I know I’ve been quiet for a couple of days but I have been reading NHS Blog Doctor and specifically his entry ‘The Independent Midwives of Kent’. I’m not the only person to have been reading it as last time I checked it had 200, yes 200, comments, obviously a provocative entry. Now, Dr Crippen is an old adversary, I like to consider it a love/hate relationship, he hates ‘madwives’ and loves to rant about them, on this occasion though he does have, more or less, my support. His entry was a comment on a birth story, Sharon’s story, published on the Independent Midwives of Kent’s website. The link is to the Google cache as, last time I checked, the original story had been removed, more on that later. I’ve read the story and, as a midwife who has a role encompassing homebirths, I have to admit that I felt quite tense at several points throughout the narrative, especially when polyhydramnios entered the equation. Polyhydramnios, basically too much fluid around the baby, may have no cause but it can be associated with several serious abnormalities in the baby, as I learned the hard way. Several years ago I was caring for a friend, J, in her second pregnancy, I had also cared for her during the first where there were no complications and she gave birth to a healthy baby girl. This first experience decided J that she would like a homebirth this time round so that is what was planned, until 32 weeks, when I was doing a routine antenatal and thought that there may be too much liquor, polyhydramnios, so I asked for a consultant opinion and ultrasound. This was done, nothing abnormal detected but due to the polyhydramnios we were no longer considering homebirth so we just prepared for baby being born in hospital. J was also a midwife and I don’t remember there even being a discussion about whether we should go ahead with the homebirth, we were both just aware of the risks associated with too much fluid; cord prolapse, haemorrhage before or after baby is born, malpresentation so the hospital would just have seemed more appropriate. J was induced at 37 weeks as she had become so huge, when the membranes were broken the room was awash with liquor, quite spectacular, but nothing untoward happened and labour progressed uneventfully. As is practice with an induction of labour J was monitored continuously, baby was a happy bunny, and so when he was born after 4 hours of labour we did not expect a problem but there was, a major problem, he couldn’t breathe. As he took his first breathe his little chest collapsed, he tried again but with the same result. Some babies will have chest recession, this is where their chests will go inwards as they try to breathe and this may be a sign of respiratory distress, but J’s baby’s chest was concave, it was an horrific sight as he battled to breathe. The paediatricians were there immediately and he was rushed round to NICU where he was X-Rayed and ventilated. I have to admit now that everything after that was a blank, according to J’s husband I was brilliant, apparently I didn’t panic, I was very calm and I just carried on delivering the placenta and helping J to wash and get ready to go round to special care to see their baby. I’m pleased I was so in control, it must have been an automatic response. When I finally left the hospital they still had no idea what was wrong with baby, I was certain that it was my fault, I must have missed warning signs, something should have alerted me during the labour. In the middle of the night J’s husband phoned me, baby had been transferred to a high level NICU, he had a severe, right-sided diaphragmatic hernia, nothing could be done, his lungs had never been able to develop, his ventilator was switched off after 48 hours. Why am I recounting this? If I was that Kent Midwife I would have gone ahead with a homebirth, the outcome would have been the same but, supposing that the hernia had not been as severe, having been born at home would certainly have jeapordised him. How would J, her husband and I felt if the same scenario had happened at home, would we ever have been able to come to terms with the sad outcome, would we not be saying ‘what if…’? An ultrasound had been performed when the polyhydramnios was discovered, the sonographer failed to see the hernia, unfortunate, but right-sided are unusual and more difficult to visualise, even so there on the report was a tick to indicate that the chest was normal, we believed that baby was fine, our only worry was the polyhydramnios causing problems, not a problem causing the polyhydramnios, the Kent midwife could have believed it just as we did. So, after tensing myself throughout her description of the labour, her only doing a vaginal examination because Sharon asked (supposing a cord or shoulder was presenting), I was relieved when baby, huge baby, was born without any problems and I relaxed, only to be bought up short by the haemorrhage and the management of it. 1500mls, that is a large bleed, not one that you just sit around observing, keeping a paramedic unit with you for 2 hours, and then finally go into hospital to ‘cover your back’. Supposing the woman had continued to bleed, there had already been one episode where “She then vomited and at the same time passed a huge amount of blood and clots”, this was after 2 previous ‘large’ bleeds’, how much more evidence of the advisability of medical support did the midwife require? All was well, thankfully, but to publish this story on the website, with such detailing of her minimising the risks, was sure to precipitate a reaction from many homebirth detractors, whilst giving them plenty of ammunition.
The story disappeared from the web-site after about 24 hours, hence the Google cache, the midwife has now been reported to the NMC, she has done nothing to dispel the caution with which Independent Midwives are viewed and helped reinforce some commentators opinion about homebirth.