Originally Posted by Kanna
The thing that started this particular discussion was Paigekitten being of the opinion that parents are responsible for picking a competent, skilled midwife.
I thought that there were several factors that hampered parents ability to do so and since this was the case, it would be states' responsibility to make sure as far as possible that ALL midwives that practice are skilled and that it is made transparent for parents exactly what kind of skills a specific type of midwive posessed and what kinds of situations she's able to handle.
Where I live, there are licenses, regulated midwives, so I can choose one that the government and doctors approve of, if that's what I want. However, the final choice is mine, and if I want one who isn't regulated, I have that option, too. This is not an area where I want my responsibilities to be handed over to the state, thakn you very much. Their approach to regulation has hurt me badly over the course of my reproductive life. I agree that, if a midwife is licensed, that should mean she has a certain level of education and experience (or the license is meaningless), and should be held accountable if she fudges that. (Actually, I think an unlicensed midwife should be hit hard if she lies about her experience and education, too. I'd guess that, after the fact, it would be hard to prove what she did or didn't claim, though.)
I think this should be done because there have been several instances of negligent or at least incompetent midwives being responsible for the deaths of babies.
And while there are incompetent, negligent doctors too (see the story of Lisa1970), if a doctor messes up, you can sue his pants off. It's not possible to do that with midwives, since, amongst other things, they don't usually carry malpractice.
Malpractice insurance protects the person being sued. It doesn't enable a lawsuit. If I wanted to sue an unlicensed provider, who didn't carry insurance, I could still do it. It's just that 1) I may not receive as much (as any award is limited to what they actually own), and 2) it would hurt them a lot more than someone with insurance (whose rates go up, but isn't in danger of losing their home, car, etc. etc.). In any case, I have no desire to sue anyone's pants off, unless they do a c-section on me while they're drunk, or something equally egregious. I consider it a simple fact of life that doctors and midwives make mistakes, and those mistakes can be very serious. I don't consider that to be malpractice (no matter how "malpractice" is defined in law) - I consider that to be human.
So I feel that if you can't sue if things go wrong, the parents should at least receive help in picking a midwive that WON'T mess up and I think that the current amount and quality of information available (and the lengths you need to go to to find it) make that next to impossible.
Help from whom? I know of several midwives that I wouldn't use. I know of several other people who have had bad outcomes with midwives that I can't identify. But, if I were birthing in those people's areas, I'd definitely get in touch and ask for more information.
So for starters, there might not be a lot of parents that are not good at doing research, but even if they are few, they deserve to get the information they need in order to make an informed choice. They need to know that if things go south, the midwife will be able to recognize that, recognize it in a timely fashion, that she has made appropriate provisions for transfer to a hopsital where complicaitons can be dealt with and that she will be able to stabilize the situation until they arrive at the hospital. The information you currently find on the internet concerning such a situation is completely insufficient.
That's actually more information than I've ever had about a doctor - it's just assumed that they know all those things. In any case, there is no way to have this information, because all births are subjective, and there's no way to know how things will go south, if they do. I lost my son in a hospital (yes, after a homebirth transfer). I had continuous EFM, and was actually waiting for a c-section (not because things had gone south - the only reason I was ever given by hospital staff for needing a c-section was that I'd already had three). Nobody knew things were going south, except that I'd exceeded guidelines on how long I'd been in labour, until his heart simply stopped - no decels. Since I was in a hospital at that point, everything's fine, and the hospital staff are presumed to have done everything right, and "everything they could". If the exact same thing had happened while I was still at home, people would have been screaming for my midwife's head, and accusing her of incompetence. If all the OB's experience, and the L&D nurse's experience, and a decision to incision time of less than 10 minutes (to the best of my recollection, it may have been under 5, but I've misplaced my records and can't check), were insufficient to prevent my son's death, then what "information" from a homebirth midwife could have done so? She could have handled many other situations (I know women she's attended who have had complications, which have been handled well), but there's no way to "stabilize" a stopped heart.
FWIW, the hospital staff made one or two minor errors, imo. I have no idea if they'd have been able to save my son if they hadn't, but I'm not out for revenge or payback. The mistakes they made were only human.
It's good that you and paigekitten have mad researching skillz....but not everybody does and it shouldn't be a requirement for parents that are looking for ways to have their kids safely.
I never said that I have "mad researching skillz". But, any care provider, doctor or midwife, licensed or not, can have skeletons in their closet. Having a license or being regulated doesn't mean you never screw up, or that you can do everything you claim you can.
The bottom line is that people can set up whatever licensing or regulation they want to. I can't stop them. But, as a pregnant woman (to be clear, I'm actually not pregnant - I'm done having babies), I also have the right to choose a care provider who suits me, whether or not my pregnancy fits into the guidelines required by a regulatory board. I've never had a baby safely, except for an externally imposed definition of "safe", and that's partly because of the guidelines and regulations put in place to "protect" me. (At least one of my c-sections was done almost entirely to protect the OB from a potential lawsuit, because I was outside guidelines on length of gestation. The really sick aspect of that is that I wouldn't have sued, and that c-section did permanent physical damage to my pelvis...for which I have no legal recourse, because he was "within guidelines". The rules protected him, not me...except that I wouldn't have sued for that, either.) I like the fact that there are unlicensed, "rogue" midwives, because they maintain an element of choice that's utterly absent in the regulated system.