a preventable death?

Whenever I hear of the intrapartum death of a baby, or other major morbidity or mortality around birth, I wonder what actually happened: was it preventable?

What were the critical decisions leading up to the adverse outcome?

Speculation is not helpful. When my sources are limited to media reports, blogs, and email discussions, I am unlikely to ever know the detail, or be able to form an opinion, on a particular case. However, there is great value in critical reflection on my own experiences, considering what happened, why it happened, how I responded, and how I might respond in the future if faced with a similar situation.

Readers of this blog are probably aware of the Coroner's inquiry that has been proceeding in Adelaide, into the homebirth deaths of two babies, and the well-known homebirth advocate Lisa Barrett who was in attendance at these births. Now Lisa has again been mentioned in a newspaper report, of "the death last week of a newborn twin".

An American blogger who is definite and unrelenting in her anti-homebirth position, Dr Amy Tuteur, has informed her audience of this newspaper report.

The key point of difference between those who support homebirth is whether the choice to plan homebirth can be made by the woman, or if that is a matter requiring professional 'duty of care' in declaring whether or not homebirth is considered a 'safe' option. Can a woman be allowed to make an informed decision? 

The International Confederation of Midwives' (ICM) position is that

“The ICM supports the right of women to make an informed decision to give birth at home.”

Australian Private Midwives Association (APMA)’s ‘position’ is

“We support home birth with a midwife in attendance for women who have uncomplicated labours.”

I don’t think anyone would argue that a twin birth can be called uncomplicated prior to the birth. But the big question is what the midwife does when a woman who knows she has twins on board makes what she considers to be an informed decision to give birth at home.

I’m not wanting to put my head in the sand; to shift the blame from the midwife to the woman. A decision to plan to give birth at home requires a whole series of conversations, during which the midwife and the woman consider the situation, and the woman decides whether to stick with 'Plan A', the natural, physiological process, or to move to 'Plan B'.

A woman who thinks she has made an 'informed' decision  can be horribly ill-informed, whether the decision related to home birth or to medically managed birth in hospital. For the record, here's a recent example:

A woman who has a young baby believes she made an informed decision for the birth and nurture of her child. The woman has been treated by a specialist psychiatrist for depression. The psychiatrist *informed* the woman that her depression could become worse if she was sleep deprived, and encouraged her to suppress lactation and artificially feed her baby - to prevent sleep deprivation. The obstetrician supported this plan, and furthermore encouraged the woman to undergo elective Caesarean surgery - also in order to keep everything well controlled. The *informed decision* that was reached, in consultation with both doctors, was that a Caesarean operation would be performed without labour; that the baby would not go skin to skin on the mother's breast; that the mother would receive medication to suppress lactation; and that the baby would be separated from the mother, and cared for in the hospital's nursery for most of the mother's hospital stay.

This scenario leaves me wondering. 

Thankyou for your comments