midwife under fire in MO - Page 2

[MsBlack]

Multimomma--

you asked about maternal mortality rates: YES, childbearing women are more likely to die in hospitals than at home--the actual % of maternal deaths in hospital birth is greater than for homebirth. This is primarily because of our nationwide cesarean rate (30% plus, depending on region/hospital/OB); and women are 2-3 times more likely to die as a result of cesarian complications than from natural birth (postpartum hem, wound infection, other). Repeat cesareans raise the maternal mortality rate even more, because the risks of cesarean surgery elevate greatly with each successive surgery. If you go to ICAN's website, you can see the stats and studies.

ican-online.org (probably looking for the 'white papers' link on homepage will be best way to find quick answers).

[MeepyCat]

Earlier someone said I was 'blaming the parents', but I am talking about responsibility, not blame. "Taking responsibility", for me, is about being able to respond--being committed to responding on your own behalf to life's conditions. Yes, we should be able to trust care providers, and safely empower them to do things with/for us that help us get the safe happy birth we want. Just as much as we trust ourselves, our own knowledge and intuition about our life situations. Just as much as we empower ourselves to act toward health and safety.

MsBlack, I don't know if you understand what a terrible advocate you are being for midwifery here.

How is a laboring woman supposed to "take responsibility" and "respond to life's conditions"? Practically speaking? Am I, in labor, supposed to be able to recognize the signs of shoulder dystocia and coach the people around me concerning what to do about if Gaskin maneuvers have no effect (or if I'm already on hands and knees and Gaskin maneuvers will, therefore, do nothing)? Am I supposed to be able to identify exactly how large a splotch of blood indicates dangerous bleeding? To massage my own uterus to stop the hemorrhage while running an IV line for a transfusion?

And then let's throw in the fact that medical conditions - like shock, blood loss, and intense labor - are KNOWN, and UNDERSTOOD to affect cognitive processes.

I think that laboring mothers have every reason to choose to hand power and responsibility to professionals in these circumstances. When things go wrong and mothers aren't able to identify and respond to the problems, my first thought isn't "the mom should have done something," it's "the mom was in labor." The midwife doesn't have that excuse.

If the midwife cannot be relied upon for anything, if whenever something goes wrong with a midwife, it will be explained that the patient should have been more on the ball - well, what's the point of hiring a midwife? If I go to a hospital and my baby dies, at least I can be assured that there will be a thorough investigation into what happened and how it can be prevented from happening again.

You mention the case of an OB in San Diego who killed a baby during a botched vaccuum extraction. I remember that case. In that case, advocates of hospital birth didn't line up to defend that guy - they acknowledged that he had acted badly, that he had caused a baby's death, and that he shouldn't be practicing.

[MsBlack]

Yes, Meepycat--as Hermione Granger once said: "well spotted!" I am not trying to be a good advocate for midwifery--not exclusively-- nor even as much as my desire to advocate for safe birth and happy families.

Anyway, to me, this active self-empowerment and self-advocacy has to start WA-A-A-Y-Y-Y before an 'emergency point' is ever reached at birth, when a woman (as you astutely point out) is simply not able to think straight. When people do empower and inform themselves, they are just much less likely to need to 'think straight' in an emergency birth situation. This is because EITHER they will already have reached well-placed trust in their provider (instead of 'blind trust'), OR, they will have avoided an emergency in the first place--through self-care as well as self-advocacy.

I am trying to advocate for happy families and safe birth anywhere and with anyone, by trying to help de-construct our standing mythos concerning health care and personal power. That mythos is that the most important parts of knowledge belong to providers, and that therefore the power should rest with them. Generally in our health care, we are grossly under-informed and give way too much power to our health care providers. But no one needs a medical or midwifery degree to know 'enough' for making good decisions; and giving up all of our power is always a mistake.

Boiling it down to a couple of basic points, IMO:

1. of first importance to a safe birth is sufficiently informed and fully self-responsible self-care--ONLY a woman can grow and a birth a baby.

2. 2nd, know your midwife or doctor very well: ask the hard questions before you hire someone, don't take flimsy reassurances for an answer to important questions. Don't go on your friends' happy experiences--find out the down side because every practitioner has one. Risk is part of life, and birth; we can't eliminate it but we sure shouldn't dismiss it from our minds because we 'like' a mw or OB, or know happy former clients.

3. Insist on fully informed consent, all the way through care. Make real decisions based on evidence along with your own values, rather than taking anyone's word for it. MDC is full of stories of moms/fams who do this!

4. Insist on exercising your own intuition and being respected in that. Your care provider should be trying to elicit your intuitive knowing, and should find your hunches as important or even more so than their knowledge or intuition.

Meepycat, I'm pretty sure that a lot of midwives would agree with you--that I am not being a good advocate for midwives Unfortunately, some mws are just as happy as any OB is, to be the Hero to families and don't want pesky questions or any interference with their decisionmaking. Luckily, advocating for midwifery is not my intent even if it wins me no friends in the professional sphere. Safety is my biggest concern.

Pulling this world out of the mess it's in, by encouraging greater self-empowerment by individuals in all realms of life, is my larger goal.

Yes, all mws and health providers SHOULD be competent; we should be able to trust them a lot--with our lives, in a real sense. And no matter how skilled a provider is, giving them all the power has turned out to do us all a lot more harm than good. Hey, great if there is someone to sue or prosecute if things go badly, right? But as for 'responsibility' goes--well, only the family will have to 'be able to respond' to events in their own lives. Giving up our power to midwives, OBs, or anyone isn't just a mistake--it's the grandest delusion of all, given that only a family will live now and forever with their choices, giving up all power turns out to be far more destructive than helpful.

Who do you want to be, if tragedy occurs at your birth? Someone grieving, who feels entirely ok about all choices made, and trust placed...or someone grieving who has someone to blame/prosecute--and who may 'win' the case but STILL has to live with possibly poor choices made and trust misplaced?

[MeepyCat]

Anyway, to me, this active self-empowerment and self-advocacy has to start WA-A-A-Y-Y-Y before an 'emergency point' is ever reached at birth, when a woman (as you astutely point out) is simply not able to think straight. When people do empower and inform themselves, they are just much less likely to need to 'think straight' in an emergency birth situation. This is because EITHER they will already have reached well-placed trust in their provider (instead of 'blind trust'), OR, they will have avoided an emergency in the first place--through self-care as well as self-advocacy.

Without licensure and reporting, how is anyone supposed to be able to accurately evaluate a care provider? Without these things, it's possible for any professional to hugely misrepresent their record (this has been done in a number of professions, including midwifery, and the self-reporting you advocate doesn't solve the problem - it just removes professional consequence for negligent practitioners). Without licensure and reporting, parents would have to basically run a personal background check including a private investigator to be sure that there are no really alarming skeletons in the midwife's closet, and that they aren't blindly trusting someone who shouldn't be trusted.

Your suggestion that self-care and self-advocacy in advance can prevent childbirth emergencies is laughable. So many of the problems that arise in childbirth are temporary crises, which we cannot effectively act to prevent.

I am trying to advocate for happy families and safe birth anywhere and with anyone, by trying to help de-construct our standing mythos concerning health care and personal power. That mythos is that the most important parts of knowledge belong to providers, and that therefore the power should rest with them. Generally in our health care, we are grossly under-informed and give way too much power to our health care providers. But no one needs a medical or midwifery degree to know 'enough' for making good decisions; and giving up all of our power is always a mistake.

The only births I have ever been present for have been the births in which I was involved. That's fine for me - I haven't chosen to make birth my profession. There's a limited number of things that any person can be an expert in, we choose, we specialize, and then we find ways to share our expertise. No, I don't need a medical or midwifery degree to attempt to make good decisions for my family, but without the expertise represented by those degrees, I might well not know when choices need to be made, or what the risks and benefits of those choices are. I certainly don't have any guarantee that I will know what it looks like when those choices arise.

No one can become an expert on childbirth - normal or otherwise - in nine months to a year of even very highly motivated personal study. Expertise in this field involves a great deal of experience. Midwives should, as professionals, be willing and able to demonstrate that they do actually have expertise and experience to offer, so that they can be of meaningful assistance.

[MsBlack]

Originally Posted by MeepyCat

Without licensure and reporting, how is anyone supposed to be able to accurately evaluate a care provider? Without these things, it's possible for any professional to hugely misrepresent their record (this has been done in a number of professions, including midwifery, and the self-reporting you advocate doesn't solve the problem - it just removes professional consequence for negligent practitioners). Without licensure and reporting, parents would have to basically run a personal background check including a private investigator to be sure that there are no really alarming skeletons in the midwife's closet, and that they aren't blindly trusting someone who shouldn't be trusted.

Your suggestion that self-care and self-advocacy in advance can prevent childbirth emergencies is laughable. So many of the problems that arise in childbirth are temporary crises, which we cannot effectively act to prevent.



The only births I have ever been present for have been the births in which I was involved. That's fine for me - I haven't chosen to make birth my profession. There's a limited number of things that any person can be an expert in, we choose, we specialize, and then we find ways to share our expertise. No, I don't need a medical or midwifery degree to attempt to make good decisions for my family, but without the expertise represented by those degrees, I might well not know when choices need to be made, or what the risks and benefits of those choices are. I certainly don't have any guarantee that I will know what it looks like when those choices arise.

No one can become an expert on childbirth - normal or otherwise - in nine months to a year of even very highly motivated personal study. Expertise in this field involves a great deal of experience. Midwives should, as professionals, be willing and able to demonstrate that they do actually have expertise and experience to offer, so that they can be of meaningful assistance.

Seems to me the mistake we make is assuming that a licensed professional can be blindly trusted. Anyone can have skeletons in their closet--of many sorts, including practice violations--that might be found with some searching. Most people don't do that search with their licensed professionals, OR the unlicensed ones...but IMO, should be doing some kind of searching on both kinds. Our licensing system is no sort of guarantee of safe, respectful, competent practice.

You are right--there are birth emergencies that cannot be prevented by advance choices. There are also birth emergencies that no one can 'manage safely'--they are fatal in and of themselves, no matter where or with whom you give birth. These both are in the smallest categories of problems arising at birth; there are many many more problems that CAN be prevented through self-care and self-advocacy--that is, the healthier the mom/baby going into birth, the more informed and prepared the family, the lower their risk for any kind of birth problems. It seems that this is something you don't understand very well--perhaps you haven't looked into it very deeply yet. But it doesn't make your point any stronger, by calling my point 'laughable'. This IS something that I have looked into deeply, over many years now. And again, it's not only about prevention (which isn't always possible) but also about how we feel about what happens, whether or not we feel that we made the best possible choices along the way.

As for expertise--yes, there is a reason for it in health care, and no, no one is going to have the same level of understanding of all the issues around some problem or another in pregnancy/birth. But let's take the example of prolonged rupture of membranes: the average person can understand the basic facts about it, and make sound decisions regarding it. This is something that a birth provider can explain to families, including risks, benefits, precautions, possible courses of care. I've seen it go both ways at home: families who choose to tranfer care to hospital w/prolonged rupture, solely based on risk factors and not on observable poor signs; those who choose to stay home with prolonged rupture, taking precautions and closely monitoring signs. This is info that I think needs to be shared with families, who are encouraged to be actively engaged in decisionmaking. On the other hand, you have OBs with ridiculous protocols such as having all moms with ruptured membranes IN the hospital immediately, and IN bed constantly, induced/augmented ASAP, w/csec in an arbitrary # of hours; this is not evidence based practice and families are not given good info or allowed to make decisions.

there are many such examples that exist in pregnancy/birth--most often, there is plenty of time to provide info and make decisions. This is where most care providers fall way too short--whether licensed or not. It is also where families sell themselves short; how many needless csecs and other interventions, so many of them causing all kinds of harm even if mom/baby make it through ok, because famiilies just go with our cultural mythos that Dr (or mw) knows best?

When it comes to the true (and rare) emergencies at birth, obviously there is going to be no committee meeting about what to do! Then, of course we have to trust our care providers to take timely appropriate action that we cannot decide or do for ourselves. I still submit that one's trust can best be placed when placed in a provider who has already proven various things about him/herself: knowledge, integrity, humility, a sincere desire to share the knowledge and power (instead of dominating the relationship), and a committment to fully informed choice by families.

Life, birth and licensing provide no guarantees. IME, the best we can do is remain awake, as involved and responsible as possible, and ready for what life brings us. I want for all midwives to be as knowledgeable and skilled as possible, with high integrity and sufficient humility about their limitations. And that will still never replace families doing their whole part; yes, we must at times trust our care providers with our lives, but we must still own our decision to do so. We have to be realistic about the conditions we face, and face them more mindful of our own well-being than we expect anyone else to be.

[sg784]

Originally Posted by MsBlack

Seems to me the mistake we make is assuming that a licensed professional can be blindly trusted. Anyone can have skeletons in their closet--of many sorts, including practice violations--that might be found with some searching. Most people don't do that search with their licensed professionals, OR the unlicensed ones...but IMO, should be doing some kind of searching on both kinds. Our licensing system is no sort of guarantee of safe, respectful, competent practice.

You are right--there are birth emergencies that cannot be prevented by advance choices. There are also birth emergencies that no one can 'manage safely'--they are fatal in and of themselves, no matter where or with whom you give birth. These both are in the smallest categories of problems arising at birth; there are many many more problems that CAN be prevented through self-care and self-advocacy--that is, the healthier the mom/baby going into birth, the more informed and prepared the family, the lower their risk for any kind of birth problems. It seems that this is something you don't understand very well--perhaps you haven't looked into it very deeply yet. But it doesn't make your point any stronger, by calling my point 'laughable'. This IS something that I have looked into deeply, over many years now. And again, it's not only about prevention (which isn't always possible) but also about how we feel about what happens, whether or not we feel that we made the best possible choices along the way.

As for expertise--yes, there is a reason for it in health care, and no, no one is going to have the same level of understanding of all the issues around some problem or another in pregnancy/birth. But let's take the example of prolonged rupture of membranes: the average person can understand the basic facts about it, and make sound decisions regarding it. This is something that a birth provider can explain to families, including risks, benefits, precautions, possible courses of care. I've seen it go both ways at home: families who choose to tranfer care to hospital w/prolonged rupture, solely based on risk factors and not on observable poor signs; those who choose to stay home with prolonged rupture, taking precautions and closely monitoring signs. This is info that I think needs to be shared with families, who are encouraged to be actively engaged in decisionmaking. On the other hand, you have OBs with ridiculous protocols such as having all moms with ruptured membranes IN the hospital immediately, and IN bed constantly, induced/augmented ASAP, w/csec in an arbitrary # of hours; this is not evidence based practice and families are not given good info or allowed to make decisions.

there are many such examples that exist in pregnancy/birth--most often, there is plenty of time to provide info and make decisions. This is where most care providers fall way too short--whether licensed or not. It is also where families sell themselves short; how many needless csecs and other interventions, so many of them causing all kinds of harm even if mom/baby make it through ok, because famiilies just go with our cultural mythos that Dr (or mw) knows best?

When it comes to the true (and rare) emergencies at birth, obviously there is going to be no committee meeting about what to do! Then, of course we have to trust our care providers to take timely appropriate action that we cannot decide or do for ourselves. I still submit that one's trust can best be placed when placed in a provider who has already proven various things about him/herself: knowledge, integrity, humility, a sincere desire to share the knowledge and power (instead of dominating the relationship), and a committment to fully informed choice by families.

Life, birth and licensing provide no guarantees. IME, the best we can do is remain awake, as involved and responsible as possible, and ready for what life brings us. I want for all midwives to be as knowledgeable and skilled as possible, with high integrity and sufficient humility about their limitations. And that will still never replace families doing their whole part; yes, we must at times trust our care providers with our lives, but we must still own our decision to do so. We have to be realistic about the conditions we face, and face them more mindful of our own well-being than we expect anyone else to be.

Originally Posted by Multimomma

I cannot back this at all, in the slightest. I cannot support a midwife who is not qualified to help birth. I don't know if this is the truth in this particular case, but to just jump on and defend her is unconscionable to me. People hire midwives to help birth because our society is not one that readily provides a natural understanding of how birth works.

Multimomma, its not up to you or anyone else to decide how qualified this woman is or isnt to help anyone give birth. It was up to the woman who chose her. Its about responsibility. Part of what makes homebirth so hugely different from hospital birth is who is taking the responsibility. If you walk into a hospital you are handing all your responsibility for yourself and your baby to those authorities. With a homebirth, you keep it, or share it with your provider.

As much as the BOBB and the big push has "helped" the homebirth "movement" I feel like it has done it grave injustice. I feel like the attitude is now is more so that people are expecting a hospital birth in the home. They think its "the same" because after all, you have a midwife! Women expect to be "saved" they expect their baby to be "saved" and its not right.

Midwives can not save anyone. The CPM credential does not save anyone. There are loads of DEM's that have waaaay more experience and education than the avg CPM, never-mind the newly certified cpm. CPM does not mean "qualified savior of mothers and babies" And as much as it is the parents responsibility to interview and find the right provide, it is also the mw's responsibility to screen clients. I know a mw who asks every client "what happens if the baby dies?" Well, thats a sobering question for a prenatal, isnt it?! Not many think about that, do they! Usually they're thinking the same thing as the family who goes to the hospital. "well, if anything goes wrong they'll handle it". Handing over the responsibility to a medical "authority" and if they screw up, they have someone to sue. These are not the kind of people who should be having home births. If you expect your "medical provider" to save you or your baby then get to a hospital. End of story.

There are women who will chose to UC and other women who will choose a DEM or a woman who simply has a lot of birth knowledge/experience. The point is, it SHOULD be a choice. Allowing the state or whoever to decide that someone is qualified but someone else isn't, simply takes that choice away.

I wish you'd poke around on the UC board here --there have been quite a few good discussions on responsibility in birth.

[Multimomma]

Originally Posted by sg784

Multimomma, its not up to you or anyone else to decide how qualified this woman is or isnt to help anyone give birth. It was up to the woman who chose her. Its about responsibility. Part of what makes homebirth so hugely different from hospital birth is who is taking the responsibility. If you walk into a hospital you are handing all your responsibility for yourself and your baby to those authorities. With a homebirth, you keep it, or share it with your provider.

As much as the BOBB and the big push has "helped" the homebirth "movement" I feel like it has done it grave injustice. I feel like the attitude is now is more so that people are expecting a hospital birth in the home. They think its "the same" because after all, you have a midwife! Women expect to be "saved" they expect their baby to be "saved" and its not right.

Midwives can not save anyone. The CPM credential does not save anyone. There are loads of DEM's that have waaaay more experience and education than the avg CPM, never-mind the newly certified cpm. CPM does not mean "qualified savior of mothers and babies" And as much as it is the parents responsibility to interview and find the right provide, it is also the mw's responsibility to screen clients. I know a mw who asks every client "what happens if the baby dies?" Well, thats a sobering question for a prenatal, isnt it?! Not many think about that, do they! Usually they're thinking the same thing as the family who goes to the hospital. "well, if anything goes wrong they'll handle it". Handing over the responsibility to a medical "authority" and if they screw up, they have someone to sue. These are not the kind of people who should be having home births. If you expect your "medical provider" to save you or your baby then get to a hospital. End of story.

There are women who will chose to UC and other women who will choose a DEM or a woman who simply has a lot of birth knowledge/experience. The point is, it SHOULD be a choice. Allowing the state or whoever to decide that someone is qualified but someone else isn't, simply takes that choice away.

I wish you'd poke around on the UC board here --there have been quite a few good discussions on responsibility in birth.

Bold the first: When a thread is started asking us to contact people to support her, yes, I do want to decide how qualified she is before I do so.
Bold the second: No. Even with a hospital birth, you retain rights and privileges. I had a much freer birth with my fifth child in the hospital, than I did with the midwife from my first birth. Because i was educated by then. However, most people don't have five children, and get that kind of practice.
Bold the third: I don't know what this is supposed to mean. Midwives can't save anyone? So, if I have a full on SD, that I couldn't resolve myself, my midwife couldn't help deliver the baby using maneuvers and 'save me'? Could you please explain this?
Bold the fourth: I had my first UC seven and a half years ago. I've had two since. I have been active on the UC board, and read many of the threads on responsibility.

[Multimomma]

Originally Posted by MsBlack

Multimomma--

you asked about maternal mortality rates: YES, childbearing women are more likely to die in hospitals than at home

Thanks for the verification and the links. Do you know how the numbers are affected by women who are transfered and/or booted from midwifery care? I'll look at the ICAN website, it's a good one and I didn't think about it for the stats.

[MsBlack]

Originally Posted by Multimomma

Thanks for the verification and the links. Do you know how the numbers are affected by women who are transfered and/or booted from midwifery care? I'll look at the ICAN website, it's a good one and I didn't think about it for the stats.

No, I don't know anything specific to maternal deaths where care originated at home. HOwever--logically thinking, I extremely doubt that the US' overall maternal mortality rate is impacted in any significant degree by homebirth transfers: the US homebirth rate is 1-2%. The 'national average' of homebirth transfers is about 10% (I've seen this cited as a 'normal' rate for prudent care, and have heard many mws state that their own transfer rate is about 10%). So--if we say that the homebirth rate is 2% of all births, and 10% transfer care to hospital, then statistically speaking that is .2% of women who end up in the hospital who originated with homebirth (2 of every 1000 birthing women, home OR hosp. birth plans). Which is a very small number of women--and of course, very few of them die, once at the hospital.

Does that make sense? Let me try this instead, attaching some actual numbers to clarify:

10,000 birthing women total
200 with homebirth plans (2%)
20 who transfer from home to hospital (10% of homebirth-intending women)

So--only 20 of 10,000 women who give birth altogether, were transfers from hb care. Maybe you can see that it is such a small pool of women that even if a few maternal deaths occur relating to hb care specifically, it's not going to raise the overall maternal mortality rate in a visible way.

Over 30yrs, I've only heard a very few maternal death stories at home, or in hospital following transfer of care. Very, very few--and one was the story famous in Florida a few years back, where 'religious mws' let a mom bleed to death over the course of a couple of days, praying over her and exhorting her to have faith that she could be healed by Divine Intervention (but she had a blood clotting disorder...).

Maternal deaths are mainly related to surgery complications and infections (whether originating from surgery or not). A fairly large number of maternal deaths are women with multiple csecs, because csec, and especially multiple csec, significantly elevates maternal risk for MANY issues compared to women who've never had surgery. Again, see the ican site White Papers pages.

[Multimomma]

Thanks MsBlack...very useful!

[MsBlack]

Originally Posted by sg784 

I want you to take a good look at what you're saying. Only "state licensed, certified, legal midwives" and only "legal" births should be promoted. All this does is give the state or governing authority ALL of the expectant mothers power. Its wrong.

I am lucky enough to live in a state where there is no licensure no regulation, and every choice is the mothers. The mother gets to decide who is qualified to attend her. The mother. Not some governing authority. When you take birth from the mother and hand it to anyone, you are not practicing midwifery. Midwife means WITH woman. It is up to the woman to choose who is qualified to stand WITH HER. Period. The end.

When the provider makes the choice--or fights for the choice--they are fighting for themselves--serving themselves, serving their pocketbooks, their fears, their issues! Until we begin to put mama's and baby's first, we will loose this battle time and time again and it will be the mama's and baby's that suffer-- eventually the majority of the women who will be seeking home births will not be able to find someone to help them because their states will have decided they are not candidates for home birth because of this or that!

It is vital we stand behind unlicensed midwives, who are committed to their women, babies and families and their choices over any governing authority. It is critical. The whole licensure thing is identical to what happened to the Granny midwives of old--they were trashed, discredited, run off the scene and this is exactly what is going to happen to the very skilled, wonderful, highly capable "direct entry" or "lay midwives" who choose to serve mama's and babies, not the Big Push, or any certifying or licensing agency!

Yes, every mom should have a choice--but the choices are already out there! Leave things alone OR if you must fight--fight for the right people--mothers/baby's NOT midwives.

Some have said on this thread that they are leery of supporting a mw who may not have performed according to safe standards in a particular birth.  This makes sense to me--and since I don't know the mw or anything about the birth except from media reports, I really can't say if I 'support the mw' herself.  Yet I still support her in her pursuit of justice, because to me, this case is NOT about her or that birth.  It is about the power of parents to make their own decisions, and about working to curtail the gov's power in our personal lives.   

For me the point of supporting this case *somehow* lies in sg784's words above.  Unfortunately, such a case is never going to be simply 'about a mw and a birth'--cases against mws have been brought up numerous times in the past 30+ years (ever since homebirth re-emerged), and these cases are increasingly used to make court-judgements and laws that affect all of us.  Those judgements and laws ALL concern our power of choice, our individual freedoms and the State's place in all of that. 

I can't remember the mw's name right now, but there was a big case against a PA mw a couple years back, that went into the higher courts.  The judge who made the last ruling said some very

scary things about the State's place in people's lives--directly stating that the State has a legal interest in the birth/health of citizens...sorry to be so fuzzy here, hopefuly I can find a link and quote him exactly.  The point is that his ruling represented another weakening of individual rights, and a greater establishment of the gov's power to make choices for us. 

Seems to me more and more in recent years, we are surrendering our individual rights and personal responsibility to a gov that treats us more and more as children in need of State guidance; the State behaves more and more as the Parent who must make decisions for us in order to save us from ourselves.  sg784 also said that 'a CPM can't save you'....and what I heard in that statement is that a CPM can't save you from the way life, and birth, IS...can't save you from the reality of personal responsibility'.  The gov, more and more, is trying to save us from ourselves, and save us from personal responsibility as well.

And what many do not seem to really comprehend is the degree of political power held by the medical institution.  The problem is that at this point, the gov takes the words of med professionals as absolute truth about health and birth; it's a case of 'straight from the AMA's mouth to the gov's ear'.  The gov doesn't know beans about health or health care, nothing about all the many valuable alternatives to western medicine; it relies upon 'experts' (lobbyists, consultants) to understand any of it. Never mind if an experienced mw is the true 'expert' on normal birth; only someone with a med degree is considered 'expert enough' to get the gov's ear.  The gov has no apparent concept of how much illicit power is held by the med institution, NOT because it is a 'better way' but only because of political and finacial tactics used by the AMA to gain and keep the gov's attention.

 How many cases have we seen of forced medical care in recent years?  People taken to court to argue over csec, or other medical matters where the family wanted a choice different from the med institution's will for them?  Why on earth are courts even making themselves available to this kind of case?  Just as the MO Supreme Court ruled that the the MO medical Assoc had no 'standing' to argue against the CPM law (basically, the courts said 'this is none of their business; this argument does not belong in court')...just as the MO Sup. Ct made that ruling, so can other judges everywhere refuse to hear cases concerning family choices in health care.  Yet the courts DO hear these cases, and too often rule in favor of the doctors--ruling AGAINST individual choice/rights.  We have to think about this if we are not to surrender even more power in our health care and lives. We have to realize that the AMA has won far too much power in our govs--that the AMA is ONLY a professional guild looking to serve it's own profits.  And they have found THE best way to maximize profit: to have a gov-endorsed monopoly in health care; to become, in essence, the 'medical branch of gov'. 

So to me,  this case against Elaine Diamond is nothing so much as a way for the AMA to further consolidate power and profits, by striking another blow against homebirth and family choices.  Supporting her case is an opportunity for us to counteract the growing trend of our gov in assuming more and more power in our lives.  An opportunity to counteract the growing trend of the AMA to form itself as "The State Medicine", whose permission and practitioners we MUST utilize perforce of law. 

I don't ask anyone to surrender their personal opinion about the way a birth was managed by a particular mw (though I do ask you to remember that we really DON''T KNOW enough of the facts to make a clear assessment).  I'm not saying you 'should' support her.  I am saying that if we don't look beyond the particulars to the Bigger Picture as it impacts us all, we will ALL continue to lose more ground.  I am saying--support Elaine's case somehow, only in support of your own rights to choose in birth and all of your health care.