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Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 5

post #81 of 394
Quote:
Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

 

I am so sorry, Knoel. How heartbreaking. My heart goes out to you. This is so, so sad. I can't imagine not having an answer for my child's death, either. How incredibly hard.

 

Thank you bringing us all back to the reality that when we discuss safety statistics we are talking about real people and real lives - not just numbers.

post #82 of 394
Quote:
Originally Posted by Escaping View Post

At 60 babies and $2,500 per baby, it doesn't really seem to me that the government would be squeezing midwives out of the system. There aren't many professions in Canada which take 4 years of university where you're almost guaranteed a job and paid that kind of money. If it's something you enjoy doing (you couldn't pay me a zillion dollars a year to deliver babies! lol) it seems like a pretty good deal to me. 

There seem to be a strong disagreement within (some of) those who support homebirth midwifery and many who oppose it about whether midwives make a lot of money. My impression is that homebirth midwifery is a fairly low-paying job for comparable stress and work-load. 

 

Let's keep in mind that even if a midwife takes her allowable 60 births/year, she has expenses even in areas where midwives either do not or cannot afford malpractice (another hot issue).  All of the midwives I'v seen have and office, an office manager, supplies and equipment galore, stock herbs and medicine, a full library, must have an extremely reliable car, and in the States they must pay for things like private medical insurance and pay taxes out of that salary. 

 

Multiplying midwifery fees times the number of births does not give a remotely accurate view of a midwife's salary, I am quite sure (as someone who worked closely with a small business owner).  

 

Maybe some of our midwives can comment more on this subject...

post #83 of 394

Yeah, midwifery is not exactly lucrative around here. My last homebirth, 4 years ago, was $3000 but I'll assume it has gone up by now. That covers everything except the birth kit and nbs. She has to pay her assistance, bloodwork, licensing fees, office expenses, urine tests, repair and replace equipment, additional birthing supplies, fuel for her vehicle, vehicle upkeep, phone and pager, educational upkeep, professional memberships, advertising,  etc... and be on call so she can't exactly schedule a bunch of women all together. And yes, Idenity is right, she must pay her own self-employment taxes in addition to federal and state income taxes and her own health insurance and liability insurance if she can afford it. Not to mention that so many midwives believe their work is a service to the community amd women they serve so they often will reduce fees or allow women to make payments over many months. 

 

My husband charges a comparable hourly rate for his work. On the surface you would think we were doing well, but after expenses and the number of hours he has to put in vs. the hours he charges for it doesn't amount to much, not enough to be considered a living wage for our area.

post #84 of 394

FYI, in a CU, midwives are still handling the vaginal deliveries--they just don't run the unit. It's slightly confusing in that you can technically be under midwife care for antenatal and deliver in a CU. Most women deliver in CUs--the distinction is more analogous to a birthing center (MLU) vs labor & delivery (CU). The issue with getting an epi in a CU is separate; until a few years ago, not all units maintained 24/7 anesthesia availability or restricted it to surgery only. Most units now maintain it but staffing is not always adequate to ensure all women who want one get it, plus there is politicization of epidural when it comes to the RCM and some midwives do not behave well when one is requested. As a practical matter, especially out of hours, coverage in consultant units is not always adequate. There have been changes since my first delivery, but back then, consultants worked office hours. Nights and weekends, registrars (residents) were doing all the work. 

 

If you developed pre-eclampsia (FYI, I delivered my first in the UK, chronic hypertension with superimposed PE) you would be transferred from MLC to CLC antenatally and would automatically deliver in a CU. I was transferred to consultant led care early in pregnancy when my hypertension was discovered--it is considered risk out for midwifery. The official criteria for MLC in my trust were extremely stringent (no VBACs for example) and there is some "turf war" over cases. In addition you can be nominally under consultant care (as for VBAC) but yet have the vast majority of your care done by the midwives as the consultants have their hands full with women who actually need specialist obstetric care. (I had all my regular antenatal visits with an OB, but when I needed to come in just for urine and BP, I could see a midwife.) 

 

As for education: it's hard to compare UK based education to American. First of all, a number of health related fields that are considered graduate entry in the US are considered undergraduate in the UK, so our insistence on graduate level preparation for midwives has to be considered in light of the fact that we also require it for physical/occupational therapists, which they do not. (In fact, medicine is a first degree in the UK--a 5-6 year program with no previous bachelors required.) In addition, the UK BSc in Midwifery prepares you for all aspects of care--home, hospital, and community. The American CPM only prepares you for home, which is part of the reason it would not be considered adequate in Europe. 

post #85 of 394
Quote:
Originally Posted by IdentityCrisisMama View Post

There seem to be a strong disagreement within (some of) those who support homebirth midwifery and many who oppose it about whether midwives make a lot of money. My impression is that homebirth midwifery is a fairly low-paying job for comparable stress and work-load. 

 

Let's keep in mind that even if a midwife takes her allowable 60 births/year, she has expenses even in areas where midwives either do not or cannot afford malpractice (another hot issue).  All of the midwives I'v seen have and office, an office manager, supplies and equipment galore, stock herbs and medicine, a full library, must have an extremely reliable car, and in the States they must pay for things like private medical insurance and pay taxes out of that salary. 

 

Multiplying midwifery fees times the number of births does not give a remotely accurate view of a midwife's salary, I am quite sure (as someone who worked closely with a small business owner).  

 

Maybe some of our midwives can comment more on this subject...

I was just speaking about the Canadian system... Their average salary is $80,000-$100,000 after overhead and expenses. If they're not making that much they're either not working as much or not managing their practice properly. Almost everything is written off and the corporate tax rate keeps getting lower and lower. Insurance is mandatory but written off as well as professional memberships. Any medications on the "Drugs in Midwives’ Authority" list are dirt cheap in Canada anyway (that's why we get busloads of Americans filling their prescriptions here and going back with suitcases full of pills). I'm not saying that it's easy work or that I could even do it, but if it's something someone loves to do, it's pretty decent compensation compared to other government funded professions in this province, and the chances of finding work are almost guaranteed.... whereas if you study to become a teacher, you require more education, make about half as much and there are currently 3x more teachers graduating than there are teaching positions.... so it seems to me that our government under compensates equally and without prejudice.   

post #86 of 394
Total on call hours would show that there needs to be more midwives because the hours are over and above what is thought to be reasonable...so if all the hours were truly tallied then there would be more employed midwives- the demand in Canada is high and the home births get booked way out ahead and there are waiting lists, but most of the births midwives are handling are hospital births in Canada. Of course not every doctor is against midwives, not my point, intergration into the hospital is still not just simple perfect and seamless. There are some basic policies in general that are different than the majority of US hospitals- like continous electronic fetal monitoring- does every laboring mom have this in Canadian hospitals?
post #87 of 394

40% of women in Ontario who request a midwife don't get one, so that alone should indicate we need more midwives but there doesn't seem to be any interest for many to become one. The university programs are undersubscribed, I heard there are only something like 30-40 new midwives registering each year.

 

Not ever laboring mom has fetal monitoring here, I've never heard about it used with anyone I know. 

post #88 of 394

mwherbs

 

I left a reply to one of your post farther up this thread. You stated that nurses only get 1-2 hours didactic for pregnancy and birth. Do you have a source for that statement?

 

Thanks
 

post #89 of 394
Quote:
Originally Posted by Escaping View Post

I was just speaking about the Canadian system... Their average salary is $80,000-$100,000 after overhead and expenses. If they're not making that much they're either not working as much or not managing their practice properly. Almost everything is written off and the corporate tax rate keeps getting lower and lower. Insurance is mandatory but written off as well as professional memberships. Any medications on the "Drugs in Midwives’ Authority" list are dirt cheap in Canada anyway (that's why we get busloads of Americans filling their prescriptions here and going back with suitcases full of pills). I'm not saying that it's easy work or that I could even do it, but if it's something someone loves to do, it's pretty decent compensation compared to other government funded professions in this province, and the chances of finding work are almost guaranteed.... whereas if you study to become a teacher, you require more education, make about half as much and there are currently 3x more teachers graduating than there are teaching positions.... so it seems to me that our government under compensates equally and without prejudice.   

 

There isn't really a "Canadian system", it varies widely from province to province, and even from region to region in some provinces.  I'm also pretty sure it's even higher stress than teaching, and there are more hoops to jump through in order to become fully trained.

post #90 of 394
Quote:
Originally Posted by Escaping View Post

40% of women in Ontario who request a midwife don't get one, so that alone should indicate we need more midwives but there doesn't seem to be any interest for many to become one. The university programs are undersubscribed, I heard there are only something like 30-40 new midwives registering each year.

 

Not ever laboring mom has fetal monitoring here, I've never heard about it used with anyone I know. 

you need to do more research :) The university programs get hundreds of applicants, it is incredibly hard to get in, in Ontario only 90 places between the three schools and over 900 apply, the same goes for MRU and UBC, they get probably 6-10 times more applicants than there are seats. This is my third year applying. We have more than enough interest the problem stems from not being able to have enough preceptors for our students and as such we cant raise the seats higher than we can support. Midwives have to pay professional fees every year as well as other business expenses, out of pocket, this is deducted off their paycheque. You are on call 24/7 and depending on where you work you either have 6-8 days off a month or 2 weeks off call, while still doing clinic work. Midwives do make decent money but they still have disparages in their pay and it's a job of passion not money or prestige.

 

electronic fetal monitoring is generally used when there is an indication

post #91 of 394
Quote:
Originally Posted by starrlamia View Post

you need to do more research :) The university programs get hundreds of applicants, it is incredibly hard to get in, in Ontario only 90 places between the three schools and over 900 apply, the same goes for MRU and UBC, they get probably 6-10 times more applicants than there are seats. This is my third year applying. We have more than enough interest the problem stems from not being able to have enough preceptors for our students and as such we cant raise the seats higher than we can support. Midwives have to pay professional fees every year as well as other business expenses, out of pocket, this is deducted off their paycheque. You are on call 24/7 and depending on where you work you either have 6-8 days off a month or 2 weeks off call, while still doing clinic work. Midwives do make decent money but they still have disparages in their pay and it's a job of passion not money or prestige.

 

electronic fetal monitoring is generally used when there is an indication

Are you positive about that? I hope to god you're wrong because I have two "friends" (on FB) who have gotten in, both on their first tries basically (by their on admissions) that they're "not good at anything else". If there are really hundreds of people lined up to get in, I have absolutely no idea how these two nitwits got accepted.

post #92 of 394
Quote:
Originally Posted by Swallow16 View Post

Alan/Slackerinc, do tell the truth! You weren't banned. You were forbidden to go off-topic.

 

You derailed threads about any and every subject into endless harping about breast vs bottlefeeding.  A discussion about feminism was sidetracked by your insistent nagging about male circumcision. An when there was a thread that was supposed to be about breastfeeding, you insisted on discussing your stellar SAT-scores.

 

I'm not a supporter of Dr Amy but the way you hijacked that forum wouldn't have been appreciated on a pro-homebirth blog either. You made several hundreds of posts.

 

Besides, I am noticing  the same pattern here: why are you bringing up your shenanigans in a thread with a completely unrelated subject? 

OT: I've always been behind the 8 ball & the last to know.  Someone enlighten me to this, please?

 

Thanks,

Sus

post #93 of 394

I don't know how helpful this is but in case it matters to anyone I can clarify re midwifery in the UK

 

We have direct entry, which is a 36 month course. This does not require you to have studied at degree level. You'd usually have A levels which I think are basically your high school diploma. Older applicants can offer alternative qualifications. It is highly competitive.

 

There is also an access to midwifery option for those who hold nursing degrees, which lasts 18 months. Again, highly competitive and you'd need to, iirc, have studied adult nursing to get on. Its being phased out. The main reason, as I understand it, for the phase out is that midwives actually don't appreciate the nursing crossover as they consider themselves a separate profession. Midwives, fundamentally, assist normal, healthy people at a particular stage of their life, and there is great emphasis on the client as in charge of their own treatment.

 

Midwifery is a recognised profession and seen as a branch of medicine in its own right. Midwives practice quite independently of both nurses and doctors and have a very distinct identity. 

 

Home births are normal, not seen as terrible outlandish, but relatively uncommon here. The midwives who cover them are also the midwives seen by all women routinely as part of antenatal care, and they also tend to cover birthing centre work so its quite normal to transfer from a home birth to a birthing centre. 

 

My understanding is that the statistics are around equal for safety for low risk women. Midwives tend to be quite proactive around suggesting home births IME, but tbh its a very flexible thing. With all three of mine a home birth was my first choice but I transferred to a ward in one case and the midwifery led unit in the other, only had one home birth, the last. It doesn't feel like a big, big deal really, certainly my midwives advised me to plan for a home birth because that was the hardest logistically for me, but were totally relaxed about any of the options.

post #94 of 394
MotherCat... I was looking for some documentation for you. Mostly this has been personal communication with RNs... There was awhile back a doula who was in nursing school and she bloged about it- because she had tried to set up some additonal speakers for her class- unfortunate her blog is now private invites only.
Labor and delivery nurses now often have additional- professional develelopment POST basic RN cert/ licensing that has to do with EFM terminology and intrepretation, including what meds do to strips.... Stuff like that. But that does not mean that every CNM candidate has even worked Labor and Delivery other than inital roation in school. When researching CNM schools i came across an application form that allowed for RN without L&D experience to enter if they had taken a birth education course...
post #95 of 394

Has anyone posted this yet?  Oregon mandated reporting of out of hospital birth rates in 2011.

 

The following testimony was just provided in committee for the state legislature, showing a 6-8 times higher rate of death for birth with a DEM (versus the 2 - 3 times we are discussing here). 

 

https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

post #96 of 394
Quote:
Originally Posted by Buzzbuzz View Post

Has anyone posted this yet?  Oregon mandated reporting of out of hospital birth rates in 2011.

 

The following testimony was just provided in committee for the state legislature, showing a 6-8 times higher rate of death for birth with a DEM (versus the 2 - 3 times we are discussing here). 

 

https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

 



This deserves its own thread. The most compelling thing about this is that it comes from Judith Rooks, CNM. Who has published numerous articles on OOH birth. This is not coming from ACOG, or Dr Amy, or evil obstetricians somewhere - this is coming from a midwifery professional and proponent of OOH.(Though she is a proponent of safe OOH birth). It's time to start paying attention.

post #97 of 394

I've removed several posts on this thread because MDC is not going to host discussions about member participation on other forums. Contributing to this topic is 100% welcome but how that topic plays out specifically on other forums will not be hosted. 

post #98 of 394

With DEM's specifically?  Or are non-CNM's being assumed to be DEM's?  (Just wondering b/c often state-reported homebirths include unplanned unassisted births - like "back-alley crack babies" - and preterm deliveries, which would obviously be different from planned at-term homebirths.  I'm not saying this is one or the other, just wondering.)

Those stats certainly don't match what we see in any of the other studies done in countries that have bothered to study the stats.
 

post #99 of 394

The link emphasizes that this is an analysis of planned homebirths/birth center births and is focused solely on the outcome for term births.

 

What the materials demonstrate very clearly is just how good hospital mortality rates are for term infants.  Also, I find it interesting that she did not specifically call out a line in the table for CNM births.  You can get there simply by subtracting the DEM attended birth information from all the planned homebirth/birth center birth information.

 

When I do that, I get 2 deaths for CNMS out of between 600 and 700 births attended. 

post #100 of 394
Quote:
Originally Posted by Escaping View Post

Are you positive about that? I hope to god you're wrong because I have two "friends" (on FB) who have gotten in, both on their first tries basically (by their on admissions) that they're "not good at anything else". If there are really hundreds of people lined up to get in, I have absolutely no idea how these two nitwits got accepted.

Um, I'm on my third year applying and am an administrator on a facebook group of 300 people trying to get into the program, I have talked and worked with midwives and students and hopefuls for the program, so yes I am absolutely 100% sure I know what Im talking about. It is extremely hard to get into the program and the majority of people have to apply more than once to be accepted, applications range from 6-10 people applying for every seat.

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