home, result in the death of the mother or baby. I’ve caught (not delivered), two babies in the field. They both were great, and neither needed to go to the hospital afterward. Due to protocol, I advised and pressured both to come to the hospital as a precaution.   

A midwife friend of mine recently attended a birth that surprised her. The woman wanted a home birth and was not interested in an ultrasound or any other tests before delivery. The woman delivered her daughter in the birth pool and then moved to the bedroom to deliver the placenta. Once in the bed she was continuing to have some cramping and back pain. The midwife went to check her out to see if there was a problem, only to find another head coming out. Needless to say, there were some surprised looks on the parents’ faces. Both girls were born 11 minutes apart at home. There was no emergency, both of the girls responded immediately and were pink and alert. The midwife and her assistant were able to check out both of them and make sure they were ok. 

Most hospitals I work with would have considered twins a high risk pregnancy.  Many hospitals would have either pressured or required the woman to have a C-Section. Most likely had this happened in the hospital she would have had an emergency C-section once the OB realized there was another child coming. This otherwise totally normal process of birth could have been made into an emergency for no reason.

I don’t mean to say that all hospitals would be the same. Some OBs would have let her have twins vaginally in the hospital, and some would have held off on a C-section and just let the second baby come out. I think in the world of birth we need to start talking about what an emergency is, when a situation becomes one and what the appropriate response is. Fathers and partners need to step up and educate themselves about birth issues and be the advocate and supporter their wife or partner needs. Doctors and nurses need to stop pushing and start listening to the needs of women in labor, and start believing once again that birth in its self is not dangerous. Midwives who specialize in out-of-hospital birth, CPMs, can work well with OBs so that if a transfer needs to happen it’s not about the midwife failing, but that the situation is heading toward an emergency and that a OB could handle.

I hope that in the future birth can be something we teach our children about. Maybe more women could get their education from family and not from Maternity TV shows who make birth out to be something only a trained OB can handle.

 I’d be a fool to suggest that no births are in fact emergencies. Some should be planned C-sections to avoid the death of the mother or the baby. For these reasons I am thankful for OBs who train as much as they do to prepare for those situations. I hope that if my wife finds her elf heading toward an emergency, our midwife’s training and my education will get us to a labor and delivery unit OB whose emergency skills we will openly accept.

Thanks for reading. I plan to get hold of some great birth stories in the near future and get them posted. Let’s keep the conversation going. All births are special and amazing achievements no matter where or how they occur.

Photo by Fotolia/Devilpup