Poll- Do you support "underground" midwives? - Page 2

[Novella]

Thanks for great post! Absolutely agree. The law got to be "the law" only because a certain number of people agreed and made it a priority - not necessarily because it's more correct than something that is not law.

Originally Posted by XanaduMama 

How about if there were no "steps" they could take to become licensed? If doctors or dentists weren't recognized in your jurisdiction, and there was no alternative? This is the reality for many midwives in states that don't recognize CPMs and where CNMs don't do homebirths, and was the reality for hundreds, thousands of years, in fact: licensing is very new, historically, and still fairly limited, geographically, and isn't necessarily a guarantee of anything. Millions of people all over the world are treated by practitioners that aren't recognized by a state, and millions do just fine. And I don't see why "illegal" necessarily means "unethical"--since when is the law always the last word in ethics?

[Jane93]

This is the sort of thing I'm talking about when I say the interests of the illegal midwife and patient are not aligned...see the following text from the book "From Calling to Courtroom"...

"For those midwives who do carry Pitocin, I would advise them to never admit it to anyone who has the ability to testify (that is, anyone except your husband). If a midwife ever feels the need to inject Pitocin or administer any kind of drug, such as Methergine, she should refer to such substances as "minerals.""

So basically, the advice is to deny the mother information about what is being injected into her body and make it so she cannot accurately report to the hospital (in case of transfer) what medicines she has had during labor (an extremely important point for her new medical team to know). 
 

[Kanna]

No, I don't support "underground midwives".

Moms would face incredible difficulties to even do a basic check on that midwifes' credentials and if things go south it'll be next to impossible to hold that midwife even a little bit accountable.

Come to think of it.....if you want to get a really good picture of whether working with an "underground midwife" is a good idea, find a couple moms that gave birth with an "underground midwife" in attendance and then experienced some kind of complications / emergency.

THAT will give you a good picture like no poll can.

Edited by Kanna - 8/21/11 at 11:51am

[philomom]

No, I do not support underground midwives. I want midwives to be of the certified nurse midwife CNM type where you have a four year nursing degree and a master's in midwifery.

[loveyourohana]

Absolutely I support them, nor do I think it should be illegal in the first place!!!  JKSeaWell basically took the words from my mouth so... in agreement with her post:)  I feel that having a license from the state or certifaction is great but there are pearls of knowledge out there that have been handed down, knowledge from past generations with way more knowledge and experience than someone with a piece of paper and less experience.  I would rather have someone who has the hands on experience and knowledge from generations past legal or not...   My babies will always be more to me than someone elses opinion, a law, or a statistic! 

[LiLStar]

Umm, heck yeah I support them. I had my first baby in a state that did not license midwives, so my choices were: underground midwife, 5 hour drive to The Farm, a hospital with a CNM who I didn't click with very well, the hospital being the most natural birth friendly BUT had a mandatory nursery stay for the newborn for at least an hour (if pediatrician signs off on it) but usually more like 4 hours. (And, being incredibly active in the birth community had never even HEARD of anyone who successfully fought the policy) or hospitals that were less natural birth friendly but didn't have the unbendable nursery stay policy. I chose the underground midwife. Obviously its not ideal, but I felt it was my best choice. A choice I agonized over for the first 24 weeks or so of my pregnancy (that was when I made my final decision) Underground midwives (at least the ones I knew in that city) weren't underground because they are "unethical and have a high tolerance for risk". Its because they are passionate about offering choices to women in an area that had few choices. They were honest and upfront about what kinds of situations they were and were not comfortable with, safety wise. And when things weren't looking good, they transferred to the hospital, staying with the mother. The biggest risk they face is prosecution, but they stick their necks out to offer women that choice, and yeah, I damn well appreciate them for it! I personally DID transfer, and unfortunately had a c-section (chose the not-very-natural-birth supportive hospital option because at that point I knew I was not getting a natural birth, but wanted to keep my baby with me at all times!) my midwife and her apprentice stayed with me and cooperated with hospital staff, identified themselves as lay midwives, handed over prenatal/labor records. They are actively trying to change the laws to license midwives there, but in the meantime, women deserve a choice somewhere between hospital and UC. I can see how in a location that is openly hostile towards midwives and they're being prosecuted, there's the possibility of it being "less safe" because a midwife's risk tolerance could be stretched thin, delaying transfer with signs of distress to avoid being "caught" at the hospital. I'm sure it happens. Luckily where I used underground midwives, I have not heard of any attempts to prosecute, so that is not hanging over their heads. When there's distress/abnormality, they transfer.

[cinderella08]

Originally Posted by philomom 

No, I do not support underground midwives. I want midwives to be of the certified nurse midwife CNM type where you have a four year nursing degree and a master's in midwifery.

I huge *yeahthat* to philomom.  I am in 100% agreement with this post.

[mindfulmomma]

IMHO I believe women should be able to use any midwife they want. How is it fair that another person judge how a woman should give birth and who she chooses to attend her birth. One added point is that in many states a VBAC at home also known as a HBAC is not legal with any attendant. Soooo a woman not wishing to give birth in a hospital  has the choice of giving birth at home without anyone there or go with an underground support person.

[philomom]

Originally Posted by mindfulmomma 

IMHO I believe women should be able to use any midwife they want. How is it fair that another person judge how a woman should give birth and who she chooses to attend her birth. One added point is that in many states a VBAC at home also known as a HBAC is not legal with any attendant. Soooo a woman not wishing to give birth in a hospital  has the choice of giving birth at home without anyone there or go with an underground support person.

How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.

[XanaduMama]

Originally Posted by philomom 



How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.
 

Wait--how does "not licensed" necessarily = "not qualified"?? If a MW is licensed in one state, and not in the next, does that make her "not qualified"? Who gets to decide what being "qualified" really means? You evidently believe in certification, state-issued licensing...but who's to say that this is the best way to evaluate qualification? This may be your comfort level, and that's great--everyone has different risk-tolerance and ideas about what qualification entails, but it's a huge leap from there to condemning all mothers who choose "underground" MWs as dangerous mothers bent on endangering their babies.

[LiLStar]

You can't lump all underground midwives into the same category. Hypothetical midwife A could be just as experienced, skilled, and well trained as hypothetical midwife B  who lives in another state, with the only difference between them is a piece of paper and some licensing fees. I see you live in the PNW. I do too. Its amazing here and there's no "need" for underground midwives. Even if all the licensed midwives were gone and a would-be homebirther had no choice but the hospital, the hospital choices are decent enough that even a very homebirth minded woman could probably have a fulfilling birth without much/any fight. At least around major cities, at least. It is *not* like that everywhere. If a woman is wanting a VBAC and has no hospitals within a couple hours who allow them and either no licensed midwives, or the licensed midwives can't attend VBAC, the choices are forcedERCS, UC, or underground MW. There may be instances were women successfully fight VBAC bans and give birth in a hospital with a ban. Sometimes it goes well. Sometimes they'll be treated poorly postpartum (inventing an excuse to force a healthy/normal newborn to stay in the nursery/nicu for "observation" isn't unheard of) Sometimes it doesn't go well and they are coerced, lied to, or even physically forced against their will into a repeat cesarean. When ICAN did their nationwide survey of all hospitals in the US with maternity services, one of the questions asked of those with a ban was "what would happen if I came into the hospital in labor and refused surgery?" and there were more than a couple who straight up said they would put the mother under general and perform the cesarean. Without consent. And there are women on the ICAN list who have had that happen to them. Rare, yes, but so is having the guts to fight a VBAC ban head on like that. Forcing a woman to have unnecessary surgery against her will is NOT okay. There is a NEED for underground midwives in this country. And until hospital policies begin aligning themselves with evidence based practices AND every state licenses midwives, that need isn't going anywhere. 
 

Originally Posted by philomom 



How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.
 

[Storm Bride]

Originally Posted by Jane93 

Part of the ethics issue is that the very base of the relationship, the provision of the service, is illegal.  So from the first moment of meeting, the practioner has a significant goal (not being arrested) that has nothing to do with providing the best care possible to the patient. 

This is different from the medical profession in what way?

[Storm Bride]

Originally Posted by philomom 



How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.
 

You don't think I shoudl be able to choose my own care provider, and you think I'm dangerous?

Licensed, professional medical doctors have effed up my body for life, and done major, probably irreparable psychological damage, and I have no recourse whatsoever, because the system says that they have the right to make decisions for me, and it's assumed by the majority that they would only act in my best interests, even though we see regular stories where this is not the case (and I'm not only talking about birth when I say that).

Also, when you type "qualified/licensed", it suggests that qualified and licensed are the same thing. They're not.

[Storm Bride]

Originally Posted by Kanna 

No, I don't support "underground midwives".

Moms would face incredible difficulties to even do a basic check on that midwifes' credentials and if things go south it'll be next to impossible to hold that midwife even a little bit accountable.

Come to think of it.....if you want to get a really good picture of whether working with an "underground midwife" is a good idea, find a couple moms that gave birth with an "underground midwife" in attendance and then experienced some kind of complications / emergency.

THAT will give you a good picture like no poll can.

How will that give you a "good picture"? If you're going to do that, then let's talk to a "couple of moms" who gave birth with "qualified", licensed midwives or doctors. If they have horror stories about the way they were treated, does that mean we can lump together all the OBs, too?

In case I haven't said it, I absolutely support underground midwives. It's nice to know there are some women out there who are willing to take big risks for women who have been backed into a corner.

[Kanna]

Originally Posted by XanaduMama 

Wait--how does "not licensed" necessarily = "not qualified"??

Kanna: Hmm...I think that the point is more that "not licensed" CAN mean "not qualified".

If you want to practice midwifery, because you love birth and moms (and because it can mean quite a good income too), without licensing you CAN go ahead an do that, even if you are woefully underqualified. In States like Oregon, you can even practice legally. And then, babies like this one end up dying:

http://www.kval.com/news/local/127689363.html

Reaction of the midwives involved? They just told the mom to "own her birth" and if she had picked them, and something had gone wrong....well, then that obviously was HER fault:

http://www.10centimeters.com/darby-and-laura-speak-up/

If a MW is licensed in one state, and not in the next, does that make her "not qualified"? Who gets to decide what being "qualified" really means?

Well, there are the NARM examps that CPM's need to pass to get licensed. But some consider even these woefully inadequate:

http://midwifeology.blogspot.com/2011/08/educational-standards-of-american.html

You evidently believe in certification, state-issued licensing...but who's to say that this is the best way to evaluate qualification?

I think we all can agree SOME way to evaluate qualification is needed. As for the specifics: suggestions welcome?

This may be your comfort level, and that's great--everyone has different risk-tolerance and ideas about what qualification entails, but it's a huge leap from there to condemning all mothers who choose "underground" MWs as dangerous mothers bent on endangering their babies.

The question though is: are moms to be REALLY risk-tolerant? Or are they merely underestimating the risks and thus tolerating something that they wouldn't if they were indeed fully aware of all the risks and possible complications?

[philomom]

Originally Posted by Storm Bride 

Licensed, professional medical doctors have effed up my body for life, and done major, probably irreparable psychological damage, and I have no recourse whatsoever, because the system says that they have the right to make decisions for me, and it's assumed by the majority that they would only act in my best interests, even though we see regular stories where this is not the case (and I'm not only talking about birth when I say that).

I'm sorry that anyone has had to live the experiences you have had.


But that doesn't make me any less committed to making sure that any birth attendant a woman may choose to attend her birth is safe and qualified to be there. I'm here in the states and I write letters to my government officials all the time. The laws in my state are pitifully lax for midwives.. a woman can hang up a shingle here as direct entry midwife (DEM) after taking a handful of courses and attending just 20 births. There have been some fatalities. In my mind, that's far too little experience and learning for me to place the lives of myself and babies into.

[Storm Bride]

Originally Posted by philomom 



I'm sorry that anyone has had to live the experiences you have had.


But that doesn't make me any less committed to making sure that any birth attendant a woman may choose to attend her birth is safe and qualified to be there. I'm here in the states and I write letters to my government officials all the time. The laws in my state are pitifully lax for midwives.. a woman can hang up a shingle here as direct entry midwife (DEM) after taking a handful of courses and attending just 20 births. There have been some fatalities. In my mind, that's far too little experience and learning for me to place the lives of myself and babies into.

Obviously, you have to do what you believe to be right. But, it terrifies me that there are women out there actively trying to take away my ability to function without the "help" of the guidelines and regulations imposed on my uterus externally. If I choose a midwife who has only attended 20 births, then that choice is on me, not her. (I do think any care provider, be they an OB, family doctor, licensed midwife, underground midwife, or other, who lies to potential "patients"/clients about their experience - be that number of births attended, number of babies or mothers lost, c-section rate or anything else - should be prosecuted to the fullest extent of the law.)

[cinderella08]

These ideologies often boggle my mind....   A few questions....

Originally Posted by Storm Bride 

Obviously, you have to do what you believe to be right. But, it terrifies me that there are women out there actively trying to take away my ability to function without the "help" of the guidelines and regulations imposed on my uterus externally. If I choose a midwife who has only attended 20 births, then that choice is on me, not her. (I do think any care provider, be they an OB, family doctor, licensed midwife, underground midwife, or other, who lies to potential "patients"/clients about their experience - be that number of births attended, number of babies or mothers lost, c-section rate or anything else - should be prosecuted to the fullest extent of the law.)

Interesting.

So - do you believe a care provider (CPM, DEM, LM, CNM, OB, ect) should be prosecuted if they are negligent??  Because many OBs and CNMs are, but due to the fact that *most* CPMs/LMs/DEMs do NOT carry MP insurance and are not legal and/or licensed in many areas - they often get a slap on the wrist even if a baby dies simply for practicing w/o a license which is a misdemeanor....  Not saying all OBs/CNMs that have suits filed are convicted, but at least there is the option!

Also - you say if you choose a MW who has only attended 20 births - that should be your choice.  So, knowing the MW is illegal, or unlicensed, or has only attended 20 births - and she kills your baby because of something she did - pure negligence - but you trusted her and thought she was a good MW - you are going to take FULL responsibility that your child now lies in a casket instead of in your arms?  You aren't going to place ANY blame on that midwife for her negligence?  Your baby is 6ft under in a white casket because a midwife thought the heart tones she was hearing were the baby's but they were yours?  Or she poo-poo'd mec in the fluid and your baby aspirated it and died of an infection?  Or your baby was deprived of O2 too long due to shoulder dystocia that your MW didn't have a clue how to resolve?  All of these issues are PREVENTABLE deaths and you would actually step up to the plate and take the full blame for your child dying??  I can not fathom how most mothers would do that?  Or perhaps we can say we would now, but what if it actually happened to you??  Could you honestly say it was your fault for choosing that MW (even though at the time her credentials looked great, her training was adequate, she had amazing reviews from past clients, ect...)?

[starrlamia]

why would you need a nursing degree and a masters degree? That is more indepth then most countries, most have specifically midwifery courses that do not incorperate nursing. It is direct entry midwifery, this includes countries with much better maternity outcomes then the USA.

I dont know how I feel about underground midwives. I dont believe midwifery should be illegal in any state, and I do not look badly at any midwife who does practice illegaly but it opens doors for people who are not properly trained and able to practice independent midwifery. It is unfortunate that litigation is the an arguement here, this is one of the main reasons for the decline in care in many countries, especially in the USA, many doctors are practicing in fear of litigation which has pushed c-section and intervention rates up.

The risks of childbirth are actually fairly small, under 10% is a pretty small number, most women go through birth normally and if they choose to go with a midwife who has only delivered 20 babies, that is their choice, not one I would agree with, but thats the beauty of freedom isnt it?
 

Originally Posted by cinderella08 

Originally Posted by philomom

No, I do not support underground midwives. I want midwives to be of the certified nurse midwife CNM type where you have a four year nursing degree and a master's in midwifery.
 

I huge *yeahthat* to philomom.  I am in 100% agreement with this post.

[Jane93]

Starrlamia --

CNMs in the U.S. do have both a nursing degree and a midwifery masters.  In Europe, I understand that there are no "lay" "DEM" or "CPM" equivalents that can legally pratice.  Instead a 4-year (or longer?) midwifery degree is required.

So the U.S. has a situation where a number of "legal" midwives are grossly underqualified as compared to Europe, and a number of legal midwives are more qualified.

I am in favor of the nursing degree requirement because a woman (even a pregnant woman) is more than a uterus and breasts.  The body works together as a whole and I believe someone with a nursing degree has a better understanding of the whole body function than someone with just a midwifery degree.