Unfortunately, most of the complications that home birth midwives dismiss as "variations of normal" carry real risk that increase the chances of harm to the baby or mother. And ignoring the risk does not make it go away, as many home birth mothers have learned the hard way.
Some of the risks most commonly dismissed by home birth midwives are the risks associated with going past your due date. "Babies come when they're ready," they say. "Babies know when to be born."
But if this is true, why are any babies born prematurely? Prematurity can result in serious long-term complications for baby, months-long NICU stays, and death. If those babies didn't know when to be born, how can a home birth midwife be so sure that *your* baby knows when to be born? Just like preterm birth, postterm birth can result in serious complications and sometimes death.
Postterm Death Rates
The different "terms" of pregnancy are defined as: preterm (before 37 weeks), early term (from 37 weeks to 38 weeks and 6 days), full term (from 39 weeks to 40 weeks and 6 days), late term (from 41 weeks to 41 weeks and 6 days), and postterm (42 weeks and beyond):
 |
| "Definition of Term Pregnancy" |
At the end of pregnancy, there is a balance between babies being born too early and babies being born too late. Too early, and their organs might not be ready yet. Too late, and the chances of stillbirths, cord accidents, shoulder dystocia, meconium aspiration, and placental failure increase.
The chart below shows what those risks look like balanced against each other.
The risk of babies dying after they're born birth is higher before 37 weeks, decreases and is it its lowest point between 39 and 40 weeks, and increases from then on. The risk of babies dying before they're born (being stillborn) increases from 37 weeks on, increasing exponentially after 40 weeks. The following chart shows those trends, with deaths of babies after birth in blue, stillborn deaths in red, and the combined risk of the two in yellow:
 |
"Risk of Stillbirth and Infant Death Stratified by Gestational Age" |
As you can see, the risk of death from both complications after birth and from stillbirth rises after 40 weeks and just keeps getting higher.
The study that this table is from, Risk of Stillbirth and Infant Death Stratified by Gestational Age, shows that the risk of stillbirth is more than twice as high at 42 weeks than 40 weeks, and only keeps increasing from there. Medscape summarizes the findings of multiple studies as "Perinatal mortality (defined as stillbirths plus early neonatal deaths) at 42 weeks of gestation is twice that at 40 weeks (4-7 vs 2-3 per 1,000 deliveries, respectively) and increases 4-fold at 43 weeks and 5- to 7-fold at 44 weeks."
What are the risks of going postterm?
So why does the risk of death begin to increase so much after the 40th week of pregnancy?
There are only two things that can happen post-dates, and both are potentially bad. Either the placenta stays strong, or it doesn't.
If the placenta stays fully adequate, the baby keeps getting bigger and bigger, which is going to be a problem when labor finally starts. Complications for the baby can include "prolonged labor, difficulty passing through the birth canal, and birth trauma (eg, fractured bones or nerve injury) related to difficulty in delivering the shoulders (shoulder dystocia)." Risks to the mother "are related to the larger size of postterm fetuses, and include difficulties during labor, an increase in injury to the perineum (including the vagina, labia, and rectum), and an increased rate of cesarean birth with its associated risks of bleeding, infection, and injury to surrounding organs."
If the placenta starts to fail, then the baby gets weaker and becomes more stressed the longer things go on. The chance of oligohydramnios (low amniotic fluid levels) increases, raising the risk of umbilical cord compression (which cuts of the baby's source of oxygen). Babies are also more likely to pass meconium (baby poo) in the womb and inhale it, which can cause serious breathing problems and death.
The risks of postterm pregnancy are real
Clara Edith
Heather O., the author of the blog The Destiny Manifest, has written a heartbreaking account of how her daughter Clara died from postterm pregnancy complications. In a post called She Was Still Born, Heather writes,
"I reached the 40 week mark on June 14th. I was thrilled to have made it to my due date, feeling a little arrogant about how the doctors had said I would “never carry a baby to full term”, but also feeling ready for our baby girl to make her appearance. We had read all of the research that shows that 40 weeks is just the average length of a normal pregnancy — anything from 38 to 42 weeks is considered in the normal range, and I know of several women who have had their babies at 43 and 44 weeks. We weren’t worried.
At 41 weeks, I was still 4cm and baby girl was at 0 station. We discussed induction but decided against it. I wanted a vaginal birth after cesarean very badly, and pitocin is generally contraindicated in a VBAC, particularly when the mom has a “special scar” like I have.
By this point I was very uncomfortable and ready to not be pregnant...David and I had a long soul-searching conversation over the course of a couple days and decided that, since baby girl was still fine, with a great heart rate and passing every kick count, we’d give it until 42 weeks and then reconsider the hospital induction. We felt very good about this decision, having weighed all of our options.
On the afternoon of Thursday, June 28th, the day that I hit 42 weeks, we made the decision that if I was not in “real labor” by the next night...we would go into the hospital for a medical induction. We didn’t make this decision based on any worry about the baby’s health, as she was still kicking quite exuberantly in her very tight living quarters. We made the decision because I was uncomfortable and oh-so-ready to meet our baby.
I woke up on Friday morning to contractions, but this time they felt different...I told David that I was pretty sure these weren’t going to stop. They felt more real than any of the other times...The contractions slowed down that night but never stopped completely. The next day was much like the one before, painful contractions but nothing I couldn’t handle.
I woke up on Sunday in real pain. It didn’t feel like the labor I’d been having, and it didn’t feel like the way countless books and birth stories and friends have described labor. It was pain and it was harsh...I told David that something felt wrong, that it hurt too much and I needed to go to the hospital NOW.
The doctor came in and began the ultrasound. After a couple more minutes, David and I looked at each other and the realization that there was a problem began to dawn. I said, “Can you not find her heartbeat?” and the doctor said “No, here is her rib cage and there is no heartbeat there.”
Time seemed to slow to a crawl. I felt cold, lost in some surreal nightmare. David ran to the bathroom and collapsed to the floor, sobbing. The nurses and tech disappeared from our room. The doctor said “I’m so sorry.” David asked if he could possibly be wrong, that maybe he made a mistake. The doctor said that there are no guarantees in life and that there was a chance he was wrong. I asked “how quickly can you get her out?” and he answered “with a cesarean, we can get her out right now.” I said, “then do it, get her out now.”
Over the next 15 minutes, I signed a consent form, was shaved and prepped for surgery, and had my blood typed...I was crying, but still believed absolutely that they were wrong. I would hear her cries any minute. She might need some help, maybe she’d need to go to the NICU, but she would be fine.
The smell of infection filled the room when our doctor opened my uterus. David stood and watched as the doctor pulled our daughter from my body...My husband looked down at me and shook his head slowly. I began to sob in earnest and the anesthesiologist, with tears running down his own face, gave me “something for anxiety.” The nurse called David over and handed him our beautiful daughter, Clara Edith. He brought her to me and I touched her cheek, still warm from my body. I wanted to hold her so badly, and I was assured that they would take pictures of her right then and bring her to me as soon as I got out of surgery.
It took almost an hour and a half after Clara was born before the doctors were done cleaning out all of the infection in my uterus...I was taken back down the hall of crying and healthy babies to a room at the end, where my husband and I waited for our lifeless daughter to be brought to us. An hour after the surgery, a nurse brought in a cart with a white basket draped in a hospital blanket. She asked if I wanted to hold her and I said that I did. She laid my baby girl in my arms and told us to take as long as we needed.
...What if we had decided to medically induce at 40 weeks? What if we had decided 41 weeks was our limit? What if we had gone on to the hospital as soon as those contractions started on the Friday before she was born?
The doctor said she had been gone between 1 and 3 days...She died sometime between Friday evening and Saturday afternoon. The doctor’s theory is that my amniotic fluid level dropped drastically and she passed and ingested meconium, which poisoned her and ended her life."
At 41 weeks, I was still 4cm and baby girl was at 0 station. We discussed induction but decided against it. I wanted a vaginal birth after cesarean very badly, and pitocin is generally contraindicated in a VBAC, particularly when the mom has a “special scar” like I have.
By this point I was very uncomfortable and ready to not be pregnant...David and I had a long soul-searching conversation over the course of a couple days and decided that, since baby girl was still fine, with a great heart rate and passing every kick count, we’d give it until 42 weeks and then reconsider the hospital induction. We felt very good about this decision, having weighed all of our options.
On the afternoon of Thursday, June 28th, the day that I hit 42 weeks, we made the decision that if I was not in “real labor” by the next night...we would go into the hospital for a medical induction. We didn’t make this decision based on any worry about the baby’s health, as she was still kicking quite exuberantly in her very tight living quarters. We made the decision because I was uncomfortable and oh-so-ready to meet our baby.
I woke up on Friday morning to contractions, but this time they felt different...I told David that I was pretty sure these weren’t going to stop. They felt more real than any of the other times...The contractions slowed down that night but never stopped completely. The next day was much like the one before, painful contractions but nothing I couldn’t handle.
I woke up on Sunday in real pain. It didn’t feel like the labor I’d been having, and it didn’t feel like the way countless books and birth stories and friends have described labor. It was pain and it was harsh...I told David that something felt wrong, that it hurt too much and I needed to go to the hospital NOW.
The doctor came in and began the ultrasound. After a couple more minutes, David and I looked at each other and the realization that there was a problem began to dawn. I said, “Can you not find her heartbeat?” and the doctor said “No, here is her rib cage and there is no heartbeat there.”
Time seemed to slow to a crawl. I felt cold, lost in some surreal nightmare. David ran to the bathroom and collapsed to the floor, sobbing. The nurses and tech disappeared from our room. The doctor said “I’m so sorry.” David asked if he could possibly be wrong, that maybe he made a mistake. The doctor said that there are no guarantees in life and that there was a chance he was wrong. I asked “how quickly can you get her out?” and he answered “with a cesarean, we can get her out right now.” I said, “then do it, get her out now.”
Over the next 15 minutes, I signed a consent form, was shaved and prepped for surgery, and had my blood typed...I was crying, but still believed absolutely that they were wrong. I would hear her cries any minute. She might need some help, maybe she’d need to go to the NICU, but she would be fine.
The smell of infection filled the room when our doctor opened my uterus. David stood and watched as the doctor pulled our daughter from my body...My husband looked down at me and shook his head slowly. I began to sob in earnest and the anesthesiologist, with tears running down his own face, gave me “something for anxiety.” The nurse called David over and handed him our beautiful daughter, Clara Edith. He brought her to me and I touched her cheek, still warm from my body. I wanted to hold her so badly, and I was assured that they would take pictures of her right then and bring her to me as soon as I got out of surgery.
It took almost an hour and a half after Clara was born before the doctors were done cleaning out all of the infection in my uterus...I was taken back down the hall of crying and healthy babies to a room at the end, where my husband and I waited for our lifeless daughter to be brought to us. An hour after the surgery, a nurse brought in a cart with a white basket draped in a hospital blanket. She asked if I wanted to hold her and I said that I did. She laid my baby girl in my arms and told us to take as long as we needed.
...What if we had decided to medically induce at 40 weeks? What if we had decided 41 weeks was our limit? What if we had gone on to the hospital as soon as those contractions started on the Friday before she was born?
The doctor said she had been gone between 1 and 3 days...She died sometime between Friday evening and Saturday afternoon. The doctor’s theory is that my amniotic fluid level dropped drastically and she passed and ingested meconium, which poisoned her and ended her life."
I encourage you to read Heather's full account; there's a lot that I couldn't include here.
Daxton
Daxton Green is a baby who died shortly after being born at the Carolina Community Maternity Center (a freestanding birth center) on January 20, 2015.
In an inquest following his death, his death was ruled a homicide.
The Charlotte Observer explains:
"The jury had four options in ruling the manner of death – undetermined, natural, homicide and accidental."
"Homicide in this particular case is not a legal definition; it’s a description of the manner of death,” Gast said after Thursday’s verdict. "[The jury decided] there was enough information in the testimony today and the documents provided to them that...there was a responsible party for the death of Daxton.”
"Homicide in this particular case is not a legal definition; it’s a description of the manner of death,” Gast said after Thursday’s verdict. "[The jury decided] there was enough information in the testimony today and the documents provided to them that...there was a responsible party for the death of Daxton.”
Daxton's mother's pregnancy was being overseen by midwives at the birth center, who, as she got closer to her due date, moved her due date so that she could still deliver at the birth center instead of a hospital.
Daxton's father testified that he and his wife "had no issues during prenatal care, but they started getting worried about risking out due to approaching 42 weeks gestation. Christine [the midwife] told them they could switch to using the ultrasound due date instead of the date established by “last menstrual period” to get an extra week. She did not discuss any risk factors of approaching 42 weeks gestation, only that the rules stipulated that it wasn’t allowed to go beyond that point. Thus, M.G.’s due date was moved from January 5th to January 12th."
So what happened on January 20th?
At the inquest,
"The midwives all told the same story: the baby’s heartbeat was always just fine, and they put the mother on oxygen only to treat her lightheadedness and help her collect herself. The amniotic fluid was clear until the baby’s head was born and shoulders released, at which point heavily meconium-stained fluid was revealed. They attempted to resuscitate him and called 911. The baby was declared dead shortly after arriving at the hospital."
"The medical witnesses (specifically the maternal-fetal medicine specialist, the pathologist, and the perinatologist) were all very clear that the midwives’ story did not make sense to them. They testified, based on their examination or on the records that they reviewed, that Daxton was completely overwhelmed by meconium, completely, inside and out. No one thought it was feasible that the midwives could have seen clear fluid. They indicated that the midwife should not have moved the due date, did not adequately monitor the baby during labor, and did not do a proper resuscitation. They indicated that oxygen should never be used for the purpose that the midwives stated, but that it could be used during repeated deep decelerations that should cause great concern for the baby’s wellbeing. The perinatologist made it clear, as the director of neonatal care at a well-known local children’s hospital, babies do not die like this in the hospital. This death would have been prevented in a hospital setting."
"The medical witnesses (specifically the maternal-fetal medicine specialist, the pathologist, and the perinatologist) were all very clear that the midwives’ story did not make sense to them. They testified, based on their examination or on the records that they reviewed, that Daxton was completely overwhelmed by meconium, completely, inside and out. No one thought it was feasible that the midwives could have seen clear fluid. They indicated that the midwife should not have moved the due date, did not adequately monitor the baby during labor, and did not do a proper resuscitation. They indicated that oxygen should never be used for the purpose that the midwives stated, but that it could be used during repeated deep decelerations that should cause great concern for the baby’s wellbeing. The perinatologist made it clear, as the director of neonatal care at a well-known local children’s hospital, babies do not die like this in the hospital. This death would have been prevented in a hospital setting."
Gavin Michael
Gavin Michael's full story is already here on this blog. You can read it here: Gavin Michael.
Gavin Michael's mother Danielle was planning to have a home birth with the certified professional midwife Christy Collins. At 42 weeks, Danielle had a biophysical profile to check on the baby. The test showed that she had no amniotic fluid. Instead of telling her to go immediately to the hospital, her midwife told her that the baby "looked terrific and everything was fine," and to go home and drink water.
After she told them to go home, Danielle's midwife crowd-sourced for information from other midwives on Facebook. Shockingly, the other home birth midwives seemed as relaxed about the risks as she was.
After the baby was found to have a low heart rate the next day, Danielle and her husband went to the hospital and Gavin Michael was delivered by cesarean section, but it was too late. Since he had no amniotic fluid, Gavin had nothing to swallow or breathe but meconium, and it killed him. The doctors tried incredibly hard to revive him and worked on him for 47 minutes after he was born, but it was just too late.
Unbelievably, the midwife responsible for Gavin Michael's death posted this poem on her facebook page just four days after he died from post-dates complications:
The full poem reads:
I repeat - Gavin Michael died directly as a result of post-dates pregnancy complications. He died because the pregnancy went too long. And just 4 days after he died, his midwife posted this poem on her facebook page.
The risks of postterm pregnancy are real, and should not be dismissed by home birth midwives.
