Poll- Do you support "underground" midwives? - Page 8

[lovebeingamomma]

You're putting words into my mouth, I never said that.  I don't think midwives should practice illegally.  But It's still legal to have a homebirth in all 50 states.  
 

Originally Posted by Youngfrankenstein 

I did not have a transfer so I don't know, for a fact, how one would go.  We interviewed and felt good about hiring this midwife.  She doesn't work "legally" in Ohio as a midwife.  

You're telling us that we who live in states with no legal midwives we shouldn't home birth.  I disagree with that.

[lovebeingamomma]

My "poll results" have to do with how people feel about underground midwives- it doesn't prove anything, it's just opinions.  In my state, underground midwives are not upfront about the legality.  Women have birthed with them having no idea it was illegal.  I've heard first hand accounts of this.  So while you would like to think they're being upfront about it, that's not always the case.  To be honest I'm surprised at the number of women that support illegal midwives, and are not at all concerned about it.  I was looking up homebirth in Ohio and found this: 
http://www.mothering.com/community/t/1131174/ohio-homebirth-family-being-criminally-prosecuted  I had no idea this could even happen.

I'm not out to change anything, women can do whatever they want.  I just wanted to talk about it.  It's not my intention to cause a heated debate, I really do thank you all for adding to the discussion.  

Originally Posted by iowaorganic 

So you disagree with your own poll results?  I would like to think most midwives are upfront about their credentials- but it is obviously up to the mama to double check and be sure that they are ok with it.  Also- are there many who are completely naive about a transfer and think it will be sunshine and puppies?  I hope not- because if I had to transfer I know it would go bad- most likely really bad.  Cause what are they going to do with my paper records that get left in my cupboard after each appointment as a security issue- probably laugh and throw them away!?  Yet I am still cool with that.  And who doesn't google their midwife to see it they have been arrested?  I would think everyone would google them...  But it is again up to the mama on if that matters to her and her family.  In a perfect world there wouldn't have to be underground midwives.  Reality being what it is- it is necessary or a lot of us would be run again through the OB baby system with not much hope of anything better.  

[littlest birds]

I transferred smoothly with underground midwives for my twins, although it was not a major emergency I did have to switch hospitals as well and my midwife came with us and was present and participating for the entire birth in a doula role.

[Buzzbuzz]

Talking about the transfer issue, I remember reading an interview with a homebirth loss mom.  She lived in WA near the border with OR. 

When in need of a transfer, the midwife insisted on taking them across the border from WA to OR because the hospital was allegedly "homebirth friendlier" -- the mom is now convinced it was because the standards for midwifery care in OR are much looser than in WA and the midwife was concerned about prosecution.  So, rather than accessing the nearest hospital care in an emergency, the midwife covered her own butt.  

I hear sort of similar things again and again where midwives have preferred hospitals that are frequently significantly further away.   I believe that in many cases the preference arises from how pro-active certain hospitals may be versus others about reporting the illegal practice of medicine and/or midwife malpractice. 

I would encourage that any mother in an emergent transfer situation should consider obtaining care from the nearest rather the "most midwife preferred" hospital.

[Plummeting]

Originally Posted by lovebeingamomma 

You're putting words into my mouth, I never said that.  I don't think midwives should practice illegally.  But It's still legal to have a homebirth in all 50 states.  
 

So what ARE you saying? That they should have an unassisted birth? Because that's going to be their only option if there are no CNMs or OBs providing home birth services where they live (in some states CNMs are not even legally allowed to attend home births). And come on, how many OBs out there are doing it? You are saying that midwives should never practice illegally, but that if there is no licensed person willing to attend a home birth, women who want to give birth at home should....what? I really don't understand what you're saying. If what you really mean is that women shouldn't have home births in those situations, why not just say it?

[lovebeingamomma]

Ok well let me try to think of all the legal options...traveling to a state where it's legal (some midwives attend births in hotel rooms), unassisted birth, birth centers, hospital birth.  I support all the choices I mentioned.  And I get it, many of you think you deserve the kind of birth you want no matter what.  I don't believe that, I don't think anyone is above the law, and I think it's more risky (did you just ignore BuzzBuzz's post and the story I linked to?).  Yes unassisted birth has it's own risks, but you're not putting your trust in someone who may or may not do what's best for you in a transfer situation.  However having this opinion does not change that you can still do whatever you want.  I respect your free-will to do what you want, if you don't respect my opinion so be it.
 

Originally Posted by Plummeting 

So what ARE you saying? That they should have an unassisted birth? Because that's going to be their only option if there are no CNMs or OBs providing home birth services where they live (in some states CNMs are not even legally allowed to attend home births). And come on, how many OBs out there are doing it? You are saying that midwives should never practice illegally, but that if there is no licensed person willing to attend a home birth, women who want to give birth at home should....what? I really don't understand what you're saying. If what you really mean is that women shouldn't have home births in those situations, why not just say it?

Edited by lovebeingamomma - 3/15/12 at 7:16am

[slmommy]

I don't see how using an underground mw is worse than uc (and i am a ucer.) Just because UC is not "illegal"? Don't women realize that whatever type of midwifery/hb in their state is illegal? Are illegal mws trying to pass off as legal? I was under the impression it was fairly difficult to find these ladies. If you are going to choose whatever hcp for your birth, you are responsible for knowing what their deal is. Do people not ask about transfer situations while interviewing mws? If you are worried that your mw is not experienced or going to mismanage your labor to cover her own ass... why go that route? I don't see a problem with women using a mw who they are comfortable with, and it is their responsibility to know about the situation. I think some of these laws are totally arbitrary (and hard/unlikely to change)... 5 miles away the mw could be totally legal but cross state lines, and no? and that makes her less of a mw?

I don't know, I kinda view this situation as say having a uc, and asking a friend/family member to be there with you, maybe someone who has some medical/birth experience... if you transfer are they going to let friend stay with you or inform dr. about your labor? would you let that person tell you to go to a hospital further away? I guess women who go with underground mws just have some more responsibility to learn about birth/legalities/transfer situation, and be more proactive about their situation. If they can't do that, or don't want to, they probably shouldn't go with an underground mw.

I don't think things change from "right" to "wrong" just because one state decides to legislate it that way. But probably my perspective is way skewed...

I live in a different country (with huge c/s rates). I uc'ed, and knew that if I transferred I would be met with hostility and automatic c/s. If I had a mw, who are legal here, she would have been physically barred from hospital, (of note, many cb educators are also banned from private hospitals here... even the ones teaching vag birth with epidural). I uc'ed because that's what I wanted, and I didn't find a mw I was happy with. In this country, homeschooling is illegal. I can't do so because I would face fine/jail time if found out, (not that I'm sure I would even want to hs). Does that mean hsing is wrong? I know there are some activists here who hs anyway and get thrown in jail... but that's on them right? are they really "wrong"?

[Buzzbuzz]

Laws are supposed to be a community's way of determining their general standards.  One community might decide that speed laws are an unreasonable burden on the individual's freedom and that there should be no restriction on how fast one can travel.  Another might decide that safety and enviromental concerns outweigh an individual's freedom to travel at an unlimited rate of speed and impose laws that no one can drive faster than 55 mph.

In any scenario, deciding to break the law comes with certain consequences and the question must always be whether those consequences are worth the perceived benefit of breaking the law.

And in fact, to respond to a couple of your questions -- illegal midwives can be easily found on the internet, including on this website.   I have also read about midwives clouding the question of whether they are legal or not.  Some may claim they are in fact "alegal" -- a status which doesn't really exist.  In particular, I remember reading a story on mothering about a woman who was convinced her midwife was legal until the end of her pregnancy when she discovered she was not. 

Edited by Buzzbuzz - 3/15/12 at 9:13am

[Buzzbuzz]

I am a great believer in consumer protection -- I think that when you buy a car, the listed miles per gallon should be accurate, that the car seats I purchase should meet some minimal governmentally imposed safety standards, that when I take a trip that the airplane that I fly in has passed some level of governmental regulation, that when I buy a "Grade A" steak that the steak is actually "Grade A", that when I take medication that it has passed some level of inspection to know that its not actually toxic and that when I go to a licensed health care professional that they have met certain standards of educational achievement and professional and ethical fitness.

I feel that there are a number of consumer protection issues around licensed midwives themselves, let alone the sort of consumer protection issues that surround unlicensed and illegal midwifery.

[slmommy]

Originally Posted by Buzzbuzz 

Laws are supposed to be a community's way of determining their general standards. 

This seems overly simplistic and idealistic to me. There are quite a few moneyed interests in law-making.

As far as consumer protection, what consumer protection would a uc-er have? None of course. I don't see how choosing an "illegal" mw would be different. If you are choosing something "underground" you are "underground." Even though you are paying for a service it is totally off the radar from any body who could regulate consumer protection, because according to the state, it shouldn't exist. I don't have a problem with underground mws unless they are individually misrepresenting their status and services. I'm sure that happens. I hope most women who choose hbs with mws do some reserach into legalities in their states and the status/operations of their mws. Should we add some legislation to require women trying for hbs/mws/uc to pass a written test to make sure they know the legalities of their state and possible medical consequences of their choices and actions? 

ETA: I thought most women looking for underground mws had to find through word or mouth or private messages on mdc. I haven't ever done that search personally... just what I've seen here.

Edited by slmommy - 3/15/12 at 10:20am

[Buzzbuzz]

"This seems overly simplistic and idealistic to me. There are quite a few moneyed interests in law-making."

Note, I said "supposed to be".  However, at the end of the day, I do believe that we still have a vote.

Your point regarding UCing and consumer protection makes no sense.  A UC-er needs no consumer protection because they are not consuming the services of a health care provider or any other third party.

"Should we add some legislation to require women trying for hbs/mws/uc to pass a written test to make sure they know the legalities of their state and possible medical consequences of their choices and actions?"

I know this isn't a popular position anymore, but an internet connection and google does not an expert make.  I don't want to have to become an expert airplane mechanic before I get on a plane.  I don't want to have to become a pharmacist before I feel safe taking medicine.  And, in reality, I don't think I could become an airplane mechanic or a pharmicist without devoting many hours and years of time.  Given that is the case, I look to the government to regulate certain areas to help me avoid injury and fraud.  I think having a system that regulates health care providers on the state level is an important part of ensuring consumer safety and injury -- just like having drugs tested by the FDA and dispensed by a licensed PharmD is an important part of ensuring consumer safety and avoiding injury.  While being an educated consumer is important, I think it is false to claim that an individual can, on their own, replace all the protections of the FDA for example, or the NTSB.

[lovebeingamomma]

For the record, all the information I got from underground midwives (who I thought were legal) were posting here on Mothering publically (either themselves, or others recommending them), all by name, all acting like it was legal.  It was not hard at all to get their names or contact them, in fact, one woman saw my thread afterwards, had birthed with X midwife, and still thought it had all been legal.

Also, I think the laws needs to change to allow all CNM's and CPM's to legally attend homebirths in every state, I do think women should have those options. 

[Buzzbuzz]

Homebirth midwives are illegal in Kentucky.  Just googled Kentucky Home Birth Midwives and found around 5 CPMs servicing Kentucky on the first page of results alone.  Wouldn't exactly call that underground.

[slmommy]

ehh... like I said, I have never done a mw search anywhere in the US before. I have seen ppl coming to mdc upset that they can not pursue hb/vbac whatever with current care providers, and have to try to find illegal mw, at which they don't know where to start. 

I dont think women should be or are being forced to use illegal mws if they do not feel comfortable. If you know the legalities in your state, can you not check up on an individual mw? Are they producing fake credentials? On the other hand, there are plenty of women being forced to use care providers they are not comfortable with... in settings they are not comfortable with... the mainstream option.

The legality of the issue lays on the back of the mw, if I understand correctly... so if they want to advertise and be transparent, attend births, that's their issue too.

BuzzBuzz - I was referring to "underground" colloquially like everyone else in this thread, and in the sense that if you choose an illegal mw, you do not have the same options for things like transfers and "consumer protection" that you were concerned with.

ETA - sorry, lovebeingmomma, had a question for you but re-read your posts and you already answered it!

Edited by slmommy - 3/15/12 at 12:41pm

[slmommy]

Originally Posted by Buzzbuzz 

"This seems overly simplistic and idealistic to me. There are quite a few moneyed interests in law-making."

Note, I said "supposed to be".  However, at the end of the day, I do believe that we still have a vote.

Your point regarding UCing and consumer protection makes no sense.  A UC-er needs no consumer protection because they are not consuming the services of a health care provider or any other third party.

"Should we add some legislation to require women trying for hbs/mws/uc to pass a written test to make sure they know the legalities of their state and possible medical consequences of their choices and actions?"

I know this isn't a popular position anymore, but an internet connection and google does not an expert make.  I don't want to have to become an expert airplane mechanic before I get on a plane.  I don't want to have to become a pharmacist before I feel safe taking medicine.  And, in reality, I don't think I could become an airplane mechanic or a pharmicist without devoting many hours and years of time.  Given that is the case, I look to the government to regulate certain areas to help me avoid injury and fraud.  I think having a system that regulates health care providers on the state level is an important part of ensuring consumer safety and injury -- just like having drugs tested by the FDA and dispensed by a licensed PharmD is an important part of ensuring consumer safety and avoiding injury.  While being an educated consumer is important, I think it is false to claim that an individual can, on their own, replace all the protections of the FDA for example, or the NTSB.

Sorry, I missed this reply! I brought up ucing and consumer protection because, I believe and correct me if I am wrong... that legally, if you use an illegal mw, you have all the recourse/protection as someone who uc'ed.... none... because it is as if you uc'ed, which was what I meant by this:
 

"Even though you are paying for a service it is totally off the radar from any body who could regulate consumer protection, because according to the state, it shouldn't exist." (by body I meant governing organ/board)

Is it really so hard to find out if your mw is a cnm or not? An individual does not have that ability? Again, I haven't done this myself, so I am asking.

[Youngfrankenstein]

This is a little crazy to me.  I truly can't see how going to another state (minimum 2 hour drive), using a hotel in that state (unsanitary), or having a UC (I'd never attempt) is better or safer than the illegal midwife I hired.  My midwife is very out in the open.  She isn't a CPM or a CNM.  CNMs are not legal to do homebirth in Ohio without full back up of an OB.  That doesn't happen.  

I'm trying to think of an appropriate analogy for the scenario and I can't.  I suppose hair cutting is the closest example.  I realize that hair cutting isn't dangerous but the legalities are there.  People with licenses aren't allowed to cut other people's hair at home.  It's illegal.  Does it happen?  Yes.  Would you find that wrong?

I don't know.  I guess you have made your point and we don't all agree.

[Plummeting]

Originally Posted by lovebeingamomma 

Ok well let me try to think of all the legal options...traveling to a state where it's legal (some midwives attend births in hotel rooms), unassisted birth, birth centers, hospital birth.  I support all the choices I mentioned.  And I get it, many of you think you deserve the kind of birth you want no matter what.  I don't believe that, I don't think anyone is above the law, and I think it's more risky (did you just ignore BuzzBuzz's post and the story I linked to?).  Yes unassisted birth has it's own risks, but you're not putting your trust in someone who may or may not do what's best for you in a transfer situation.  However having this opinion does not change that you can still do whatever you want.  I respect your free-will to do what you want, if you don't respect my opinion so be it.
 

First of all, I didn't say anything about your opinion. I asked you to tell me what it was. If you think that asking someone to tell you exactly what their opinion is somehow constitutes disrespecting said opinion, that's not an issue that has anything to do with me. I can't read your mind, and if you want to have a rational discussion about a topic in which you expect everyone else to share their opinions, then it's only reasonable for you to tell us what yours is, if you're going to continually express your disagreement.

I did read BuzzBuzz's post. Perhaps you ignored the fact that it wasn't about an underground midwife, or at least if it was, she did not say it was. She merely said that the midwife wanted to transfer to the state with looser laws. Well, crappy midwives who were doing things they weren't really allowed to do might want to do that, whether the midwives were practicing legally or not. And your story only goes to disprove your other claim, which was that women have all sorts of options. No, they don't. Do you honestly think that the same thing wouldn't have happened had that family gone unassisted? That would seem incredibly naive.

[Plummeting]

Originally Posted by Buzzbuzz 

I have also read about midwives clouding the question of whether they are legal or not.  Some may claim they are in fact "alegal" -- a status which doesn't really exist.  In particular, I remember reading a story on mothering about a woman who was convinced her midwife was legal until the end of her pregnancy when she discovered she was not. 

Yeah, it does actually exist. If midwifery isn't illegal, but there is no licensing procedure, then it's not illegal. So what, exactly, do you propose those midwives be called? The definition of illegal is: Contrary to or forbidden by law, esp. criminal law: "illegal drugs". If independent midwifery by people other than CNMs is not contrary or forbidden by law, then it's NOT illegal, no matter how much that thought makes you uncomfortable, and if those women are practicing out in the open, they also aren't underground. You can't unilaterally determine that something is illegal and/or "underground" based on the fact that you don't like it. So, my midwife doesn't have a license to practice midwifery in this state, because my state does not grant licenses for midwives. They're technically legal based on state law, but the state doesn't license midwives. My midwives' practice isn't underground. Their website and names are all over the internet. Other states have no laws at all regarding midwifery. Not only do they not license them, but the law never addresses the fact that they are either legal or illegal - it's like they don't exist. So those women aren't hiding the fact that they're midwives (they're not underground) and they aren't practicing illegally (they aren't forbidden by law). Your black and white insistence on things being either underground or regulated by law is in complete disagreement with the actual facts in many places.

[Buzzbuzz]

I believe that the Big Push For Midwives agrees that there is no such thing as alegal status.  My understanding is that if there is no statute permitting midwifery and money changes hands, a midwife in such state can be prosecuted for practicing medicine without a license.

And, of course, licensing and legality are two separate things.  Oregon permits unlicensed midwives to legally practice, for example.

[Buzzbuzz]

Additionally -- you shouldn't confuse an unwillingness on the part of the state to enforce the law with the actual legality of any particular action.