The tragic dangers of home births, by coroner

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A senior coroner has urged a change in the guidelines for midwives on home births after two breech babies died.

... He said midwives should make explicit the dangers of home births for infants in the breech position. They should note their advice in writing and even get a parent to counter-sign the record.

His warning came after inquests yesterday into the deaths of Phoebe Baker and Christopher Gurney ...

... The inquest heard that Penny Baker gave birth to Phoebe at her home ...

She told the coroner's court that her midwife ... realised the baby was very likely to be a breech, but she did not want a caesarean section.

Mrs Baker said: 'The facts were put to us and it was our choice what to do with the facts.'

Although the birth appeared to go smoothly, Phoebe had to be resuscitated ...

Mrs Baker said her daughter was feeding happily when the midwives left but by the following evening she was 'sleepy and unresponsive'.

... a routine check ... found the baby was not breathing and had no heart rate.

... attempts to resuscitate her failed. The cause of death was an adrenal haemorrhage, brought on by lack of oxygen at the time of the delivery ...

He was also told of the case of Yvonne Gurney who gave birth to Christopher at home ...

He was also found to have been 'upside down' during delivery and died an hour later ...

Dr Knapman said he would write to the Nursing and Midwifery Council asking them to consider 'that in respect of home birth the guidance given should be extended to include explicit recording, in writing, in what terms the risks have been explained, including a recommendation, if any, and perhaps even to encourage the mother to counter-sign'.

... the Royal College of Midwives said ... 'Midwives record all discussions held with the mother but we would have reservations about counter- signing because it might put emotional pressure on her.'

Mrs Baker and her husband Hugh ... said they felt no bitterness towards their midwife ... 'I chose a home birth because during my first pregnancy I had an appalling experience of the NHS.'

It's an erroneous assumption that hospital birth per se would have "saved" these babies. Many women birth their babies in hospital but do not follow the policies or recommendations of the staff, potentially making the birth no safer than a home birth. Supposing these babies were born in hospital under the physiological conditions that are present at home: upright and active labour, no epidural, no forceps to the after-coming head, no episiotomy, a quiet, dimly-lit room with one midwife in constant attendance ... would the outcome have been any different? Women do have the right to make their own decisions about their care. It might be helpful to develop some standardised information that can be given to families who are planning to birth at home, or have a vaginal breech birth, or any other type of birth, because after all, all births carry some risks that we do assume merely by becoming pregnant. A well-informed family who are motivated by love, not fear, will generally make the best decisions for their family.

Lisa Barrett has some amazing home breech birth blog posts.