“do nothing”- the official slogan of home birth

With a few exceptions (namely placenta previa) the home birth midwife’s theory of practice is to not do anything. Their strategy of not doing anything (often euphemistically called “trusting birth”) is what patients shell out thousands of dollars for. Home birth midwives seem to believe that active management of risk factors causes deaths, when there are plenty of statistics that evidence the safety of hospital birth when compared to home births. Here are the numbers from Oregon. The midwives have a theory, that doing nothing is better than doing something nearly all of the time, but they ignore all the available data to check and see if their theory is correct. They put peoples lives on the line and do not check ahead of time to see if their idea is true.

The way that midwives come to believe such nonsense is that the majority of the time no one dies when they decide to do nothing. The issue with doing nothing isn’t usually death, its usually brain injury caused by oxygen deprivation. There is not any accountability or tracking of brain injuries in babies by home birth midwives, but a paper by perinatal specialists found an 18 x higher rate of them. Sometimes it takes years before the effects show up.

I began thinking about this matter because of an article on the Thinking Midwife’s page about how nuchal cords (cords wrapped around baby’s neck) are a “scapegoat” for interventions. Heres her advice:

  • During birth DO NOTHING.
  • IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ (Schorn & Blanco 1991) – see below.
  • Once the baby is born, unwrap the cord (the mother/family can do this).
  • If the baby is compromised at birth encourage the parents to talk to their baby whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. if the baby requires further resuscitation do it with the cord intact.

She emphasizes over and over again how rare it is to have to use the somersault technique, but to me that says that american home birth midwives specifically will be unlikely to actually learn this technique during a birth. Would you want to be the first patient a midwife has used this technique on? Would she even know if she were making a mistake? States that actually regulate direct entry midwives require that they fulfill educational criteria that is woefully inadequate, You can take the NARM exam and get certified after attending only 20 births- most non OBGYNs deliver more babies in med school than that.

The thinking midwife’s theory is that compressed cords are providing compromised, but not completely absent, blood and oxygen to the baby. That may or may not be true in any specific case, but there isn’t any electronic fetal monitoring to detect distress at her home births, so midwives are forced to form an opinion based on intermittent Doppler readings.

I sometimes wish I could get midwives together with malpractice attorneys sometime to talk birth injuries. Midwives who do home births attend to far fewer births than physicians, midwives get to pick their patients with more freedom than physicians, and lay midwives are less likely to actually recognize their mistakes. Home birth midwives are less likely to see the impact of their practice choices in any representative way, which probably makes it easy for them to pass around useless advice over and over. Malpractice attorneys deal exclusively in cases where someone died or was injured because critical decisions were made (or not made). They tend to have a much more common sense explanation of the problems caused by nuchal cords because they actually have to see the parents of the injured babies, and file the documents in court, and see the costs associated with the injuries, interview medical experts who explain what went wrong, etc. Malpractice attorneys have to face what these midwives would rather forget or blame on the parents. You will notice that it says in some cases the only way to treat is emergency c-section, and the only way to make sure its not an unduly delayed c-section is to use fetal monitoring. Home births have neither of these things at their disposal, so they have to push the lie that doing nothing is better than doing something that can only be done in a hospital. Admitting that it is more dangerous would lead them to having to obtain actual informed consent, and very few people would be willing to sign on for the risks of homebirth if they were honestly represented ahead of time.

 

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9 thoughts on ““do nothing”- the official slogan of home birth”

    1. even when I was into NCB I didn’t really care for the phrase. It seemed more like a slogan or something than actual advice, but after doing more research home birth midwives take it very seriously.

  1. Just to clarify a few misrepresentations in this post. Firstly I am not a nurse. I have a BScHons in Midwifery and a PhD. The information about nuchal cords is from an extensive literature review and 2 published journal articles I wrote. Please read the research I reviewed. In terms of law – there have been successful cases of negligence brought against practitioners who have cut nuchal cords (again see me refs). I have consulted with lawyers who support my recommendations. Globally ‘doing nothing’ is being implemented and reducing poor outcomes in poorly resourced countries. I’d be happy to consider any research you have that contradicts my findings and post. Oh… also I am not a proponent of ‘trust birth’ – birth is dangerous. Perhaps you would know my philosophy if you read more of my work rather than misinterpreting one post.

    1. I’ll edit the post to reflect your qualifications. I know you aren’t a proponent of trusting birth, but guess who is? The majority of midwifes and home birth patients who are reading your blog. You can’t say “do nothing about this condition” and then fail to take responsibility when someone takes that advice as part of an ill advised philosophy about child birth. You can’t recommend this approach without fetal monitoring to tell if serious problems are occurring or not and then call it a misrepresentation to point out the danger in such an approach. You also should not ignore the number of home birth deaths that result from the midwife failing to do anything when immediate action was merited.

      As for the rest- am I supposed to just take your word on what attorneys recommend, or should I use the words of actual attorneys that I linked to about what is appropriate?

  2. Saying that the safest approach to managing a nuchal cord is specific to that situation. There are many situations when doing something is the safest approach. The evidence is that a nuchal cord is not one of these situations (see linked articles, research and law cases). Perhaps the lawyers you asked were not familiar with the negligence cases (see Iffy ref for details). I teach (at uni) high risk/complications focused courses and teach that interventions are very necessary in many situations. If some one will read ‘do nothing’ in one situation as ‘do nothing’ in all situations, that is their problem. I can’t take responsibility for other people’s ingnorance and misinterpretation. People often see what they want to see, or set out to see… as you did.

      1. The literature cited in my post is largely from obstetricians… in peer reviewed journals. And the obstetricians I know who do not cut nuchal cords are currently practising. Why would I value the ‘word’ of an out-dated non-evidence based opinion writer/ranter?

    1. There is a large volume of literature supporting the benefits of continued placental circulation following birth. This is what underpins the worldwide move towards leaving the cord to finish pulsing before clamping. I have an entire folder of articles relating to this… so here are two of the most current from obstetric journals: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01708.x/full
      http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01708.x/full
      The baby cannot benefit from continued placental circulation if you have cut the cord (from around his neck) before birth. I you are interested in the area of post birth placental circulation look up Mercers’ work.

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