It would be funny if it weren’t so deadly.
I’m referring to the napalm grade stupidity of ‘Erin Ellis homebirth midwife.’ Erin wrote a blisteringly ignorant post entitled “If I were at home, I would have died” — The trouble with extrapolating hospital birth events to homebirth.
It is a textbook example of what passes for “knowledge” among homebirth midwives and their terrible propensity to make stuff up instead of actually learning something.
Erin “explains” that obstetric hemorrhage only occurs in the hospital, and rarely at home. That would come as news to the 140,000 women who die of obstetric hemorrhage each year, almost all of whom come from developing countries, and most of whom give birth at home. Postpartum hemorrhage is the leading cause of maternal mortality world wide. In fact, around the world, 1 woman dies of postpartum hemorrhage every 4 minutes.
Erin, of course, is entirely oblivious to this grim reality. In Erin’s fantasy world, women don’t hemorrhage at homebirth because:
Midwives honor the biological importance of the hormonal bubble after birth and do not intervene unless the mother or baby needs help.
Here’s the problem Erin: postpartum hemorrhage has nothing to do with hormonal “bubbles.”
Let’s look at the epidemiology of postpartum hemorrhage:
The increased frequency of PPH in the developing world is more likely reflected by the rates given above for expectant management because of the lack of widespread availability of medications used in the active management of the third stage. A number of factors also contribute to much less favorable outcomes of PPH in developing countries. The first is a lack of experienced caregivers who might be able to successfully manage PPH if it occurred. Additionally, the same drugs used for prophylaxis against PPH in active management of the third stage are also the primary agents in the treatment of PPH. Lack of blood transfusion services, anesthetic services, and operating capabilities also plays a role…
In other words, in direct contrast to Erin’s assertion, postpartum hemorrhage is MORE likely in the ABSENCE of interventions.
The key factor in preventing death from postpartum hemorrhage is actively working to prevent the hemorrhage in the first place. That means giving medication like pitocin BEFORE hemorrhage starts. It means giving more pitocin, or more powerful uterine stimulants like ergotrate, if hemorrhage is not prevented. It means blood transfusions and it means surgical intervention.
What causes postpartum hemorrhage? Erin has no clue; she thinks:
When you hear someone say ‘I would have died if I had a homebirth’ or ‘my baby would have died’ please remember that these are very emotionally charged declarations. In many cases, unnecessary interventions have caused the complications that women and babies suffer from.
It is unlikely that Erin would babble such utter nonsense if she had ever bothered to learn the basics of postpartum hemorrhage. Postpartum hemorrhage is so common, and its causes so well known, that there’s a mnemonic, the four T’s: tone, tissue, trauma, and thrombosis.
Tone stands for uterine atony, the failure of the uterus to fully contract after delivery. Tissue stands for retained placenta, which makes it impossible for the uterus to contract fully after delivery. Trauma is lacerations, and thrombosis refers to the clotting disorders that often accompany pregnancy.
Atony is the most common cause of postpartum by far.
Uterine atony and failure of contraction and retraction of myometrial muscle fibers can lead to rapid and severe hemorrhage and hypovolemic shock. Overdistension of the uterus, either absolute or relative, is a major risk factor for atony. Overdistension of the uterus can be caused by multifetal gestation, fetal macrosomia, polyhydramnios, or fetal abnormality …; a uterine structural abnormality; or a failure to deliver the placenta or distension with blood before or after placental delivery…
Unlike other areas of the body, uterine bleeding does not stop by clotting. The bleeding comes from the blood vessels of the uterus that are wide open and exposed after the placenta detaches from the uterine wall. The ONLY way to stop uterine bleeding is for the uterus to contract forcefully to clamp the blood vessels closed. Uterine atony can occur in any woman, but it is more common if the uterus has been distended either by the baby before delivery, or with blood after delivery.
It is also more common in women who have labors that are very short or very long. Long labors are often a sign of poor uterine contractility, and in developed countries, such labors are stimulated with pitocin. Not surprisingly, the same women who needed pitocin to achieve contractions strong enough to deliver the baby, will need pitocin to achieve uterine contraction strong enough to halt uterine bleeding after the baby is born.
The second most common cause of postpartum hemorrhage is “tissue,” pieces of the placenta that have broken off and remained inside the uterus. The uterus cannot contract effectively if there is anything in the uterine cavity. Contrary to the fantasies of homebirth midwives like Erin, retained pieces of the placenta is extremely common in “nature,” and with traditional birth attendants.
The common causes of postpartum hemorrhage are rounded out by lacerations and by clotting disorders, either pre-existing or triggered by pre-eclampsia or other conditions.
How can postpartum hemorrhage be prevented? Hint: it’s not by facilitating a “hormonal bubble.”
High-quality evidence suggests that active management of the third stage of labor reduces the incidence and severity of PPH. Active management is the combination of (1) uterotonic administration (preferably oxytocin) immediately upon delivery of the baby, (2) early cord clamping and cutting, and (3) gentle cord traction with uterine countertraction when the uterus is well contracted (ie, Brandt-Andrews maneuver).
The value of active management in the prevention of PPH cannot be overstated. The use of active versus expectant management in the third stage was the subject of 5 randomized controlled trials (RCTs) and a Cochrane meta-analysis…
How effective is active management in preventing postpartum hemorrhage? There is an 80% reduction is cases of postpartum hemorrhage requiring treatment.
… The results indicate that for every 12 patients receiving active rather than physiological management, one PPH would be prevented. For every 67 patients so treated, one patient would avoid transfusion with blood products.
Let’s summarized what we (but evidently not Erin) know about postpartum hemorrhage:
1. It is common in nature; in fact, it is the LEADING cause of maternal mortality world-wide.
2. It is typically caused by failure of the uterus to contract effectively or by pieces of the placenta that have broken off and remained in the uterus.
3.It is far better to prevent postpartum hemorrhage than to treat it.
4.Active management is much more effective than watchful waiting in preventing postpartum hemorrhage.
The stupidity of homebirth midwives like Erin Ellis is downright appalling. She apparently knows nothing about the leading cause of maternal death. That’s bad enough. What’s worse is that she is unaware of her ignorance. And what’s even worse than that is that in her arrogance and ignorance she actually presumes to educate laypeople on a topic that she knows nothing about.
Erin, if you read this, and I’m sure you will, do the world a favor and take down your idiotic post. Oh, and before you do ANYTHING else, get a textbook and read about obstetric hemorrhage. Your ignorance and stupidity are nothing short of appalling … and potentially deadly.
