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Death of newborn rekindles home-birth debate

Hilo-area obstetricians are calling for stricter government oversight of home birthing and midwives following the death of a newborn on Wednesday.

Few details about the incident were available, and a Hilo Medical Center spokeswoman said she could neither confirm nor deny reports of a death of a newborn, citing the hospital’s patient privacy policy.

However, two members of HMC’s obstetrics staff, who spoke on condition of anonymity, said that a mother and baby were transported to the emergency room around 6 a.m. Wednesday after complications arose during a planned birth in Kapoho. The baby was pronounced dead shortly thereafter.

The Tribune-Herald has learned the identity of the midwife who assisted in delivering the baby but has chosen not to name her.

The midwife would not confirm her involvement when reached by phone Wednesday afternoon.

“I’m sorry, but I don’t talk to reporters,” the midwife said.

One obstetrician said that Wednesday’s death had taken a toll on hospital staff, especially because of the fact that it was another in a disturbing trend.

“This is an ongoing problem here. … Within the last five years, I’ve seen at least three dead babies from home births, and just a week ago I took care of a patient who nearly bled to death after a home birth,” the doctor said. “All of the obstetricians here have had similar experiences. And in all of these situations, the standard of care of obstetric practice was not followed by the practitioners. I believe that all of these bad outcomes could have been avoided if good practice patterns were actually followed.”

The obstetrician said that state law does not require licensing and oversight of midwives and other practitioners that aid in the home birthing of babies, which can lead to dangerous situations.

“You need a license to be a plumber, you need a license to be a carpenter, you need a license to cut hair in the state of Hawaii. You do not need a license to deliver a baby,” the doctor said. “I have had multiple occasions where babies died, and did not need to die, and there are no repercussions for the people who misled these patients.”

In the case of Wednesday’s death, the pregnancy had been determined to be a high risk, and therefore should never have been attempted outside of a hospital setting, the doctor said.

“While we have no licensing body in the state of Hawaii, from a purely ethical standpoint, it is not appropriate for someone to attempt high risk deliveries in a home setting. That’s the problem. A lot of folks want to paint it as it’s a war between midwives and obstetricians. I support midwifery practice. I’m not necessarily against home deliveries as a whole. What I’m against is insane practices of home deliveries of high-risk pregnancies in remote locations, and no formal system to address the emergencies that will inevitably happen,” the doctor said.

“This is life. … Sometimes unpredictable things happen. And then we can only do our best. (Wednesday’s) case, and the case we had two weeks ago, were entirely predictable. In fact, the case from two weeks ago where we had a near maternal death, not only was it predictable, the woman came in six weeks before, and the obstetrician advised her she was high risk and she should stay in the hospital. … She walked out of the hospital.”

During the 2014 session of the state Legislature, state Sen. Josh Green worked to pass a bill that would have established a home birth task force within the Department of Health to recommend to the Legislature standards of care and licensing requirements. After receiving a very negative response from home birth advocates, however, the bill failed to make it out of committee.

“My focus was to have uniform standards so that everyone would have enough training, and to formalize the relationship between midwives and obstetricians in case there were complications,” Green said Thursday.

“I believe in home delivery and a partnership between obstetricians and midwives, but there has to be some formal relationship and regulations to prevent tragedy.”

Lea Minton, a certified nurse midwife and president of the Midwives Alliance of Hawaii, said Thursday that her members are not opposed to legislation aimed at setting standards and improving communication between obstetricians and midwives. However, Green’s bill and others have largely failed to give midwives meaningful input.

“We would like it to be a bill we can come to the table with and have support from both sides,” she said. “We don’t want to continue to put energy toward killing bills that make home birth illegal.”

Minton said that the original incarnation of Green’s bill did much more than form a task force, effectively “making home birth illegal.”

“When they tried to regulate certified nurse midwives under the Board of Medicine, that is taking away scope of practice and our already given rights to be performing home birth,” she said.

“The way that it was written was that we needed to be supervised by a doctor who would watch us do (50 births) in order to sign off for us to do home births. That is never going to happen, because there’s no doctor who’s going to come to a home to supervise us.”

Midwives maintain that in cases of low-risk pregnancies, home birth remains safe, with no increase in adverse outcomes for mothers and babies, she added.

Other nations are more enlightened about home birth, Minton said, and just last year, Britain’s national health service advised healthy women that it was actually safer to have babies at home or in a birth center, as opposed to in a hospital.

However, a 2014 study using newborn mortality data provided by the Centers for Disease Control and Prevention found that midwife-facilitated home births carried nearly four times the risk as those taking place in hospitals. Researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2 for every 10,000 births in midwife hospital births, and 12.6 per 10,000 births in midwife home deliveries.

“This risk further increased to about seven-fold if this was the mother’s first pregnancy, and to about ten-fold in pregnancies beyond 41 weeks,” said Dr. Amos Grenebaum, a co-author of the study.

Minton argued that many such studies include data from unplanned home births, which are “very different situations,” including instances in which people may be traveling to a hospital for the birth but are stopped in traffic and end up “having the baby on the side of the road,” she said.

Email Colin M. Stewart at cstewart@hawaii tribune-herald.com.


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