“The baby could be born in a breach [sic] position, or with the umbilical cord
wrapped around its neck. The mother could suffer from significant tearing or
from a maternal hemorrhage and bleed to death in as little as five
minutes.”
Dear Women,
The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.
I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.
First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING. Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough I.V. fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could. I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.
Think about it – would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes? I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1000). Two women have required transfusions. The other 8 recovered with I. V. fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.
What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post operative mothers very distressing.
I hope this information is helpful to you.
As far as the other nonsense this person is trying to frighten you with:
1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.
2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs”. Breech presentations are about 3 percent of births.
3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.
Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at www.consciouswoman.org
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008
www.trustbirthconference.com
The Trial of Labor 
Where did you find that? I’d like to repost her comment and am curious to where she originally put her response. Thanks!
Hi Rixa! Thanks for stopping by. Actually, she posted it on the main ICAN list today, and I posted it up as fast as my fingers would type!
I’m wondering what your thoughts on maternal hemmorhage in homebirth settings are . . . Care to respond here or blog it?!
Best,
Kimberly
I am baffled that Gloria could write that women ONLY hemorrhage from surgical wounds. That is more astounding than I could ever say. Read my blog from yesterday and see that I watched a woman die from DIC due to an amniotic embolism in under 5 minutes. AFE is an extremely rare occurence, absolutely, but it CAN happen and since it CAN happen, perhaps Gloria won’t attend births anymore? (Something that she should consider anyway considering the outcomes she has had in the past.)
I’ve watched women hemorrhage for no apparent reason. They didn’t die, but if we hadn’t utilized medications and skill, they surely would have (eventually). I’ve had 2 clients that hemorrhaged in the hospital so badly they nearly lost their uteri – had hemabate to quell the torrential hemorrhage. No one DID anything to the women, either. No fundus fiddling, no pulling on a cord… NOTHING… and the measured amount one woman had was 1800 cc’s. In less than 2 minutes.
What a homebirth midwife and client does, however, is weigh the risk of such a rare event occuring with the risks of all the *other* things that can (and do!) happen in the hospital that *cause* problems of hemorrhagic proportions.
Life is weighing the risk and benefits.
We do the best we can to hedge our bets in the right direction.
NGM,
Thank you for your comment. It doesn’t really surprise me to read/hear that it does indeed happen. And I support your statement: “What a homebirth midwife and client does, however, is weigh the risk of such a rare even occuring with the risks of all the *other* thanks that can (and do!) happen in the hospital that *cause* problems of hemorrhagic proportions.”
I myself am trying not to let the “what if” scare me out of homebirth. You can weigh risks all day and try and prepare for what will likely happen, but at the end of the day, not all experiences are that uncomplicated. I went into the hospital thinking I needed treatment for dehydration only to find out that I was 9cm. The baby should have just slid right out after AROM. It didn’t happen.
What do direct entry midwives do when their clients start to bleed out? I live a mere 10 minutes from the hospital, but it sounds like there wouldn’t always be time to transfer in the unlikely event that a hemhorrhage would occur.
Best,
Kimberly
I posted a comment DAYS ago, but I guess it never made it. Sorry!
I am a Licensed and Certified Professional Midwife, so that is somewhat different than a DEM. I am permitted to carry pitocin and methergine. Some carry cytotec ONLY for torrential hemorrhages.
If a woman starts to bleed before the placenta, the goal is to get the placenta out… a shot of pitocin can do that. (Some midwives start with herbs, but my experience isn’t so wonderful with herbs, so unless a mom is *really* into herbs, I will use pit first.) Thankfully, due to a LOT of training on how to get a placenta out, I am able to coax a placenta out *fast* – again, *only* if mom is bleeding loads before the placenta is born… usually because part of the placenta has detached, but the rest is still adhered.
If she is bleeding afterwards, massage is the first step, then pitocin, then another shot of pit and one of methergine. If I have to go to the third shot (each injection is about 3 minutes from the last) and bleeding is still excessive, I would call 911 and start an IV with pit drip in it. If, at any time, the bleeding subsides, nothing but watching to make sure the uterus is contracted occurs.
We always make sure a mom doesn’t have to pee (a common cause of a uterus not being able to contract properly), is nursing and visualizes her uterus tight and in a ball. Those things happen simultaneously to the other, more medical means.
It’s hard to describe excessive bleeding that would require medication, but it is a LOT. And usually keeps coming in rivulets or even gushes. When a midwife has to change 2-3 soaked-with-blood Chux pads in a short amount of time (sometimes it’s within a minute after birth!), it’s getting quite excessive.
Does that help? Hope so!
Quote:
<>
Barb, please read what I said again. Your interpretation of my words is incorrect. Gloria
what about the babies?
Sarah,
I am not accustomed to receiving slanderous comments on my weblog, and I’d like to keep it that way. I also prefer not to heavily moderate this blog, but I suppose all of that hinges on what commentators bring to the blog.
Rest assured that Ms. Lemay is aware of this post and that some action – deletion and/or a response from Ms. Lemay or me – will be taken.
~ Kimberly (labortrials)
UPDATE 10:00pm, September 10, 2008
Per Gloria Lemay’s request the offensive post has been removed. In this case the request is warranted and therefore honored. I like to encourage discussion, but the comment that was posted was slanderous and false. I will not tolerate attempts to defame good people.
Sarah’s initial post with the question, “what about the babies?” is permissible here. To answer the question, MOST of the time for low-risk women (and their babies), homebirth is a perfectly acceptable venue for birth and likely more conducive for a natural untampered birth. It is a valid CHOICE with a history as long as our species’ to back it up. Do babies regrettably die? Yes. And likely (though not always) these babies were not meant for our world – they would have died no matter where they were born. Women and babies also die in hospitals – some from natural causes; some from iatrogenic causes or infections acquired at the hospital. Riddle me this – if hospital birth is so safe and our current maternity system is so sound, then WHY ON EARTH do we have some of the worst maternal-fetal health statistics in the industrialized world?
thank you for sharing your wisdom. And what about the dangerous gushing hemorrhaging that happen right after birth either before placenta is born or after. Don’t these things happen by themselves also at noninterventing home births?
Yes, Sara, gushing hemorrhage can (rarely) happen at homebirths. As I said, if you carefully re-read my original post, one must take prompt action. It’s perfectly appropriate with a bad hemmorhage to call 911 within minutes of the birth and get the mother to hospital. However, the original dr who spoke on Good Morning a.m. to whom I was responding stated “bleed to death in as little as five
minutes”. This is not true and not a reason to give up the idea of an unassisted home birth. The doctor is trying to alarm people into going to a hosp. The mother who bleeds after a “noninterventing” home birth will not bleed to death in as little as five minutes. Ask any maternity nurse if she has ever seen a woman bleed to death in five minutes when she has an unmedicated birth (well, probably she hasn’t seen ANY of those, but ask anyway.) This letter of mine was well discussed on many nursing lists and they agreed that the bleeds that had brought mother’s close to death quickly were the ones that included surgery.
Gloria
3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.
This paragraph (above)cprompted me to respond.
What could you possibly mean by saying that “the smart babies put their cords……….? It could happen to ANY baby, and the cord isn’t always “easily unwrapped”. It could KILL a baby. In fact, it DOES. The baby would then be STILL BORN , which occurs in one out of every 110 deliveries. Not necessarily the cord, it could be placental abruption, etc, or no true answer.
Anyway, your comment about the “smart” babies and how easily cords can be unwrapped made no sense whatsoever.
Wow.
“Do babies regrettably die? Yes. And likely And likely (though not always) these babies were not meant for our world –”
I am sure that comforts parents of dead babies.
I’ve read about women hemorrhaging after birth, but not severe enough to warrent hospitalisation or surgery, when the birth was normal and not interfered with. I have read some horrendous birth stories about mother’s who hemorrhaged really badly however after birth, requiring surgery and transfusion. Only their births were intervened with with gels and pitocin to speed delivery. The cervix was not ready and rather than stretch softly, it tore, and the pressure of the baby being pushed down quickly spread the tearing down the vagina. I’ve read all too often of women giving birth peacefully on their own, even when the circumstances weren’t ideal according to the medical industry. And if these woman had of been having a hospital birth they would most certainly have received one intervention after another. Maybe instead of Obs trying to scare mothers into hospital births, they would do better to completely change their approach of hospital births. I have been researching hospital vs homebirth for quite some time now and am truly more scared of going to hospital and have to fight for my rights and due to the adrenaline then having labour stop, then I am about having a homebirth. I have had the hospital birth, and I know that the Dr on call who you get that night will most likely care about hospital protocol and getting it over with efficiently then they would about letting the mother’s body take control. I would love to hospital birth with the knowledge of having back-up medical assistance there if needed, if I knew that respect and patience were also part of the hospital policy for women in childbirth.. Unfortunately for those like me, the fear tactics and desire to treat the mother’s body more like a machine that is to be tampered with by the ‘professionals’, leaves a hospital birth not only an ugly thought, but something I can’t bear to put myself into the picture of. I am more afraid of this than I am a hemorrhage at home that I am confident if the birth has not been tampered with, will pass on it’s own with the techniques mentioned above.