Would You Trust This?

[ColwynsMommy]

The MW we used with Fiona was great. Just as hands-off as we wanted, super experienced (several hundred births, I forget exactly how many), easy to get along with, etc. The birth went well, though she missed it by 5 min (extremely short labor, she left the house immediately when we called and got here super fast). Postpartum care was good, though we had a little miscommunication about the 6 week visit (she had told me that she was going out of the country on vacation, but wasn't super explicit about when, so I didn't realize I wouldn't get a 6 week visit). Anyway, overall, I was really happy with her. I'd never, ever heard a bad thing about her. I'd always heard that usually women who have traumatic hospital births seek her out specifically.

Anyway, she had a bad outcome earlier this year, and is no longer listed on various midwifery websites. I haven't heard the full story, only hearsay from some doula friends, and nobody I know is really sure whether it was a fluke or negligence. I wasn't sure if she was practicing at all, plus I sort of wanted a different type of person to attend my birth. I picked the first MW because I felt like she was the older, more experienced, wise-woman sort, y'know? This time I want someone who's in a similar place to me, raising young kids, someone I'd be friends if we met at a park day or something. Anyway, I found that someone, who is a great fit in other ways as well, but she has to discontinue care for all her clients due to some unforseen circumstances. So now I'm 22 weeks and without a midwife.

So, the new midwife says she knows the whole situation and trusts my old midwife completely. Logically, I know that if I would trust the new midwife to attend my birth, I should also trust her judgement about my old midwife. I know we don't get any guarantees when it comes to birth. I want to believe that the HB community's reaction of distancing themselves from this midwife is an instinctive emotional reaction and not based on the midwife's actions at the birth, but I don't know.

What do you think? I really don't want to have to go through the whole interview process again..

[sunfish21]

Can you set up a time to talk to the original midwife, say that you have heard somethings, and ask her what happened? She knows that people are talking--she might welcome the chance to have her side heard.

[Xiaohua]

Originally Posted by sunfish21

Can you set up a time to talk to the original midwife, say that you have heard somethings, and ask her what happened? She knows that people are talking--she might welcome the chance to have her side heard.

I agree, you already know her, and she is being recommended by the other midwife, whom you trust. So maybe meet with her again and see what she has to say. If you have other questions now would be the time to sort things out. Just meeting her once doesn't mean you are commited for the duration, right? If you still have doubts after a meeting, then maybe call her back and tell you you need a little more time to decide. It doesn't seem like you have anything to lose. And if for some reason you decided NOT to go with her, are there other mw options in your area?

Serena

[ColwynsMommy]

There are few options, to be honest. Even though my state has a lot of midwives practicing, the area I live in is sort of a weird void. There are only two midwives that are less than 45 minutes away from me, and one of them is my old midwife. I interviewed a few midwives when barely pregnant and while they all seemed competent, I didn't really click with any of them. There's one more midwife I can interview, and then I'll just have to suck it up and choose.

I'm hesitant to call my old midwife and ask her about what happened.. it's just not a conversation I want to have, you know?

[MsBlack]

You are right--distancing ourselves from someone who has experienced some sort of disaster is an emotional reaction we have. And yet it is a sad and terrible thing for someone who is going through tough times! Never so sad and terrible as when people who do know you, who do respect you, withdraw along with others out of their fear of being near your difficult feelings, or fear of somehow being touched or tainted by your difficulty--as if disaster is contagious.

And you are right--we get no guarantees with birth (or life). Mws are merely human and certainly can have bad days or make mistakes--but I think it's safe to say that the great majority of times that a skilled, experienced mw is part of a disaster at birth, it's really not her fault. Sure, in *any* situation we can look back and think of things that any member of the event might have done differently to possibly bring about a different outcome (in the case of a birth, the mom/parents as well as the mw can apply that retrospective view). Signs could have been interpreted differently, responded to differently; more caution could have used, all kinds of things can be proposed in retrospect. But remember that hindsight is not really 20-20, it only seems to be. And you can't change the past, you can only move forward.

Midwives take part every day in birth--which is ALWAYS a matter of life and death, they always have to walk a perilous walk, especially in a culture that disdains midwifery and keeps it suppressed and generally disrespected. Every mw will in time be part of death, pain, disability--there is simply no avoiding that. Every mama here gets her homebirth *because* women like your midwife are willing to walk that perilous walk....a walk made all the more personally perilous because in this culture that disrespects mws, people DO turn away when the mw has a sad or difficult birth happen.

Consult your heart and discover only if your knowledge of this woman, and your prior experience with her, merits your trust in her now. You may find a mw who has never experienced a terrible outcome...but that will only be because that mw is not very experienced! But, any day I would rather take the mw who has lived through difficult outcomes any day, and emerged a stronger and wiser person and midwife, than she who has not yet had her trials by fire.

Talk to her about your upcoming birth, your need for services--but NOT about her difficulty. Or if you feel you must--if only to clear the air because otherwise the rumors you've heard will stand between you--then only say that you heard she has been through a tough situation since last you worked together. Ask if she has been able to find the support of other mws in learning from the experience and moving past it. Don't pry--because confidentiality issues should be in play for her, not to mention that it might well be something she is not comfortable discussing with anyone but her closest friends in terms of the emotional aspects of it.

good luck

[ShwarmaQueen]

I would find out her side of things. Death in birth just happens sometimes, nobody's 'fault'. You might also find out if a peer review was done and if the state board disciplined her, etc. I wouldn't write off an otherwise good MW though because of a unforseeable circumstances.

GL!

[moonglowmama]

I agree with what MsBlack said. I have several friends who are midwives, and one has been sued for a bad outcome. Totally not her fault, but for some reason midwives are treated very poorly when there is any bad outcome. OBs never are, or it takes many times more cases of mismanagement to have any negative effect on their practice.

Think through your relationship with your first midwife and whether knowing her as you do, you would hire her again. It is largely only a matter of experience that makes the difference between a midwife who has had a bad outcome and one who has not. My midwife is very upfront with each of the losses she has had and what the reasons for them are (never giving personal details, only the facts of the cases).

Once a midwife has an outcome that someone views might have ended differently had x,y, or z been done she often cannot obtain affordable insurance, may be banned from practicing in certain arenas, or just distanced from the hb community. Like I said, you just about never see that in obstetrics. I'm not saying there are not cases of negligent care in the midwifery community as well, just that it is not usually the circumstance. The most common scenario I've seen and heard of is that a baby dies who probably would have died in any place, or with any care, and the parents are so angry they feel the need to lash out and punish whoever they can. Very sad, all the way around.

I hope you will be able to evaluate your midwife in terms of the care she has provided and will provide to you and your new baby. Good luck to you!

[MidwifeErika]

If the other midwife knows the story and says she trusts this other midwife, then I would trust in that as well. The HB community distancing themselves from her is just a normal (but harsh) reaction as it is hard to think of death. Think of a mother who loses her child and often she will find herself alone as well as her friends distance themselves because it is just hard to deal with.

I would not rule out a midwife based on 1 poor outcome. I would not rule out a doctor for 1 poor outcome either.

[homebirthing]

MsBlack, I completely agree with your words.

The hardest thing in the world is that babies die. A midwives walk will include this at some point in her journey, for most...not all. The difficult part is that while an OB/CNM/MD might see many many many babies die at the hospital (and they do) a homebirth midwife might witness one, and it can put her in jail.

Would you have hired your midwife again if you hadn't heard about this occurance? It sounds like you were leaning towards someone else anyway. If not, I would set up a time to chat, but I will echo MsBlack when it comes to her own trauma. She might not want to talk about it, and definately will have confidentiality to the family.

Happy healthy birthing!

[ColwynsMommy]

Thanks so much for the thoughtful words, everyone. Even if I'd never heard of this situation, I would have sought another midwife just because I felt like I wanted a different vibe (not that the previous was bad, but I feel like I would prefer something different this time). If I'd never heard of it, I'd probably go back to her without hesitation, though be disappointed about not being able to have that different vibe I wanted.

I got a PM from someone who lives nearby and knows who I'm talking about. She was hoping to use this midwife herself. We don't have a state licensing board here, but there's a midwifery group that offers peer review--and this group is who she got the following info from. Apparently my old midwife offered herself up for peer review (which is not required). They found her actions to be erroneous and removed her from their listing. They said they couldn't dismiss her errors that led to this baby's death.

I do trust my midwife, though I'm hesitant to accept her trust of my old midwife (horrible as this is) because she's a very hands-off midwife by nature, and while I'm okay with that and would request the level of monitoring I feel I need, I'm not positive that she would think someone was remiss in not monitoring enough during labor (for example). I have no idea if that makes sense. Sorry. The one thing that always made me a little uncomfortable about my labor/birth is that I had 48 hours of early labor, and my midwife only stopped by for an hour or two and listened to the baby's heartbeat once. She went home for the night and then I had a precipitous birth the next morning, so we weren't monitored at all during my one hour of active labor, though that couldn't really be helped. I didn't really worry about it at the time, because I could feel the baby moving, but looking back, it seems kind of weird that during 49 hours of labor, she only checked my blood pressure and the baby's heartbeat once. I have no idea if that's odd for the way my birth went, or if it could have been helped at all.

So, I'm still up in the air. I called the only other midwife who's remotely close to me, and hopefully she'll return my call and we can set up an interview. Hopefully she'll have the right vibe and I won't have to worry about this anymore.

I really do appreciate your thoughts and support. I do totally agree that there are no guarantees, and that most experienced midwives have their share of unavoidable bad outcomes. I know plenty of doctors screw up and don't get punished, nor do we ever hear about it. In the absense of surety that the bad outcome was unavoidable, though, I feel conflicted.

[bobandjess99]

OP - I think your concerns are very valid (it's what jumped into my mind) in that the old midwife might not bethe "same" as she was before. of course, all of us grow and hopefully learn from experience, but in this case, I can see a recent poor outcome DRASTICALLY affecting the midwife and everything about the care she gives...the amount of monitoring she wants to do, possibly changes in having "required" testing or intervention, practicing more "defensively", a la the way most OB's practice versus giving personal, one-on-one care to you individually and respecting your personal desires and decisions, etc. Not to mention any guilt, regret, anger, doubt or other emotional baggage she might now be bringing to her births. Any/all of this might have change dthe way she practices midwifery....or not. I woudl interview her as if you had not met/used ehr before, and assume you know nothing of the way she practices. See if her answers have changed or if her "vibe" is different now, etc.

[Usually Curious]

What if the mom didn't want monitoring? A lot of hb mamas want the absolute least amount of monitoring they can get. Is she to be punished because of this?

This is a tough one. There are so many mitigating factors.

[MidwifeErika]

As far as the early labor for 48 hours with minimal monitoring... that is pretty normal. Even if you were planning a hospital birth, if they determined you to be too early in labor to stay, you would have a quick check and then be sent home until you were more advanced in labor.

However, it sounds like you are uncomfortable using her again for a variety of reasons. I hope your interview with the other midwife goes well.

[ColwynsMommy]

So, I spoke to a friend who knows the whole story. My old midwife never offered some (standard and totally noninvasive) precautions in a risky situation. I do find it strange that the mother never asked for these precautions either, when they're common knowledge safety measures that really don't have any side effects. I guess my old midwife also botched the transfer, insisting she travel at least an hour away instead of going to the closest hospital.

I'm hoping that meeting the other midwife I mentioned as well as another one or two that were recommended to me by a friend will resolve the matter for me. I think that if I were in a similar situation in labor, either my husband or I would have insisted on doing things differently, asking for the interventions we felt necessary, etc.. so while I think my old midwife was remiss, it would most likely work out fine if I do need to rely on her.

Thanks again for all your support.

[nikirj]

I'd be wary of someone who had been kicked out of a peer review group after an incident review. It seems like (in my area anyway) MWs are quick to say "I would have handled that differently" but REALLY want to find the "but I can see why you did what you did," too. A peer review group, and in particular an incident review, is legally protected in certain ways that make it really unlikely that the MW was kicked out just because they were reluctant to associate with her.

I can't help but be sympathetic to the MW, though, because I think it's every MWs worst fear; missing something so obvious that everyone around you is saying "OMG YOU IDIOT!" and a bad outcome is clearly your fault.

[jeninejessica]

While I definately wouldn't rule out a midwife because of a prior bad outcome, I think the important thing here is that you need to be able to put trust in your midwife, and right now, you're not able to do that. Period. So whether she is or isn't at fault, if you're going to be uncomfortable and questioning wondering if you're getting the best care, then it's simply not the best option for you, IMO.

[Xiaohua]

Originally Posted by jeninejessica

While I definately wouldn't rule out a midwife because of a prior bad outcome, I think the important thing here is that you need to be able to put trust in your midwife, and right now, you're not able to do that. Period. So whether she is or isn't at fault, if you're going to be uncomfortable and questioning wondering if you're getting the best care, then it's simply not the best option for you, IMO.

I agree. Regardless of the reason, if the trust isn't there, the relationship won't work the way it's supposed to. Did you meet with the other midwife yet?