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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]OP would be well served to read the Failure to Deliver series. https://stories.usatodaynetwork.com/failuretodeliver/about-the-investigation/.

Also, Kara Keogh was 4 blocks from a hospital. Proximity to
the hospital doesn’t mean anything in a critical situation. Seconds matter. [/quote]

Yep infant rescusitation procedures are meant to be timed in seconds, with hospital equipment and drugs only a MD can administer on hand, and with multiple professionals involved. [/quote]'

exactly. even if midwives can do some of those procedures, they in no way have the set-up to be able to do it as effectively as in the hospital (infant warmer standing by, good lighting, all the instruments to measure pulse & O2), and all the trained people to help them.  [/quote]

+1 Kara Keough should have had  csection given all the risk factors and her baby was over 11 lbs. But even if she tried to deliver naturally, in a hospital with a hospital-based midwife, her baby probably would have made it because of the procedures and resources in place that can be activated in secodns. In the hospital, the protocol is that the VERY first thing you do when shoulder dystocia is suspected/apparent  is to call for help and get the neonatologist and other professionals to be at the ready to rescuscitate the baby as soon as it's delivered at the bed. Seconds count if the baby's air has been cut off while s/he is stuck in the birth canal. The OBGYN will also be hand to perform emergency surgery or other maneuvers because in circumstances where the baby is stuck for too long and can't be freed through maneuvers/episiotomy/breaking the collarbone etc, one thing they can decide to do to save the child is to force the baby back in and have an emergency C-section to deliver it as quickly as possible.      [/quote]

It was pretty horrifying she had a "good" certified midwife who didn't consider her to 'risk out' based on all of her current pregnancy and previous pregnancy factors; pretty appalling she was still considered a candidate for a home birth just from a laywoman's perspective. I'm in the "it can be safe, but too risky for me (I'm the PP with a friend who had 3 awesome births at home and died with #4) camp, but the Keough thing never should have been allowed to happen.

I guess everyone learned that lesson, just took one baby. [/quote]

Yep. In a hospital, if the risk factors are there for shoulder dystocia even if the mom wants to attempt a vaginal birth, the protocol is to prepare for the worst beforehand (via the AAFP) in order to save time and respond in seconds: "If shoulder dystocia is anticipated on the basis of risk factors, preparatory tasks can be accomplished before delivery. Key personnel can be alerted, and the patient and her family can be educated about the steps that will be taken in the event of a difficult delivery. The patient's bladder should be emptied, and the delivery room cleared of unnecessary clutter to make room for additional personnel and equipment." 
[/quote]

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