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can we have an honest discussion? - Page 15

post #281 of 301

I am sorry, but, is that it?? That's all that is needed for a midwifery "education"?? LOL
 

Is it a 4 years BS/BA?? Seeing as to how it doesn't have any actual college courses offered, my opinion stands.

 

http://www.fhs.mcmaster.ca/midwifery/about/courses.htm Now, how does this compare to CPM "educational requirements"??

post #282 of 301
Quote:
Originally Posted by mommato5 View Post

 

Then, where is the info going to come from. That is the closest we are going to get. Granted, I do know colorado publishes their information and I think Washington does too.



Better to provide no information at all than information that, in the context of a homebirth safety discussion, is misleading, inaccurate, and/or disingenuous.

 

But then, this thread wasn't supposed to be one more homebirth safety debate that you can find all over the web.  I'm sorry to see it take that turn when it began with the noble intention of ensuring women's safety in homebirth. 

 

Liz, you may have checked out by now, but it's really difficult for me (and a lot of us) to have this conversation unless, where relevant, equity is considered in the reforms.  If transparency (e.g. of stats) is expected from mw's, we need to expect it from OBs.  If we get rid of the conflicts of interest with mw's (e.g. formal complaints filed to their peers on the State Midwifery Board), we need to get rid of them with OBs (e..g formal complaints filed with the State Board of Medicine).  A ratings system set up to ferret out abusive midwives needs to do the same with abusive in-hospital providers.  Too many of us have been bruised by Big Obstetrics to ignore the problem that it poses for women.  Women need safety and transparency regardless of where they choose to give birth.   

post #283 of 301

Mommato5-I really just do not know what else to say.  I struggle with this subject because of stories like yours.  From what I know of the midwife you hired, there are more horror stories behind her than just yours.  It may be that more education would have helped her but to be perfectly honest, maybe not.  Perhaps she has terrible judgement.  There are so many CPM's that I know with the same training that I linked to that have excellent stats and who provide excellent, safe care.  Cara Muhlhahn was a Columbia University trained CNM who attended a homebirth in NYC and the baby died.  Did she not have enough training?  Perhaps her judgement in the case of this family was poor.  I don't know.  I do know that just because your CPM was crappy and because Liz's CPM made many crucial errors does not mean that all CPM's would have made the same mistakes.  I understand your deisre to protect women from midwives like the one you had.  I want to protect women from incompetent providers as well but I think what makes those providers incompetent is complex.  Simply requiring more schooling, more births may make you feel better but in the case of the CNM I mentioned above, more just may have been more.  I believe it has a lot to do with the attitude the midwife has and the respect she has for the power and wild nature of birth.  Her attitude about birth should have just as much bearing on whether or not a woman hires her as her education, training and experience.

 

Just as an aside, did you know what training/education your midwife had?  If you did, were you uneasy about it?  Did you feel it wasn't enough before your baby died?  I'm not trying to be snarky by asking those questions.  I'm genuinely curious.  To me, it sounds as though your midwife has a real problem that goes way beyond insufficient education and I only say that because having as many deaths as she had in such a short period of time is a statistical anamoly.  Maybe I misunderstood but I thought I read somewhere that she had been before a Grand Jury for other deaths in the same year your baby died.  Is that correct or do I have you mixed up with someone else?

post #284 of 301
Quote:
Originally Posted by firewoman View Post

Here is a link to the course schedule of my local MEAC accredited midwifery school.  This is a school focused on preparing students to pass the NARM and to become licensed midwives in California.  It is 39 months of schooling and does not include clinicals which are of course also required concurrently.

 

http://midwiferyatnizhoni.org/courses/



I've said before that I think that CPMs who are the product of structured academic programs may very well be more prepared than a largely self-educated CPM. My real beef, I think, was with the PEP process midwives, and how the lack of interaction with different types of midwives and different sources of information might allow for *some* midwives to "slip through the cracks" as they say. But I have to admit, I found the curriculum presented above to be somewhat alarming. One month to cover both the anatomy of the reproductive system and ethical considerations in reproductive health? What about anatomy and physiology of the rest of the body? Pregnancy can have drastic effects on the circulatory, respiratory, and digestive systems, it doesn't only involve the reproductive organs. One month to cover complications that may occur in the third trimester? One month to cover pharmocological treatments? How would one be able to help a client navigate a transfer or the need to seek medical care without being knowledgeable about the actions, side effects, compliocations, and benefits of the treatments that your patient may encounter?

 

What about microbiology? In order to truly understand a microorganisms effect on a person, on a pregnancy, one has to have some basic knowledge of cell structure, metabolic processes of the human and bacterial cell, and how various treatments exert their effects. How can one have an opinion on the implications of being positive for Group B strep if one doesn't have a grasp of these things? There is a difference between saying "My client has X infection, which I'm going to treat by administering X, because X source told me that it's appropriate." and saying "My client has X infection, and due to the structure and known functions of this organism, I am going to treat with X, because it interrupts a certain process needed by this bacteria, while causing minimal interruption to the cellular processes of the patient."

 

And especially alarming - two months devoted to business practices and legal issues, and then a certification in Advanced Life Support in Obstetrics is optional? It almost seems that the priority to protect the midwife is more important than caring for a patient in the event of complete disaster. I realize that the ALSO certification is additional to other coursework in this area, but IMO no competent or responsible midwife should ever opt out of the chance to be more prepared in a life or death situation, and this school shouldn't give one that option.

 

Firewoman - I hope you don't take offense to anything I am saying, if this is a program you are enrolled in or are considering. I truly believe that many, if not most, CPMs possess far more knowledge about pregnancy and birth than is presented in this program of study. Like many on this board, birth is a passion for them and that fact will drive them to learn above and beyond what is required, and they may in fact be excellent and competent care providers. But not every single MW is going to go "above and beyond". Some, hopefully a small minority, will stick to the education that is presented to them. And if the above is it, I must say, I'm less than comfortable about it.

 

We keep asking these moms who have had bad outcomes and are angry about it if they thought their midwives' education was satisfactory prior to the bad experience. Of course they did. Because a professional organization of other midwives bestowed a title and a certification on that midwife that said "Yes. This midwife is competent enough to safely attend your birth." If that midwife was truly negligent, it is the failure of the organization who certifies and licenses her, not the parent.

 

I'm starting to think that maybe there should be true "lay" midwives, who don't answer to any controlling body, be it MANA, the medical community, or the State Nursing Board, but also aren't putting themselves at legal or criminal risk. There are those women, many on these boards, who want to have a pregnancy and birth entirely free of interventions and not subject to mandated standards. They deserve that, and they are entitled to have that. They can choose a lay midwife who fits their needs without having to be concerned about said midwife having to answer to anyone but them. There won't be any confusion over licensure, education, previous outcomes, because in that situation, it truly would be just up to the parents to qualify the individual credentials of that provider.

 

And then for the rest of women who desire to birth at home, we can improve standards of care, improve education and preparation, improve safety for mom and baby, integrate MWs into the medical system, and all without compromising the desires of women who want a very traditional midwifery experience. We can require more of our CPMs, or as others have said, develop direct-entry midwifery programs like the CM program or those found in other countries.

post #285 of 301

 

Quote:
 

Firewoman - I hope you don't take offense to anything I am saying, if this is a program you are enrolled in or are considering. I truly believe that many, if not most, CPMs possess far more knowledge about pregnancy and birth than is presented in this program of study. Like many on this board, birth is a passion for them and that fact will drive them to learn above and beyond what is required, and they may in fact be excellent and competent care providers. But not every single MW is going to go "above and beyond". Some, hopefully a small minority, will stick to the education that is presented to them. And if the above is it, I must say, I'm less than comfortable about it.

 No offense taken at all.  I agree with the points you have made.  I'm the mother of 5 and have no time for school of any kind.  I tried three years ago to start nursing school but it was too hard to juggle school with my family obligations.  BTW-one of my classes was a college chemistry class with a lab that was only five weeks long.  Consolidating the information into such a short period of time makes it tough for the student, but it doesn't mean it isn't learned or revisited later in that person's education.

 

 

Quote:

We keep asking these moms who have had bad outcomes and are angry about it if they thought their midwives' education was satisfactory prior to the bad experience. Of course they did. Because a professional organization of other midwives bestowed a title and a certification on that midwife that said "Yes. This midwife is competent enough to safely attend your birth." If that midwife was truly negligent, it is the failure of the organization who certifies and licenses her, not the parent.

 I thought that I made it clear when I asked this question that I wasn't intending AT ALL to be rude or accusatory.  Maybe my question wasn't clear enough.  While these moms know that their midwives earned a CPM and that they were licensed through their states medical board, did they know exactly what that entailed or did they think that the training was similar or equal to a nurse midwife?  I'm not blaming any of these mothers for the deaths of their babies.  I don't believe it is their fault.  I can honestly say that I had very little understanding of what my midwife's education and training were.  I knew she completed school and had a license through the state of California but that was it.  I know that some mothers ask much more detailed questions than I did.   That is how I meant that question to be framed.  Liz and Mommato5 I do not think that any of what happened is your fault.  Not even a little bit.

 

Since we are having the discussion about education, does this program look any better?

http://www.midwifery.edu/undergraduatecatalogpage.php

 

post #286 of 301

Liz -- I see you are in the UK.  Please remember, the UK legal system and the US legal system are VERY different.  As a former medical malpractice attorney I can absolutely tell you that what you have been told is 100% incorrect.  Attorneys will take cases against a m/w who has no medical insurance, but they may end up settling or recommending settling for less.  Honestly, I would take the case without question (I own my own practice).  There are many ways to get $$ out of midwives.  Everyone owns assets which I can attach to here in the US.

 

post #287 of 301

I thought Liz was from Texas...

post #288 of 301

Yes from Texas... 

post #289 of 301


 

Quote:

Originally Posted by AustinMom View Post

(snip)

 

  I think that most Dr.s are not open the fact that MWs provide real care and monitoring during labor and they don't communicate well.  A transfer changes the flow of a woman's labor, and you add in that the Dr. is just then coming on in the middle of that flow and hasn't been with the mom before that.  ...

 

How do we improve it?  MWs need more respect from OBs, and I'm not sure more licensing will truly help with that.  They have to make the choice to look at them as care providers and not feminists, hippies, whatever.  I think the more OBs see normal, natural birth, the more they will see how safe MW care is. 

This has been an interesting discussion to read, and I will for sure not be able to address most of the topics here, but the above is very true.  Because they never come to the healthy, straightforward HB's, they don't see how the majority of the births CAN go.  I think the above point defines the animosity between.

 

I am a student midwife working toward my CPM credential, currently at the beginning of my apprenticeship and somewhat through my academic studies.  I have a background as a tech in "interventional cardiology."  I have a science degree.  I was going to go down the medical school path, but am glad now that I didn't get in because I would be forced to practice medicine in ways that went against my own grain/bias.

 

I could have done CNM but have chosen this path because I feel like it is the closest to ideal midwifery model of care.  I have had excellent midwifery care by both a CNM and a CPM for different births, so I know that it has to do with the midwife more than the letters after her name.

 

Thanks for a good discussion.

 

post #290 of 301

So we need to work on changing the laws!!! Not blaming the midwives. IMO It should be legal for a woman to birth how she wants. PERIOD!!! I do not think doctors or nurses or MW should treat them any differently just because they did not comei n at the first contraction, get the epidural and ect. But I have heard to many horror stories of women being treated horribly because they transferred or want a natural birth in hospitals. That is where the changes need to start. We need to have better trained MW, more schools for midwifery, and so much more. This is not a one solution problem. It has many working together.

post #291 of 301
Quote:
Originally Posted by Plaid Leopard View Post

I agree Liz. I think uniform training and regulation is key.


I agree, too.

I personally do not favor homebirth for myself but I want any mother who chooses a homebirth attendant to choose one that is well trained and licensed in some way.
post #292 of 301
Thread Starter 

i am in texas, an no lawyer is interested.

Quote:
Originally Posted by MomSmoo View Post

Liz -- I see you are in the UK.  Please remember, the UK legal system and the US legal system are VERY different.  As a former medical malpractice attorney I can absolutely tell you that what you have been told is 100% incorrect.  Attorneys will take cases against a m/w who has no medical insurance, but they may end up settling or recommending settling for less.  Honestly, I would take the case without question (I own my own practice).  There are many ways to get $$ out of midwives.  Everyone owns assets which I can attach to here in the US.

 



 

post #293 of 301

Ok, I think I read this whole thread.  

 

Now I'm really unsure.  I had a pretty good hospital experience with a CNM with my first, but seriously considering HB for this one.  Should I not trust the CDC statistics??  My state (CO) puts there stats in a newsletter every year - 6.5/1000 homebirth perinatal deaths for the past 7 years (including transferred to hospital during labor, but not including intra-uterine deaths before labor began- but that info was only available for some years) compared to state wide (all gestational ages!) 4.5/1000.  I just interviewed a local homebirth midwife and she said the reason for that is that some of the midwifes were counting deaths even if they transferred care to an OB in late pregnancy.  hmmm.   Whenever I bring this up to my homebirth friends I get a lot of hostility and "I would never birth in a hospital if I had a choice"  uh, not helpful.   

 

Have there been studies done in just the US on homebirth safety?  I know about the ones in other countries saying its "as safe".  

 

 

post #294 of 301
Quote:
Originally Posted by MrsWhite View Post

 

Have there been studies done in just the US on homebirth safety?  I know about the ones in other countries saying its "as safe".  

 

 


This is a good study of almost all homebirths in the US attended by certified midwives in 2000.

 

http://www.bmj.com/content/330/7505/1416.long

post #295 of 301

Having run the gamut in my birth experiences from FSBC to bad military hospital birth to HB with a CPM (although she didn't quite make it in time) to a horrendous hospital birth after serious complications necessitating us transferring care from our ND midwife to the hospital, I do think that the majority of the problem stems from the sometimes very hostile relationship between midwives and OBs/hospitals.  Which leads to some midwives being reluctant to transfer when they NEED to transfer, and also leads to poor outcomes.

 

I also feel that there are just some plainly incompetent midwives out there who do not need to be in practice.

 

I'm not sure how I feel about more regulation.  On some level, it would be good, because it would allow midwives who are incompetent to be reported and not allowed to practice.  On the other hand, in the current climate that exists in the US, it would make it that much more difficult for good midwives to practice.

 

My 2 FSBC births with midwives were wonderful.  I had a terrible military hospital birth with #3 that led to our decision to homebirth with a CPM.  We researched all of our options for midwives in the area carefully - and there were several.  There were a few DEMs that served the nearby Amish population that would also work with 'English' families & two CPMs.  One I was not at all comfortable with when she said she used Cytotec and the other we loved.  She had attended well over 1500 births and was a paramedic before becoming a midwife.  While she did not bring a second midwife, she did bring an apprentice midwife who was certified in ACLS and Neonatal resuscitation - and we did verify this.  When I went into labor that morning, and it became clear that she wasn't going to make it, she called a closer DEM who did make it in time - and she was there within about 3 minutes of the birth.  

 

With my last baby, we saw a ND midwife in Hawaii - she was wonderful.  I had not felt well the majority of the pregnancy, and had had many placental issues, first a SCH, then a previa that migrated.  I then developed mild pre-eclamsia.  One morning, I woke up in terrible pain, we immediately went to the hospital - where I was admitted for a suspected abruption (which I did have, as proven by the enormous clot on the placenta at delivery), but managed for pain for 10 days - where I developed HELLP, got an infection in my PICC line, got 12 blood transfusions before they decided to induce labor at 32 weeks - this after being told I would be sectioned the second day there.  I was managed by residents, and the plan changed every day with every new set of residents and attending.  

 

DS was born, whisked to the NICU, and I proceeded to have a massive PPH.  It took over 3 hours to stabilize me with multiple transfusions, and I spent the first 3 days of my son's life in the ICU.  I'm lucky that I lived.  I wish that I'd been able to find the voice to demand that they deliver him when I arrived.  I remember laying there, sobbing, watching the monitor go from 220 down to 80 and have them tell me that it was normal variability.  We were both very, very fortunate that we left the hospital intact.  If DS had crashed, they would never have gotten him out in time.  

 

What I learned from the ordeal is that even the most educated mother loses her voice to advocate for herself when she is in tremendous pain, exhausted and sick.  Even the most educated mother trusts her birth attendants to make the right choices for her and her baby during the birth process, and especially when there are complications.  

 

My point in telling this story is that when I started feeling 'off' - about 2 weeks before I abrupted, my midwife didn't just say, "Oh, here's some herbs," or "Nope, you're risked out - go to the hospital."  She ordered some lab tests, we re-evaluated based on the results, and she gave me some pretty strict parameters on what necessitated transferring care to the OBs.  She had OBs that she worked with, or I could go back to the ones I had seen through 16 weeks - as we use REI - it was our choice.  But she made it clear that she was in it for the long haul, and she would be there for the birth, regardless of who was the attendant.  I think having her there that terrible day my son was born made the difference for me sometimes.

post #296 of 301

I have found this to be a really interesting discussion and particularly appreciate the requests for transparency in OB care (and health care in general). 

 

Having worked in both home, birth center and hospital environments, I must agree with the midwife who attended my first birth: she used to tell clients "It's not the 4 walls that make you safe or unsafe--it's your attendants."  I believe that is so true.  I have seen some truly dangerous and scary providers in the hospital.  (Personally I have never encountered anyone like that doing out-of hospital births, but have heard plenty of stories and am sure they exist as well).

 

And my personal pet peeve:  how can birth centers be acceptably safe but homebirth be unsafe by definition.  If you have appropriate back-up facilities in close proximity to your home, what the heck is the difference between a birth center and a home birth?  In my city, there are a small number of CNM's doing home births who all have prescriptive privileges (and are therefore able to carry hemorrhage medications, antibiotics and oxygen), have a relationship with a collaborating physician with whom they can consult as needed and can safely transfer patients to the nearest hospital in an emergency or to the hospital where they have privileges.  Yes, they might get some flack from the hospital staff, but ultimately it is a safe system and I feel very comfortable having a homebirth in this environment.

 

Jessi

 

 

post #297 of 301

Jessi, I think you make a very good point. When bad things happen in hospitals, sometimes it takes so long to make a decision that the outcome is not good. In cases like that "proximity" doesn't matter. In fact, I've heard that women in a transfer situation are often seen more quickly than women who are actual patients in the hospital.

 

When my niece was giving birth in a hospital, the baby got caught in the birth canal and it took the doctor 45 minutes to make a decision. By that time it was too late for a c-section and the baby was essentially ripped from her, causing such severe damage to her cervix that she will probably not be able to carry another baby full-term. This was bad judgment by a bad practitioner.

 

On the other hand, the midwife practice I was seeing while planning a home birth ended up having five hospital transfers in one month, and one almost maternal loss. It came to light later that two of the midwives in the practice were fighting to the point of not speaking to each other. Two medical practitioners who share patients and who are not communicating is very scary indeed.

 

Bad things can happen, and bad decisions can be made, in any setting.

post #298 of 301

 

Quote:
 

And my personal pet peeve:  how can birth centers be acceptably safe but homebirth be unsafe by definition.  If you have appropriate back-up facilities in close proximity to your home, what the heck is the difference between a birth center and a home birth?  In my city, there are a small number of CNM's doing home births who all have prescriptive privileges (and are therefore able to carry hemorrhage medications, antibiotics and oxygen), have a relationship with a collaborating physician with whom they can consult as needed and can safely transfer patients to the nearest hospital in an emergency or to the hospital where they have privileges.  Yes, they might get some flack from the hospital staff, but ultimately it is a safe system and I feel very comfortable having a homebirth in this environment.

 

 

 

To answer your questions here I'd say that in this particular thread the argument has been more about what is perceived to be a lack of education/experience (especially dealing with complication) in a homebirth midwife not so much the venue of the birth.  There has also been discussion about homebirth midwives lack of malpractice insurance and the risks surrounding that fact.  Liz, the mother who began this discussion, had a very terrible birth which resulted in the death of her baby.  While she isn't anti-homebirth in my perception, she is concerned about some homebirth midwive's ability to assess a dangerous situation.  I think she was trying to raise awareness to what the real risks are regardless of how often they happen.  It doesn't matter if it doesn't normally happen but if what happened to her happened to me, I'm sure I'd have some real misgivings recommending homebirth with a CPM to friends.

 

In my state, CPMs carry anti-hemorrhage meds (pit and cytotec), can administer antibiotics for GBS and also carry oxygen.  I'm fairly sure that Liz's midwife carried all of these things as well, but it didn't save Aquila.  I believe that in Liz's view her midwife made several poor decisions relating to the assessment of Liz's complication which should have been very apparent to the midwife if she had intimate knowledge of Liz's particular complication.  It is the fact that she didn't recognize all of the warning signs that contributed to the bad outcome of Aquila's birth. 

 

My last three children were all born at home with the same CPM who I love and trust dearly.  I feel confident referring friends who are interested in homebirth to her.  I think any woman considering homebirth should be very selective in choosing who her attendant is.  Really, in any situation people should be selective.  Birth, particularly, can turn south in a hurry and if you are choosing to be home, be careful who you pick.  You need someone who can recognize the early signs of a potential complication. Be aware of what type of hospitals you live near.  Not all hospitals have OB's on staff 24 hours a day and if you need an emergent section and the nearest hospital has to call an OB at home to come in and section you, that can take precious time.  Also, consider the reality of what no malpractice insurance means.  Liz had a lot of hospital bills she had to pay for that she was anticipating and the whole family really could have used some greif counseling which they could not afford.  Choosing homebirth means taking full responsibility for the outcome of your birth, whatever that may be.  If you aren't comfortable with that, don't choose homebirth.


Edited by firewoman - 5/11/11 at 2:15pm
post #299 of 301

Hi liz-hippymom,

I am so sorry for your loss.

 

I have a belief.

Every , "wrong," is just a bouncing-off point for us to reach higher...

this means, maybe you ( or people like you) might take this wrong that has happened, and teach other mothers/ parents to navigate the same predicament --with power.

 

What if the world is waiting for YOUR book/video to bring this light?   A book/video that shows a woman that SHE can know, question, and partner with her caretaker instead of surrendering to their care?

 

We are taught to surrender to our teachers, to surrender to doctors, to surrender to others because they KNOW and we CAN'T. But that is an untruth.

 

Maybe you should write the book about what you with YOU knew. What you wish someone had told you. There are so many ways to get your information out! You tube ( free) Facebook (free) and self publishing websites!  I made my first video ( for kicks) and I got 10,000 hits, and this was just playing!

 

Check out this You tube video - a TED talk on  Innovation. Watch to the end and you will be crying with joy and excitement for the future of humanity through our ability to connect and reach large numbers of people with technology.

 

http://www.youtube.com/watch?v=X6Zo53M0lcY

 

Hugs,

Barbara

 

 

post #300 of 301

Sorry to have gotten off-topic with the birth center issue--as I said, just a pet peeve of mine.  And my question was sort of rhetorical.  I haven't interpreted Liz's comments to be anti-homebirth at all. 

 

I think the issue of competence in healthcare providers is not strictly a homebirth issue.  It may be that in a homebirth setting, women and their babies are more vulnerable to the mistakes of incompetent providers because there are no other "eyes" on the situation as there would be in a hospital setting.  But as I said, I have seen some very dangerous providers in the hospital setting.  I agree that there needs to be more transparency regarding outcomes and the safety of individual providers.

 

J

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