Twin Breech Birth Ends With Fractured Skull

While working with partner Jennifer Gallardo Jesica Dolin contracted with a mother pregnant with twins to do a home birth.  After the delivery of the first twin it was determined that the second twin was footling breech the most dangerous form of breech.  Ms Dolin did not call 911 nor transport the mother.  Instead she proceeded to forcefully pull the baby’s left arm out and then pulled the right with so much force the arm dislocated.  The infant was stuck by its head at this point and still the midwife did not call for medical assistance.  She instead reached up inside the mother and grabbed the infant by the cheeks and pulled her free from the pubic bone.  The infant was not breathing, finally 911 was called, CPR was performed and the infant was transported to the hospital where she underwent surgery for a fractured skull.  Ms Dolin expressed delight that she could film a breech birth for her “twin collection” .

http://geoffrie.wordpress.com/jeffs-birth-story/sarahs-birth-story/

http://geoffrie.files.wordpress.com/2008/08/breechtwinsmt86.pdf

Questions to consider:

  • Why was Jesica was attending this birth at home rather than at one of the centers? Did she tell the parents it was because the center could lose its license for doing a breech birth?  If the licensing standards of the facility said breech births were too risky to be performed there, wasn’t she taking a risk by having this birth at home?
  • Did Jesica tell the parents the reason CNMs and MDs won’t deliver twins vaginally if the first baby is breech? (It’s because the first baby can get tangled with the second and cause them both to be gravely injured)
  • Jesica claims to be an expert in breech birth. What does it say about her judgement that she attended the birth of these twins at home? Particularly when she found that the first one was breech? And did she not know how to rotate the second baby around to a more favorable postion? Or how to keep her chin from getting hung up on the mother’s pubic bone?
  • Somewhere between Geoffrie’s blog post about the birth and the Midwifery Today article, the depressed skull fracture changes into a congenital problem. In other words, in the earlier document it is one thing, and in the second much later document it is another. Very interesting, even to the most casual reader. Why was the story changed?
  • And if it was congenital, why did it not show up on ultrasound? (the parents say there were ultrasounds) If it was congenital, why was the baby struggling at birth, as witnessed by the emergency transport and the NICU stay? If it was congenital, why did the neurosurgeon talk of bone fragments and bleeding? And why, if it was congenital, did there need to be any surgery at all, since (a casual database search reveals) most of these resolve spontaneously?
  • Another casual search reveals that depressed skull fractures ARE associated with difficult breech deliveries (One published journal article even says, “With few exceptions, a depression of the calvaria in a neonate is caused by birth trauma and often is associated with fracture.”), so how are the parents so certain there was no connection?