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can we have an honest discussion? - Page 3

post #41 of 301

I am glad this conversation is taking place.  I think transparency in all practices (medical and midwifery) is important.

 

I am also a CPM, and about to be an RN, and very interested personally in ensuring that 1) midwives are competent and 2) midwifery grows as a viable option (in and out of hospital).  Liz, I've read your story... and it is truly heart breaking.  In this post I am going to try to keep on topic of your original question and not speak to what I know about your story.

 

1) I think that when it comes to changing and improving the way that transfers happen in the US we need to approach it from both ends.  I do think it would be best if midwives were more integrated into the system to allow for smoother transfers, but the OB system in this country doesn't follow it's own best evidence and research.  Yes, the hospital is absolutely the best place to be for emergency management... but I have seen too many moms who were outside of my scope get way too many interventions that didn't support healthy birthing.  It is very hard position to be in when, as the midwife, you know that a mother would benefit from IV fluids or epidural rest but she doesn't need a c-section.... but the options on the other end are so limited at so many hospitals.  I think that we would have the best outcomes if we do the fewest interventions possible, while also doing necessary interventions when needed- and that is a difficult balance to find.

 

2) I do have a college degree (from an accredited college) in Midwifery.  I know that those degrees are uncommon among my peers so perhaps my perspective is influenced by my own experience.  When I was a student I went to school for 4 years, and apprenticed and took on primary care under supervision during that time.  I had been to births in the triple digits before I started my solo practice.  At the same time I had a friend who got her CNM and went to about a third as many births as I did, and many of those she only had an observer role.  Just among the midwives I know in person there is a wide range of experiences, and it isn't cut and dry where the most experienced or educated midwives always have the best outcomes.... I have thought long and hard about this and the best I can come to is that we should have a high standard for the education and experience required for all birth providers.  However, it would not serve midwifery in any way for that education to be administered or created by ACOG because midwife and physicians are different so midwives need to learn midwifery and physicians need to learn medicine.  If I had to say in general, CPM's have more experience than CNM's at the start of practice.  CPM's, because of the nature of OOH birth, have also spend a lot more time with laboring women, and with un-interventive birth than CNM's.  One of tthe strengths of that kind of experience is that CPM's can (generally & should) be able to know normal from abnormal, and know when that abnormal needs to move to another setting.  I don't think that this is something that CNM's (or MD's) can say about their training.  I have been criticized in my own community for being "too medical", even when my statistics were better then "traditional" midwives.  It is an ongoing issue within midwifery that really needs resolution... we need to stop judging one another on things that aren't the heart of the issue.  To me, it should be able the ability to provide quality care as evidenced by the statistics (which should also include measurements of client satisfaction as well as harder data).

 

3) I think that all providers should be required to track and submit all of their statistics.  I also think that this information should be made available to the public in a meaningful way.  I have worked with many great midwives and doctors over the years.  I have also, sadly, been lied to by both about their protocols and outcomes.  This makes me incredibly sad as I have a very high personal standard for integrity, but it does happen.  Requiring this kind of data gathering would be beneficial for so many reasons. 

 

The MANA stats project, as far as I know, is not keeping any information from anyone.  What I do know is that there is a team of people still working with that data and working on improving the collection methods so that it can continue to be useful.  In the CPM 2000 study (published in the BMJ), they used different filters for sorting the data than other studies.... this is not wrong, or unethical, (and it is common practice in medical research), but to be able to accurately compare data and sets the information needs to be sorted so that we can compare apples to apples and not apples to oranges.

 

4) Medical and malpractice insurance only complicate this issue further.  In this thread I have read differing points of view, all of which have some validity to them.  Neither of these issues are going to be solved simply or easily, unless we move to single payer health care in this country (and I really don't think that is what this post is about).  I think that creating consistency in the education and credentialing will help a lot on their own.

 

For me, it is important to remember that midwives have always played a vital role in caring for mothers and babies, all over the world as long as we have been giving birth.  That is not to say we cannot work to grow and change and improve (I believe we should).  It would a huge loss to women everywhere for midwifery to become medicine.

 

Very interested in hearing the thoughts of others.

post #42 of 301
Thread Starter 


thank you for your info!

Quote:
Originally Posted by Birdie B. View Post




I don't know much about the state of midwife licensing or training, but I am in Florida, and my midwife carries malpractice insurance.  As someone pointed out, malpractice can make one quicker to jump on the transfer boat, and I believe my midwife is quick to transfer. But I appreciate that. I wanted to birth at home with my first, but it didn't happen. There were no complications, but the midwife takes her licensure very seriously and transferred me for what I believe to be a minor reason. But I would rather have that than a midwife who doesn't recognize true signs of danger and refuses to transfer due to hostility toward the medical community.  I am seeing her again with this pregnancy, and while I am hoping for a homebirth, I am confident that she and I will have no issue with recognizing true signs of danger and transferring if necessary.

 

I also don't know how the malpractice ins. affects costs, but I know that her fees and the other midwives in town's fees are not out of line with what people pay in other parts of the US (according to MDC members anyway).  We have 3 or 4 lay midwives in a relatively small town, and I know women who have birthed with each of them.  The costs are not prohibitive due to malpractice requirements. I am much happier knowing that my midwife has malpractice insurance and a good relationship with doctors and hospitals in town, and I believe these things make a difference in her quality of care.

 

Liz, I am so sorry for your loss, and applaud your efforts to fix the system.
 

post #43 of 301

Silverlace: I appreciated your post as a future CPM. I don't think the CNM title means more experience or better training.

 

This issue is so complicated and emotional for so many people. Honestly this whole thread is breaking my heart.

 

I am having a hard time with this discussion. It seems like many posts are being taken as an insult or personally because of the sensitivity of the subject. If I were to speak my mind I don't think my words would be heard here. I will say this... (at risk of being flamed) I want my rights protected to choose who I want to attend my birth and would still have a homebirth (with a low risk birth) knowing that death is possible....because we are never safe from it. I think in our society it is hard to accept that.

 

liz- oh my, I feel your pain and anger and have read your blog. I can not imagine how horrible it was for you to lose your sweet baby girl. I am praying for you and your familly.

post #44 of 301

This is a subject I think about quite a bit, and I honestly have no idea what the answer is.  What I do know is that in Canada there is variation from province to province, and between different health regions of the same province, so we have some very good midwifery models, and some complete trainwrecks.  The city I live in is currently in the middle of a midwifery crisis.

 

I think the concept of informed consent and individualized care often gets overlooked in favour of setting up rules, regulations and protocols.  From my limited personal experience I find that the doctors who are the most willing to collaborate with midwives are the same ones who are willing to individualize care, and actually discuss options with the patient. 

post #45 of 301


 

Quote:
Originally Posted by ferra View Post

Silverlace: I appreciated your post as a future CPM. I don't think the CNM title means more experience or better training.

 


Ferra, I have been a CPM for years already..... I am getting my RN now for a variety of reasons... in part to work on this very issue.

 

I do think the issue of informed consent is a very important one.  And again, one that is very difficult to regulate or make consistent between providers (especially in relationship based care). 

post #46 of 301
Quote:

Yes, this is a very complicated and emotional subject.

While I believe that there should be more regulation/better training etc., I certainly agree with a pp that it should not be ACOG that determines what the regulations and standards should be. When I said that ACOG needed to inform and educate consumers, I meant that they should recognize that homebirth is an acceptable option andperhaps have a list of questions and concerns that a woman considering HB could discuss with a midwife - basically the same information that midwives generally offer, or should offer, and just as there are lists of questions that a woman should ask an OB or CNM. It is certainly possible to have a rational discussion of risks, benefits and choice without the scaremongering, and without belittling women who want to birth at home.

I used a CPM for my second birth/first homebirth, and even apprenticed with her for a while. I learned a tremendous amount with her, and I wouldn't want that type of education, tradition and wisdom to be swept aside in favor of a more medical model. I believe however that the two models can co-exist, and that the direct-entry/certified midwives could  benefit from more training and education without losing their more natural approach and overall vision of childbirth as inherently safe and normal.

post #47 of 301

Silverlace, if you don't mind my asking, what exactly prompted you to pursue a degree in nursing? Do you plan to become licensed as a nurse-midwife, or are you only interested in becoming a registered nurse in addition to a CPM? I'm just curious, I think you may have a very interesting perspective in this situation.

post #48 of 301

I think in USA it can be hard to know that your Midwife "knows her stuff". She can say all the right things, but that doesn't mean she can do all the right things. Looking at their credentials, experience, statistics, etc. are a good way, but can also be misleading sometimes too. So right now, I think it can be really hard to tell.

 

As for #2 I would really like to see something like a Board Certified Midwife. I think you should be able to take more than one route to gain that status. CNM route or a DEM route but have gone to an accredited college for Midwifery. The reason I think there should be more than one route is because there are women, like me, who have no desire to ever go to nursing school but want the Midwifery education from an accredited institution. So, that way we could have a standardized Midwifery Board just like Board Certified OBGYN, or Board Certified (fill in the blank). If not BCM, then atleast something that regulates Midwives and makes it easier for women seeking homebirth to findn the ones who are good and weed out the bad ones.

post #49 of 301


 

Quote:
Originally Posted by kythe View Post

I'm just adding: I'm sorry about the above post. I posted quickly and just realized that sounded really rude. I don't think I can edit it now though greensad.gif
 

I didn't read anything into your post.  It made sense to me.  But it is a sensitive topic for sure. 



Quote:
Originally Posted by liz-hippymom View Post


i don't know anyone, myself included, who planned for an adverse event. i was low risk i planned for a living, healthy baby. i did not get that. does that mean that if i sought compensation for my expenses i am i wrong?


Liz, a low-risk pregnancy does not mean a perfect outcome, unfortunately.  No one wants to contemplate an adverse outcome, but they do happen in all birth settings with all types of care providers.  Some of this can be controlled, and people do screw up, and even at times when no one is at fault, moms and/or babies are damaged or die in the process.

 

Quote:
Originally Posted by prothyraia View Post
As someone who is currently in nursing school in the U.S., I think that there's little benefit to midwives being required to have a general nursing degree.   RNs need to know a huge breadth of things that are entirely irrelevant to midwifery, just to pass the boards.  Chest tubes?  Geriatric issues?  Trauma?  Oncology?  Colonoscopies?  Prostate issues?  Orthopedics?  Don't get me wrong, there's a lot of general medical knowledge that IS relevant, but there's a huge amount that someone wanting to specialize in women's health and midwifery doesn't need to have even the foggiest clue about.  While I'm generally a fan of education requirements as part of provider accountability, I don't think this is a good one.  Not that there are really better options available at the moment, though.

Ooo, very good to know.  Thanks for sharing this!  Do you think it would be beneficial for CPMs to be trained as EMTs??

 

Quote:

Originally Posted by Romana View Post

I think the CNM credential is superior.  They see more complications due to required clinical experience.  And transport is terrible in this country, especially in states where homebirth with a CPM is illegal or alegal.  I have felt these pressures first-hand.  Moms reluctant to call, midwives reluctant to transfer.  It is terrible.

I disagree.  The CNM credential is managed by the medical system; the CPM credential is managed by the midwifery model of care.  VERY different care models.  My first birth was a disaster - vicious flu bug forced me into labor; CNM didn't believe I was in labor; DH took me to the hospital anyway.  Instead of being treated for dehydration, I was treated for being 9cm dilated.  I made the mistake of going with my midwife's suggestions to - break my water, labor only on my side, not change positions, purple push, and didn't know how to ask for what I wanted and needed to have a successful birth.  Now yes, I have a healthy 6 year old, but that doesn't mean that that birth experiences hasn't had HUGE effects on me, my daughter, my fertility, my sanity, and the management of subsequent pregnancies, to name just a few things here.  Transport doesn't suck here in the States because the CPM credential is sub-standard; transfer sucks because of the way that hospitals, doctors, and nurses treat midwives and their clients.
 

Good discussion, gals.

post #50 of 301

I dunno, like I said, I used a CNM, and I felt I got the midwifery model of care. Yes, she did have rules on certain things (she doesn't attend home VBACs, for example) but we had long appointments, involvement from the family, respect for my choices, home visits, accessibility at all times, natural alternatives (her office is full of info on chiropractic, doulas, etc), laboring was not 'hospital like' at all. My care was very based on ME and my choices. But my midwife wasn't silent on her feelings and the medical literature on certain things, but she didn;t FORCE those things, she simply presented the evidence. There were things that would risk you out of a homebirth...but I think these are based on her knowledge and her feelings on risk. But she also delivers at a hospital, so she does get to attend these women as well.

 

I think the knowledge gained by CNMs through their training is very important and a big reason why they have better outcomes (according to CDC data) at home and the reason why other countries have better outcomes as well.

 

post #51 of 301
Quote:
Originally Posted by aphel View Post

Silverlace, if you don't mind my asking, what exactly prompted you to pursue a degree in nursing? Do you plan to become licensed as a nurse-midwife, or are you only interested in becoming a registered nurse in addition to a CPM? I'm just curious, I think you may have a very interesting perspective in this situation.

 

Aphel- I am pursuing my RN for two reasons.  One, I learned a lot in my own midwifery education (which, like I said was a combination of college and apprenticeship) which lead me to value education which lead me to think that I might want to teach one day.... however, my BS in Midwifery is really a terminal degree that wouldn't allow me to do that (some might disagree because there are a couple of options for advanced degrees in midwifery but I have found that those degrees are not being recognized).  Along with that, I love seeing the wonderful, positive changes that come into the life of a woman (and her whole family) when she is cared for in a loving, respectful, informed way.  I am not saying that only CPM's provide that care, but I think it is more the standard than not (and vice versa with other models).  I am not saying that other providers do not care about their clients and their outcomes, but it is just an entirely different mindset.  So I have been trying to figure out how I might help bring this great kind of care to more women, especially women who cannot birth at home (for whatever reason).

 

Two, the life of a midwife (again some might disagree) is hard on family life.  There are many upsides to it- it is very meaningful and satisfying work, there is flexibility about a lot of parts (except the births) and you get to work with some really wonderful families.  But, you miss a lot of things with your won family and ask them to be at the mercy of your work/passion and that can get out of balance.  It is an immense responsibility, and honestly the compensation does not match how much work and responsibility it is.  Plus, when you are midwife in solo practice, you do everything... all the care (which is great), but also all of the prepping, cleaning, scheduling, sterilizing, paperwork etc....

 

At this point I am not planning on becoming a CNM- I am much more interested in education and health care policy- although I cannot be certain what the future holds.  I'd also love to open a birth center that serves low income families because I think there is a huge need in this country.  I could do it now as a CPM, but I couldn't get paid the way I would if I became a CNM, so that gets me thinking about it a little bit.

 

All this said, I can compare the midwifery education and the nursing education and tell you plainly that they are worlds apart.  In my midwifery education I spent years just learning about pregnancy, birth, postpartum, and newborn care.  First, we learned what is normal (broadly defined, of course), and then we learned about complications (how to identify and manage).  In nursing school we had two classes (4 hours each) on all of this, and what we were taught was not evidence based.  In my apprenticeship I attended births (and prenatals and postpartums) for years, while in nursing school we had one shift in labor and delivery and one in postpartum (and none in prenatal care which is really the bulk of the care).  There was also a lot of fear used in nursing school and I just don't think that helps develop quality providers.  I think those who work with birth should be well educated, and should also be comfortable around birth instead of afraid of it.

 

All that is being said about midwives.... like you can't know even if they give you the right answer that they will do the right thing... is true, but also true of any other provider.  And most of those providers don't spend an hour answering your questions.  While I do agree there is an issue with under qualified providers, I do not think that it's true of the majority (of CPM's, CNM's, or MD's).   I think we need to figure out how to deal with that group that is a problem but know those types of providers do not set the standard.  Those of us inside the professions would like this as much as consumers.
 

post #52 of 301


These bolded lines sound awfully dismissive to me. To Liz, who lost a baby, it's basically say: "Well, that's just life." And yet, just a few lines later it's mention how one's birth can have a lasting negative impact -- and yet I think we can all agree that the effect of Liz's mismanaged birth was far worse than this type of mismanaged birth.

 

In both cases, mistakes were made. It seems here on MDC people have no problem discussing what went wrong in the second kind of birth, but throw up their hands in the air and say "it happens" towards the first kind.

Quote:
Originally Posted by labortrials View Post


 

I didn't read anything into your post.  It made sense to me.  But it is a sensitive topic for sure. 




Liz, a low-risk pregnancy does not mean a perfect outcome, unfortunately.  No one wants to contemplate an adverse outcome, but they do happen in all birth settings with all types of care providers.  Some of this can be controlled, and people do screw up, and even at times when no one is at fault, moms and/or babies are damaged or die in the process.

 

Ooo, very good to know.  Thanks for sharing this!  Do you think it would be beneficial for CPMs to be trained as EMTs??

I disagree.  The CNM credential is managed by the medical system; the CPM credential is managed by the midwifery model of care.  VERY different care models.  My first birth was a disaster - vicious flu bug forced me into labor; CNM didn't believe I was in labor; DH took me to the hospital anyway.  Instead of being treated for dehydration, I was treated for being 9cm dilated.  I made the mistake of going with my midwife's suggestions to - break my water, labor only on my side, not change positions, purple push, and didn't know how to ask for what I wanted and needed to have a successful birth.  Now yes, I have a healthy 6 year old, but that doesn't mean that that birth experiences hasn't had HUGE effects on me, my daughter, my fertility, my sanity, and the management of subsequent pregnancies, to name just a few things here.  Transport doesn't suck here in the States because the CPM credential is sub-standard; transfer sucks because of the way that hospitals, doctors, and nurses treat midwives and their clients.
 

Good discussion, gals.

post #53 of 301
Thread Starter 


thank you liz! hug2.gif

Quote:
Originally Posted by lizziebits View Post


These bolded lines sound awfully dismissive to me. To Liz, who lost a baby, it's basically say: "Well, that's just life." And yet, just a few lines later it's mention how one's birth can have a lasting negative impact -- and yet I think we can all agree that the effect of Liz's mismanaged birth was far worse than this type of mismanaged birth.

 

In both cases, mistakes were made. It seems here on MDC people have no problem discussing what went wrong in the second kind of birth, but throw up their hands in the air and say "it happens" towards the first kind.

post #54 of 301

 

It sucks so so very much and it sucks to everyone it touches, but most of all, it sucks for the mama and the family that have lost a baby.  A life they will never know and never meet, and never raise, and have, and never see.  That pain is unfathomable to anyone, and sometimes even the family going through it.  It takes a while to wrap their head around that loss and the effects of that loss, even though they live with it every day.  I'm so sorry Liz  I am.  I so sorry this has hurt you, and your family, and every bit of your being probably.  I really wanted to say that. 

 

I think we will never know what we could have done at your birth to make it safer.  That sucks too.  But honestly, if a mom on here says, I was in labor for a long time, baby didn't descend, and pushed for 3 hours, and so we did a CS.  What could we have done to make it safer/different?  We can all say, oh, try a different position, try squatting, try hands and knees.  Don't hold your breath, etc.  Maybe those would have worked.  Maybe she had to push on her back with her legs up to chin and purple push to get baby to move under her pubic bone.  We really never know.  Never. And most likely, he next birth she will not run into this same thing, which is good.  We don't know how we could make your birth, Liz, safer.  We don't know what all was said behind your back while you were laboring.  We don't know if your MW suggested the hospital.  We don't.  I know that sounds rude.  I'm not here to defend your MW, I do know of her, and I have interviewed her, and the whole birth seems like it doesn't add up with typical midwifery.  It's crazy.  I don't think you are using your passion here to discuss your birth though, I think you are trying to turn it around and help other mamas have safer births across the world and fix our broken system.  I think that is very big of you and you should be proud.  :)

 

I know it's against the mammalist Bradley approach that we are all mammals and should birth with as much ease as a mammal in a farm, but I don't think this is true.  We are humans birthing humans and because of that, sometimes birth is hard, it hurts, there are complications and we need help.  Sometimes there are losses, yes, I am agreeing with that statement.  Sometimes there are.  So I think you should have gone to the hospital if you had signs of abruption, fever, fetal distress? Yes, I do.  Some moms would fight to stay, but if I were that MW, I'd call 911 and really force her to transfer.  It's unsafe.  As a Doula, if I am there and all these present, yes, I would question the MW and ask her...shouldn't we transfer?  As a mom, being the one I am, I would transfer even if my MW said let's stay home.  We all take that risk during our birth and as birth professionals and need to ALL be held accountable.  Yes, this is harsh, but it's the part I believe is relevant to this discussion. 

 

As far as the initial questions of this thread, how do we make sure our providers are competent?  It's up to the mom.  It's being a homebirth mom and well educated on birth (as most HB moms are) and really submitting to that trust in your CP.  So I think part is trusting your CP and submitting to that trust, which I'm sure some moms have a hard time with.  If their MW says, let's go to the hospital, you need to go.  (not saying this was your case, but I know it does happen).  Sometimes you have to get out of that warm tub for an exam.  Sometime you have to go walk around the neighborhood in the heat of transition because baby is high.  You have to trust them.  BUT, how do you know you SHOULD trust them is the real question.  They can have all the credentials in the world and still not be the best in that complication that the 1/2% of women run into.  I think it's about knowing that your CP WILL transfer if something comes up.  So maybe ask a scenario question: "How would you handle a labor who is GBS+ has a slight fever, but otherwise feeling fine, water has been broken 12 hours?"  "How would you handle a mama who has been in labor for 24+ hours and is getting exhausted?"  I have the answers to what I would want at my birth, but it's different for every mom. Ask about their relationship with neighboring hospitals and where they transfer to.

 

Quote:
Originally Posted by labortrials View Post


Transport doesn't suck here in the States because the CPM credential is sub-standard; transfer sucks because of the way that hospitals, doctors, and nurses treat midwives and their clients.

 

This is the second question: How to improve flaws:

I think this is true.  I don't think it's about the credentials.  I think that CPMs and CNMs alike have the training to know what normal birth is, and when they see a birth is out of normal, they should transfer.  Now, normal to them may be relative.  One MW may have dealt with a mama laboring 30+ hours and she came around and had an amazing birth.  Another may have never seen that and so choose to make the cut off 24 hrs.  That's OK.  Some would rather a MW transfer on the 'safe' side in labor isn't normal, others would rather transfer only if baby or mom shows signs of distress. 

 

I don't think the MWs are scared of transfer.  I hope not, I don't think this is the truth locally to be honest, but I only know my area in this.  I do think that there is a gap between what went on during a homebirth, and what is then going on at the hospital.  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.  So it'd difficult for them.  I think there needs to be a better communication and respect between the two CP and have more of a dual care upon transfer than a transition of care. 
 

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.  The more they see damages of interventions, the more they will stop doing them.  Time will help and the more women come forward with their safe un-interventive births, or births that needed intervention and had a smooth transition, the better.  The more woman will stand up to her OB and the community and say "This intervention was unnecessary and it hurt me or my baby by...." the better. 

 

post #55 of 301

 

I agree that things need to change. But I don't think requiring all MWs to be CNMs, requiring OB backup, or requiring malpractice insurance are good steps towards positive change... not in the current climate at least. As others have said - our system is broken. How could integrating HB MWs into a broken system improve things?

 

I can't fathom how anyone could possibly consider requiring OB backup to be a positive thing.

 

 

For one thing, ACOG is officially opposed to HB! So for an OB to be official "backup" is putting himself out on a legal & professional limb by going against the explicit practice recommendations of his professional organization! (For more detail on the problems this could create, I highly recommend the book, "Born in the USA" by Dr. Marsdan Wagner for his discussions of "obstetric omerta" or 'tribal loyalty.')

 

Furthermore, it restricts a MWs practice. If she can't find someone, she can't practice. This isn't very helpful to us women who need the midwives! There are already way too many examples of OBs driving MWs out of practice to kill the competition. I'm fairly certain I heard that lack of OB backup contributed to the closing of the only FSBC in Baltimore city & the delay of the opening of a new one. Nice, huh? 

 

It also restricts a MWs practice in that it's likely to result in "rules" placed on her. For example, the only FSBC currently in the greater Baltimore area won't allow you to birth there past 42W. I personally don't think a day or 2 past 42W is all that risky - and I think it should be up to the mama & her MW to decide on a case-by-case basis. But having OB backup generally requires adhering to OB rules. But most of us HBers don't WANT to adhere to OB rules! I prefer that my MW & I are able to make decisions as a team, free from such "black and white rules." The same goes for if I'm GBS+ & refuse antibiotics & want only hibiclens or nothing. (Another mama posted that at her FSBC, GBS+ mamas couldn't birth there without getting antibiotics.)

 

Finally, I don't see how it's practical. My MW sees clients within a one-hour plus range of her home/office. How is she expected to have back-up docs all over the place? & if she has one that's 40 min north from her and I live 45 min south, I really don't want to drive that far to see her 'official' backup. Plus, obviously I wouldn't transfer there in case of transfer in labor (heck, or even if I developed risk factors in pregnancy well in advance of labor, I'm not going to a hospital 1.5 hours away or more.) Where I live, there are literally about 8 hospitals with maternity care in about a 40 min drive. How is she supposed to have back-ups at ALL of these places? That's totally unreasonable.

 

Quote:

 

Originally Posted by kythe View Post

The problem is how to change the attitude of the medical community in making home births more acceptable and less stigmatized. I don't know where to begin on this one, since I didn't have a good experience with this in nursing school.

 

Yes, exactly. Further attempts to integrate HB MWs into a system that stigmatizes their entire practice is a recipe for disaster. The American medical community is what needs to change.

And I think if the American medical community started viewing birth more as a normal physiological process rather than a disease requiring medical "management" in every case, that would help.


In other words, I think the attitude towards HB is more a symptom of the prevailing views of American obstetrics. The views need to change first, before HB MWs could be successfully integrated.

 

One thing I think would help with that is to gradually have fewer OBs attend normal births. MWs should attend most normal births -even in hospitals- with OBs (trained surgeons) being reserved ONLY for high-risk cases. Once this change becomes more commonplace, the role of MWs in general will be more respected AND birth is likely to be viewed as less of a medical "problem" - and THEN the stage can be set for more acceptance of HB MWs.
 

 

As for requiring malpractice insurance - I'm very torn on that. We KNOW fear of litigation causes defensive medical practices, which can be dangerous for the mama. Not only that, but insurance providers place restrictions on practice!! Isn't it true that many OBs don't "do" VBACs because their insurance would drop them if they did?!? & that is for VBAC in a hospital!! So, again, requiring insurance could lead to further reduction of options for birthing mamas. Not good. Again, maybe if the insurance industry itself weren't the way it is, this could be a good thing... so it's insurance that needs to change.

 

 

Quote:
Originally Posted by mylilmonkeys View Post

The situation in the US is very complex.  Because only 1% or so of mothers will choose home birth, we are at a significant disadvantage to impact the overall mindset that the average citizen, much less the medical community has about home birth and midwifery care


Actually, I believe it's even less than that. 1% is the number of births that occur at home - the number actually planned to be at home is more like .5%.

 

 

post #56 of 301


Here is another place that there seems to be a double standard with regards to midwives and OBs.

 

If a mother tells about her birth in the hospital, and that the OB said that "you must have a C-section or your baby will die", no one would question it.

 

In her birth story, Liz has said that her midwife repeatedly declined her request for transfer. But in this scenario, we just can't trust the laboring women.

 

Why can the laboring woman in the hospital give a full and accurate account, but a laboring woman at home not do the same?

 

Quote:
Originally Posted by AustinMom View Post

 

I think we will never know what we could have done at your birth to make it safer.  That sucks too.  But honestly, if a mom on here says, I was in labor for a long time, baby didn't descend, and pushed for 3 hours, and so we did a CS.  What could we have done to make it safer/different?  We can all say, oh, try a different position, try squatting, try hands and knees.  Don't hold your breath, etc.  Maybe those would have worked.  Maybe she had to push on her back with her legs up to chin and purple push to get baby to move under her pubic bone.  We really never know.  Never. And most likely, he next birth she will not run into this same thing, which is good.  We don't know how we could make your birth, Liz, safer.  We don't know what all was said behind your back while you were laboring.  We don't know if your MW suggested the hospital.  We don't.  I know that sounds rude.  I'm not here to defend your MW, I do know of her, and I have interviewed her, and the whole birth seems like it doesn't add up with typical midwifery.  It's crazy.  I don't think you are using your passion here to discuss your birth though, I think you are trying to turn it around and help other mamas have safer births across the world and fix our broken system.  I think that is very big of you and you should be proud.  :)

 

 

post #57 of 301

Megboz-I think 'having OB back up' means that each owns their OWN practice (the MW and OB) and set their own rules, and each has a mutual respect for the other.  Upon transfer, it's nice if a MW knows the OB and that OB trusts and respects the MW.  I don't think Midwifery can really change much to reach this goal, I agree, the changes that need to be made need to come from obstetrics and trusting birth more.  I think if a MW works 1 hr diameter of her home then she should at least be familiar with the OBs in the hospitals so she can either trust them, or let a mom know what she is in for when a transport presents itself. 

post #58 of 301

lizzie-that is what I'm saying too.  ALL are held accountable.  The MW should have transferred when the mom said it's time to transfer.  That's just what should happen, and this is where trust comes in with a mom trusting the MW AND AND AND the MW trusting the mom.  I think there lacks to be a competent team when one or more parties can't trust the other.  I believe homebirth is all about how effective your birth team is. 

 

Again, I think the topic Liz it trying to bring up is how to better birth as a whole, not just her birth.  I think she is smart in putter her energy forward and seeing if she can help prevent what happened to her.  Correct me if I'm wrong Liz.

post #59 of 301
Quote:
Originally Posted by lizziebits View Post


Here is another place that there seems to be a double standard with regards to midwives and OBs.

 

If a mother tells about her birth in the hospital, and that the OB said that "you must have a C-section or your baby will die", no one would question it.

 

In her birth story, Liz has said that her midwife repeatedly declined her request for transfer. But in this scenario, we just can't trust the laboring women.

 

Why can the laboring woman in the hospital give a full and accurate account, but a laboring woman at home not do the same?

 


 


I'm just throwing this out there as a possibility.  Maybe we're so programed to watch out for unnecessary interventions being forced on women when they are most vulnerable.  In that mindset it's difficult to switch gears and wrap our brains around being denied interventions.   It also seems like we are aware of some of the motives for pushing for more interventions and the reasons for denying them are less obvious to us.  

 

Another issue that's been on my mind is that I can't tell you HOW many times I've heard a MW or a mother talk about one of those tell tale signs of transition being when the woman begs to go to the hospital.  I just watched the Business of Being Born and the main midwife in that movie shows her birth video and I think I remember her going on and on about pain meds and going to the hospital.  I've never really thought much about this before this thread but this dynamic must make for a very tricky and sensitive relationship between the mother and MW.  I guess it also comes down to the MW being very in tune with transition exhaustion and a mama crying out for help because something is very wrong.  That seems like something that is so essential in a MW but also something that is hard to train and evaluate.  

 

I'm not saying that this was the only factor in Liz's birth (it is clear that it wasn't) but I'm sure there have been many births where the *only* sign that there was something wrong was a mother's kind of vague notion.  Maybe she starts to panic, begs to go the hospital because on some level she knows something is wrong and she needs guidance and help making that choice.  Or, maybe this mom is in transition and will have her much wanted homebirth in a very short time and she needs her midwife to help her gather the confidence to wait it out.  I don't know about any of you but I this is the main reason I want a MW to attend my birth.  

 

*What I'm saying -- to be clear -- is that I think getting help with determining whether something is wrong or whether you're just nearing the end is a fine expectation to have of a MW.  I can see a scenario where a MW encourages a mama to stay home for a bit longer if the MW thinks the mom is close and safe...but the MW has got to be right.  That's a lot to take on.  It seems like a big part of the job of a HB midwife and it isn't something you can get a degree in.  It seems like something you may have a bit of before you even become a MW and something that comes with experience.  

 

Sorry for the ramble...

post #60 of 301

Well, if some of you want to treat what I wrote in that manner, go for it.  I thought we were having an "honest discussion."  I apologize if I didn't approach this with a high enough level of empathy.  I think anyone who reads my posts or knows anything about my history would give me the benefit of the doubt.  In fact, I think this entire "honest discussion" requires that everyone assume that we all empathize with Liz and wish that hadn't happened to her.  When it happens to you, it's 100%.  I get that.

 

It's real easy to just JUMP and attack.  Please breathe first.  Thank you.

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