I have heard about tugging on placenta before - leading to heomorage!!!

[elizaregina]

www.dailymail.co.uk/health/article-2198725/Wife-bleeds-death-midwife-persuades-homebirth-inquest-hears.html

According to the Telegraph she hired her to have support during the planned hospital birth and it was the midwife who suggested and convinced her client of homebirth.

The NHS refuses homebirth for high risk women for a reason.

The NHS can not refuse homebirth. Ever.

This is a misconception, sadly perpetuated by the healthcare providers who should know they can not refuse to attend a woman in labour.

I'm having a vbac homebirth on the NHS. Without hassle. Because I know I can not be refused.

"The NHS can not refuse homebirth. Ever. "

Thereby proving that women will continue to demand their Right to Have a Home Birth even when it is a really stupid idea!

I would swap 'warm, wonderful and passionate about her job' for 'competent and responsible' any day.

Which this MW clearly wasn't.

Cory outlines this her failings very well.

It is clear that if this mother had been in hospital, she would have been closer to emergency care and also other HCPs - instead of being under the care of one person, who left her patient quickly after the birth and then had to be rung several times by the dead mother's husband before she came back to see her patient.

Presumably though a competent and responsible MW at a homebirth would have not been so negligent about the placenta and responded more quickly to the mother's worsening condition. In which case a homebirth that went wrong (and this is the scenario we are talking about) could have been dealt with promptly and professionally, and that mother might still be alive.

I wonder how much comfort the husband and orphaned children will ever really be able to take in the 'really lovely' birth the MW wants to emphasise.

Okay, they cannot refuse to attend a birth when a labouring woman calls for help, but they can very strongly recommend against it if the risk factors are high.
They cannot force you to attend a labour ward against your will. That doesn't make your HBAC a good idea though.

They can't refuse the homebirth at all. As in to book it, and leave the equipment in the womans home.

Yes, it can be recommended against, but that is all. Recommend. And accept that a womans choice is the final word.

It doesn't make it a bad idea either btw, everyone has a different perception of risk, and what risks are acceptable or not.

I agree with TheQueenOfDiamonds.

It is just possible that a succenturiate lobe could be missed, and it is pretty rare.

I don't think everything reported in the press is completely accurate.

This was a terrible tragedy, but I don't think we know all the facts.

Such a sad situation.

To those of you who are concerned about midwives tugging on cords that is the correct way to deliver a placenta if an injection of oxytocin has been given, the time when this is not the right thing to do is when the woman is having a physiological or natural third stage when it should be left until the woman pushes it out which will often happen within an hour, tugging the cord in this situation can lead to a haemorrhage.

Interestingly when i did a recent maternal resucitatioin update we were told that cpr is more likely to work well on a floor than on a bed but that if the person collapses on a bed then we are not to move them due to the risk of injuring them, injuring ourselves and taking longer to commence cpr. I think I might have to email the resucitation officer at our trust about this to clarify.

Maxbear, I've also been told the same at recent ALS updates. I think I have one on Monday so will clarify, but have always been told that the priority is 'get on the chest' - ie start CPR immediately even if the patient isn't in an 'ideal' position.

Wrt 'tugging', I agree with whoever said upthread that CCT (controlled cord traction) can look a little brutal to the uninitiated. It should be a smooth movement but it can appear quite forceful. (And believe me, I've never seen a midwife remove a placenta as brutally as most Drs do... but that's probably another story.)

I considered independent midwifery. I'm glad I never went for it. I'm not defending or accusing this particular mw at all but please remember that appalling outcomes and bad practice happen in hospitals too...

I also dont understand why her husband didnt call an ambulance.

The article is undoubtedly one sided and the full truth will hopefully come out in the inquest.

Having had a homebirth I personally find it quite scary that obviously there was only one midwife present. Surely both mother and baby need one each? It also adds checks and balances to the process.

"Having had a homebirth I personally find it quite scary that obviously there was only one midwife present. Surely both mother and baby need one each? It also adds checks and balances to the process. "

I guess that's an additional risk of hiring an independent MW for your homebirth?

Re Tugging

As said before I think most women can differenetiate between violent or forceful tugging and a sure footed pull - to get the cord out.

As said before - I know my MW did a sure footed tug/pull or whatever you want to call it - I know therefore that had something happened to my placenta - I couldnt accuse her of un due force.

Similairy a friend who has had three babies KNOWS - KNOWS KNOWS her second time - her cord was VIOLENTLY TUGGED ON, and placenta was left in and she did heomragge and end up in life support.

She knows this wasnt the case with the first and third pregnancies.

Do all mw think we are stupid!!!!!! or just " dont know " whats going on in the mysertisous world of midwifry and birth!!!

The cord was tugged at enough for the husband to be very alarmed.

It does stagger me that mw still come on to defend the in defensible.

Had this MW been humble offered apologies etc you might think of her in a different light - the birth comment though surely says - this mad mad woman is herself brainwashed and probably does think that they all had a good birth, maybe that comforts her?

My family was involved in a terrible tragedy some years ago.(Involving the shocking death of a close family member.)

The newspapers loved it.

Every single word that was printed in the press was innacurate/misquoted, edited to mean the opposite of what had actually been said, sensationalised.

There is no doubt that this was an awful tragedy. We don't know what actually happened.

It is desperately sad for that poor family.

the queen of diamonds - he said she looked at the placenta in the dark with the torch, she said she wouldn't be so stupid and it was light (yet despite her vast knowledge and experience missed the fact that 1/3 was still missing ) - I would class this as her accusing him of lying. No?

either way she fucked up big time - either she looked in the dark and missed it or looked in the light and missed it - her mistake led to this woman's death

elizaregina Please don't make sweeping statements about MW's.

"Do all MW's think we are stupid!!!!!!!! or just "don't know" what's going on in the mysterious world of midwifery and birth!!!"
"It does stagger me that MW's still come on to defend the indefensible"

A lot of women and even more men have very little idea of the reality of childbirth before they have been through it and their personal experience often clouds their opinion of how vast the range of experiences can be. While your knowledge might equip you to know what was normal, many more will have none. Hence MW's on here are showing how different people might perceive an entirely routine procedure.
I don't see anyone defending the allegations, merely explaining details. Until the written findings are published, none of us will know exactly what was said at the inquest and even then there will be a large element of he said, she said. Relying on media reports for accurate details is shaky ground.

Maddening - I meant she didn't say he was lying about the tugging.

They're both accusing each other of lying about how the placenta was examined so i don't see why she is the only one being given a flaming in the media for it. None of us know who is telling the truth, it could be either one.

ElizaRegina - TBH, This is one reason i hate stories like this being in the media. There are too many unanswered questions. You know nothing about the situation, absolutely diddly squat. You weren't there, none of us were. Have you ever been the subject of a story like this? I have, and let me tell you, leaving things open to assumption, dumbing down the facts etc if fucking dangerous and scary.

The main points of this article that need answering;

Did she use too much force/tug on the placenta - No one knows. The husbands account is the only evidence that she did - He has never experienced placenta removal, therefore he cannot possibly know 100% whether the procedure was carried out correctly. Yes, he SAYS it looked alarming and forceful - My friend said the same about mine, She said it looked horrific, It wasn't, it was done correctly in line with the injection i'd had to remove it. My second birth was physiological, My partner said it looked like it just fell out. Neither of these descriptions are in line with what it actually felt like.

Did she examine the placenta in good light? Well again, it's his word against hers, Why is he automatically believed? They are both telling different stories, one is lying, there is no evidence to prove who, so why are people automatically accusing the midwife?

Why was a large part of the placenta left inside the woman? This is the only part of the story that is definite. A large piece of the placenta was detained and this midwife needs to explain exactly why.

Why was no ambulance called - Again, The husbands story is that the midwife said there was no need, But we don't know what he said to her - Did he explain how seriously ill his wife was? Or did he, like many men, play it down a bit? Did the midwife definitely know the woman was not merely just feeling a bit exhausted after the birth? We don't know this! No one does! If the husband was so sure that his wife was seriously ill, why did he not ignore the midwife and call and ambulance himself?

Queen of Diamonds - he was not the professional overseeing a high risk birth having a patient dying on him. But he lost his wife. I really can't see why he should get an equal pasting.

I don't think anyone should be getting a 'pasting' WidowWadman.

We also don't know why the midwife was attending alone. The woman may have refused another midwife, Or there wasn't time for a second MW to get there. Should the midwife in question have refused to assist at all?

If there had been a second midwife, I'm sure that would have been reported and she would have been subject to the inquest, too.

"If the husband was so sure that his wife was seriously ill, why did he not ignore the midwife and call and ambulance himself? "

I don't know why he phoned her instead of 999, and I guess he has to live with that question forever, too. Possibly they trusted her judgement. After all, she is the professional.

So because the papers haven't said there was one means there wasn't? And there is no valid reason why?

Lets try an excercise. Please tell me what conclusions you draw from the following extract, about what should and should not have happened.

^The family of a 20-year-old stable hand who died after she was kicked by a horse as she helped it give birth paid tribute to her yesterday.
Lucie was kicked in the head as she helped a vet at the riding centre where she had been working for a few weeks.
The vet tried to resuscitate Lucie as staff at the Equestrian Centre called an ambulance but she could not be saved.^

It is a real story, i've just taken last names out and the name of the centre.

PPH does happen in hospital as well as is actually one of the leading causes of maternal death: the big difference is that in a hospital environment, blood transfusions and immediate intervention would be available. A second, third or fourth opinion on the mother's condition would have been available.

PPH is something that needs treatment immediately and every second counts. The delay to call an ambulance and transfer was really critical here and that's something that wouldn't have been an issue in a hospital birth.

It's all very easy to say that deaths happen in hospital too but in a hospital setting at least you know for sure that all facilities and options were open to you. With a homebirth, you'll always be tortured with the idea that 'if only' you'd given birth in hospital or 'if only' you'd transferred sooner, a life could have been saved. I'm not saying that hospital staff are never negligent but there is less chance of one individual's mistake leading to death.

In general, it's odd that the MW was alone handling the birth as well. I thought there always had to be 2 midwives for a homebirth?

Napa - Yes, But it's not uncommon for a MW to arrive alone and deliver alone if the second MW is delayed and the mother is already delivering.

You can have a homebirth alone with no midwife, The only legal stipulation is that you cannot plan to have an unqualified person deliver the baby.