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Policing one's own...  

post #1 of 14
Thread Starter 
Please be open-minded and patient while reading this post. While it's understandable that this can be an upsetting topic, I'm seeking positive brainstorming and theorizing on the issue and am not up for flames.





I live in Michigan where I've been told, and always believed, DEMs were *alegal*. Thanks to the patient instruction from MWs in IL and WI at MDC, I now know understand why DEMs are *illegal* in Michigan despite sometimes being paid by health insurance, active in MI MWs Association, and even interacting freely with the health department.

One problem I see with their illegal status is there is no structure in place, that I know of, for them to police their own or for the government to police DEMs short of criminal prosecution. Have you thought about ways to maintain the good reputation of midwifery care and protect women from out of control (even renegade?) MWs in these circumstances?

I'm sure those of you from MI remember a the case of a particular nationally (if not world) renowned DEM who was extensively published on midwifery care. Laurie Morgan's birth attended by that MW compelled her to UC and she become a staunch UC advocate in the 90s. I have a friend who's now a UC activist after having the same MW manually dilate her from 7cm so she could attach the vacuum (without telling her let alone getting her consent... she was actually screaming, “Stop! Stop! It hurts! Stop it!”) and extract the baby to prevent my dear friend from suffering the pains of labor. <shudder> It wasn't until there was a dead baby that NARM revoked this renegade MW's CPM credentialing. The undisputed facts of the case are there was a baby with a congenital defect, she applied the vacuum extractor and sucked the baby's brains out before the baby. Even with her CPM credentialing revoked a Google search shows she's acting as a professional witness advocating for MWs brought up on charges and she has an apparent stellar reputation... even here on MDC.

I had a MW who managed not to kill me during my first birth. I consider her actions toward (or more precisely *against*) me as immoral, unprofessional, and even criminal. I thank God I didn't die in the process and became a Ucer as the only means I knew to ensure my safety and autonomy during pregnancy, labor, and birth. Ten years after the fact I started seeing a counselor for PTSD related to birth professionals. While I've managed fairly well at avoiding my triggers for ten years, between seeing the counselor and hanging out on MDC, I strongly believe a woman's choice should not be limited to the safety, control, autonomy and respect of UC or rolling the dice with assisted births. I am concerned that she's still in practice, has held office in the state midwifery organization, and will probably never be stopped unless there is a dead baby or mother to draw attention to her outrageous acts. Unlike Val she has very little web presence but what she has is positive... even on MDC.

If these DEMs were doctors or CNMs, we could file our complaints with insurance companies that have them as preferred providers, the hospitals where they have privileges, and with the state agency which licenses them. We don't have that option in states where DEMs aren't regulated. As mothers if we build a website www.SoAndSoEndangersWomen.com to share our stories we risk a civil suit for libel. So my question to all you birth professionals is what do you think should be done to protect the reputation of midwifery and, far more important to me, women?

Thank you for your thoughtful input.

~BV
post #2 of 14
Well you need to have a legal status to begin with.
even with legal status though it is not going to be completely possible to prevent every style of midwifery from being practiced- just like you cannot keep doctors or nurses from practicing until they have done something that shows their (great harm or poor judgment)
something to say about being a provider- 100% chance that you will make a mistake- all providers make mistakes all of them no exceptions. Should you loose a license for making a mistake? or can people learn from their mistakes?
peer review is mostly how we deal with problems and there is something else to say about this there are many ways to do things-
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now I know a bit about the situation you describe and you have some of the facts wrong- despite saying "the undisputed facts of the case " what you have said is close to the truth but not exactly the truth and that baby's death is included in the big CPM study published in 2005- subgaleal hematoma- not sucking the brains out- creating a hemorrhage within the galeal space (which can happen when using a vacuum-training in newer standards for vacuum are needed ) , --- after a peer review process she was given some educational- things to complete she decided to not comply- if your state had licensing she may have felt compelled to comply or loss of a license instead of just loosing a certification-
post #3 of 14
YEs, this is a very tough thing! Have dealt with it in my state, too...so very hard to know what to do that is legal, professional and even kind where possible.

Yes, every person on the planet makes mistakes at some point...and when you are in health care, that can cost a life. I suppose the difference being whether or not the provider is willing to own mistakes, and then to either learn new things or otherwise address issues that lead to poor decisions (in case of mws, perhaps that could mean taking fewer clients so as not to be in too much of a hurry...or other non-educational things).

But what to do about it in state's where there is no reg board in place, I do not know.
post #4 of 14
Thread Starter 
Quote:
Originally Posted by mwherbs View Post
Well you need to have a legal status to begin with.
even with legal status though it is not going to be completely possible to prevent every style of midwifery from being practiced- just like you cannot keep doctors or nurses from practicing until they have done something that shows their (great harm or poor judgment)
something to say about being a provider- 100% chance that you will make a mistake- all providers make mistakes all of them no exceptions. Should you loose a license for making a mistake? or can people learn from their mistakes?
peer review is mostly how we deal with problems and there is something else to say about this there are many ways to do things-
I completely understand mistakes are made but am concerned when they are practiced habitually and rather than being acknowledged are covered up. I also weigh a well intentioned mistake far differently than performing procedures and giving herbs/drugs without informing the patient/client in non-emergency and even non-emergent situations. In my moral code it compares to being slipped a ruffee in the bar.

Quote:
now I know a bit about the situation you describe and you have some of the facts wrong- despite saying "the undisputed facts of the case " what you have said is close to the truth but not exactly the truth and that baby's death is included in the big CPM study published in 2005- subgaleal hematoma- not sucking the brains out- creating a hemorrhage within the galeal space (which can happen when using a vacuum-training in newer standards for vacuum are needed ) , --- after a peer review process she was given some educational- things to complete she decided to not comply- if your state had licensing she may have felt compelled to comply or loss of a license instead of just loosing a certification-
Thank you for the clarification. I shouldn't have said the undisputed facts of the case. : I based my comments on the newspaper reports at the time (all I read agreed the brain was outside the skull after vacuum extraction was applied and the dispute between the parties involved were whether it was due to a birth defect or the vacuum extraction) as well as updates from her previous clients who were following the case. Were all the reports at the time incorrect in stating the brain was outside the skull after the procedure? I've also been told she has been banned from ever attending births in Michigan which, as DEMs are registered or licensed in Michigan, I can only imagine, if true, would be the result of some sort of plea agreement or agreement to avoid prosecution. Do you know if this is true?

So am I correct in assuming the CPM status was revoked solely based on this one case and the habit of performing procedures (like vacuum extraction) without consent and even with active, verbal, and loud non-consent was never considered?

Like I said before a "mistake" doesn't bother me nearly as much overriding consent in midwifery and medical care. I wish there were something like Consumer Reports, e-pinions, or especially Amazon reader reviews for MWs. These would obviously have their problems but something to let consumers know what questions might be particularly revealing about a MW's practice, if her transfer rates for first-time moms is 8Xs her rate for repeat moms, actual reasons given to clients she risked out of her practice so it can be compared to the list she gives potential clients, if she's willing to honor a clients request for no doppler but panics when she can't hear a heartbeat on fetoscope even while the baby's kicking... things like that which might make no difference to some women but a world of difference to others.

CLARIFICATION: I said in my OP that both MWs had a good reputation on MDC and was not trying to imply there are members of the MDC community. I based my comment on my searching their names here and reading only positive posts along with the isolated "PM me if you want to hear my or my friends' experience".

~BV

P.S. I want you MWs to know it's been very healing to me to read your posts. So many have struck me by your respect for and empowerment of women. I'm still not ready for an attended birth but it still does my heart good.
post #5 of 14
Quote:
Originally Posted by bryonyvaughn View Post
Have you thought about ways to maintain the good reputation of midwifery care and protect women from out of control (even renegade?) MWs in these circumstances?
For CPM's there is a complaint process available through NARM. There are also the peer reviews that are required to re-certify. But even with these processes in place, they do require consumers to act in order for others to become involved.

Women will go with the provider they feel good with, or that came recommended. The number of women I meet that feel they were treated badly or some have even used the description of raped in a hospital setting with OB's or nurses ~ generally they dont complain or follow through with seeking accountability unless there is an awful outcome, most likely a death. Do you write to the medical board and ask if a doctor your seeing has ever had a complaint agianst them? Most people dont. But many will see a practioner that was recommend to them from a friend or family member and then either continue seeing them based on their comfort with them or move on to the next recommend provider. And I think that its difficult to prove constant wrong doing because I would almost bet that anyone could find many people that think they did no wrong and still whole-heartedly will recommend them to others, loving the care they received.

It's a tough call.
post #6 of 14
I see your point........if a mw won't join an organization that polices their own, then that is up to the consumer to ask about. I certainly would.


I think the government/states should completely stay out of licensure. It has done NOTHING to help ob's in practice. Even if an ob does something outrageous, goes to court and loses the case, he/she is still practicing the next day. My friend just won her wrongful death case of her husband (not an ob) and the doc is back in practice. No one knows nor does anyone care.

The problem w/ govt licensure is this: it dupes the public into thinking their protected. How many times do we hear, "Well, my doctor said xyz", which can be totally outdated and/or wrong. But the public goes along like sheeple trusting their licensed doctor.
And then you also have the problem of the govt banning hbac, breech, etc for mw, which is just ridiculous. It's up to the mw to decide her proficiency and the mom to decide if she trusts her mw.
I'm not against accreditation, just the govt getting involved. It doesn't improve care and dupes the consumer.
post #7 of 14
Wow. This is tough for many reasons.

First, I know the midwife that you speak of in the original post. Well, not KNOW her, but know of her. I saw a video clip of that birth that she was at - and her behavior towards the mother was certainly abusive in that video clip. I know that over the years I heard conflicting things, but she was a "star midwife" and I think that adds to the feeling of being untouchable and unaccountable to clients.

The difficult thing with any sort of regulation to "ensure public safety" is that what is one person's "reckless behavior" is another person's personal choice. I'm sure some midwives in my area would take some of what I do (well, don't do) for certain clients as "reckless". In fact, if there was ever a poor outcome because of a decision a client made (for instance, not listening to baby during labor), I would be reamed for it and viewed as being "reckless".

My role as a midwife is to serve the families that hire me. That's it. Any protocol that comes with my licensure is a general guideline - and I would let a family know if something was against the state protocols, but that doesn't mean I wouldn't stand by them if they chose another path. The protocols are set up with an idea of safety in mind for the general public - but I honestly feel that for a certain population of my clients, I'll go out on a limb for them.

I don't agree with criminalization of midwives. Period. I don't favor mandatory licensure - but without mandatory licensure, I'm not sure that you can do much to ensure that midwives are held up to a certain standard. I would hope that midwives have a community that they meet with on a regular basis - or at least know - to review births that are difficult, go against protocol, or have some question about. I am not the best at attending peer review myself - not because I have something to hide but because the days haven't always worked out well for me (and to tell you the truth, I don't look forward to them). I do know that if something happened in my practice, they would either call me or expect me to call them to discuss it.

It's not an easy answer. I think that women (consumers) should be aware that not all midwives are the same. I think that for midwives who are viewed as 'reckless' that there is some conversation with their peers about their choices. I'd be willing to state where I'm coming from in regards to certain things that some might consider dangerous - and hopefully they'd realize it comes from a place of honoring a family's informed CHOICE rather than an ego out of control.
post #8 of 14

Graphic to a degree and could be disturbing !

Quote:
Originally Posted by bryonyvaughn View Post
So am I correct in assuming the CPM status was revoked solely based on this one case and the habit of performing procedures (like vacuum extraction) without consent and even with active, verbal, and loud non-consent was never considered?
OK so I wasn't at the peer review and If I were I would not be able to say as much as I have said already and I don't know what all went on at the peer review- but it would have been a response to a complaint(s)-- and it may very well be that this was part of the complaint and that lack of consent would definately have been addressed--- the other thing was what ever the things were set out to be done- and I don't have a list of those either - they weren't done- so loss of CPM credential would have been as a result of not complying with what was set out in peer review to be done--
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as for the other portion- I don't know what to say about the news reports they are infamous for getting the "facts" wrong- I could list case after case presented in the papers about midwives who were being prosecuted-- some of this has to do with midwifery and homebirth involving such a small population that knowledge and understanding of many finer points go right over most people's heads--- if what the papers said was true then - the official report of cause would have not been "subgaleal hematoma"-- if you look it up in the lit you will find a common cause of subgaleal hematoma is vaccum delivery, there are other possible causes but perfectly normal babies with a vaccum applied to their head, have had this degree of trauma- here is a link to an article on the subject
http://findarticles.com/p/articles/m...41/ai_17913632
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on a personal level I would probably write my own purge letter - and most likely re-write and re-write it till it felt right and then send it yes I would want to really tell this person my perspective of my birth experience- it may or may not change her practice but I would want to do that for myself as well as hoping that something I said could make a difference--
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Texas use to have a registration where clients left feed back- and the state kept the info= I don't know if that exists anymore- but that is one way that is a buyer-be ware form of protection.
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post #9 of 14
This is (again), so tough to work with. This is partly because of there being no legal framework in place here, nor even a voluntary one--but it's more than that. Because of a mw I knew that had so many complaints against her, I have done some thinking about this, and came up with some ideas to tell people generally about interviewing a mw:

Ask her if she does peer review with other mws--and how often
Ask if she can provide a professional ref from other mws who have worked with her, or consulted/peer reviewed w/her on a regular basis
Ask how often she misses births
Ask about poor outcomes she may have had
Ask when is the last time she did formal continuing ed (not just read a book, but went to a conference)--and how often she usually does this (most professions req at least 1x/yr)

But it turns out that many...most?...hb-hopeful fams do not feel comfortable with this kind of questioning at all. Or will accept the blithest and most flimsy of responses if something is glossed over...and sometimes are more suspicious of frank honesty than of evasion. This last I know because of what has come back to me about things I've told prospective parents about my own practice (from other mws or clients who later spoke w/a fam I'd interviewed with). The mw who does not report problems is seen as a better mw than the one who does...people do not seem to realize that ALL mws will see some issues from time to time, and if a mw implies that she doesn't, she's most likely lying! I mean, even small problems or problems that were unpreventable.

I think of one mw I spoke with--about a cord prolapse she'd dealt with years before (she didn't accompany transport, baby was 'saved' but profoundly disabled from longterm hypoxia). She spoke of how the parents didn't follow her instructions to keep mom in knee chest until csec was ready...how the hosp didn't continuously monitor in the ER/triage...how slow was the reaction to baby crashing. She didn't say at all that she might ought to have accompanied transport, or that cord prolapse could well have been caused by her AROM done with a high-sitting baby, and for what reason she believed that AROM was 'needed'...the way she told the story, in other words, she basically left herself out of it. As a mw, I was chilled...but how many consumers know anything about AROM, cord prolapse, emergency protocols? So even if they asked her about it, they'd get a story that sounded like she was in no way involved with a bad outcome.

And reputation seems to mean everything...and personality has so much to do with reputation in the first place. The way people read personality is another matter entirely! Consider the mw who does 'too many births'--too many because of missing births regularly, or not having any time at all to labor sit/monitor, or resorting pretty often to induction in order to prevent overlapping births. One parent talked about how great and selfless it was....yes, this was formerly her mw, and she did talk to this mw about being too busy at one point. This mom, however, really loved and respected her mw nonetheless--and when mw said she took so many clients because she 'didn't want to see people miss out on a homebirth and there's not enough mws here', or because so often, she would get hired early on by new clients due at a certain time but then her former clients would call her later in their pregnancies, due at same time as the early callers-- and she couldn't just turn them away, could she? I mean, her repeat clients were just so dear to her! Anyway--to me this pattern screams 'egotist!!!', someone who imagines she has no limits, someone who thinks she can give everyone the homebirth they need--and since these people particularly want HER (incl the new clients who came on friend referral), she should not just refer them to another mw and disappoint these fams, right? To that mom, tho, this mw's actions broadcast love for humanity and lots of selflessness...and nevermind all the missed births, needless inductions, poor outcomes, etc, that are going to arise when a mw is taking on too many clients.

Sorry to go on, it's a complicated topic and it seems examples are useful. Main point being:

It's about the integrity and accountability of each mw AND

It's equally about the clients' willingness to ask hard questions and take nothing for granted--or not.

Too often, I have seen to my dismay, families hear the word 'mw' and a whole bunch of assumptions rush right into place....and nevermind if those assumptions are completely incorrect. This is something I try to deal with upfront, and make sure fams know what I am and am not, can do and can't do...but I still have to deal with more assumptions along the way in many cases. Heck, I've even seen mws make the same assumptions about each other--'well, she's been to 500 births, don't you think she's learned a lot by now?' Hey, lots of mws would have learned a lot by 500 births...probably MOST mws would have made the most of those as learning experiences....and there are some who just do the same idiotic and unsafe things over and over because they WON'T get continuing ed or do peer review, DON'T believe a thing might be done differently, CAN'T imagine that their understanding of something might be pretty darn poor after all. And again, if a mw has the right personality factors in play--always appearing seamless and knowing and confident--then too many families will go along never knowing their risk.

Ok, babble done....
post #10 of 14
I think the best thing would be for there to be a group of consumers who were not involved in midwifery friendships or politics (or who would remove themselves if a midwife friend was under review) running some kind of local voluntary certification where they could de-list a midwife who refused to participate in a review of a complaint or who did not comply with recommendations or was clearly incompetent. Kind of like a Better Business Bureau. While self-policing can work in some instances, it is fraught with complications.
post #11 of 14
to MsBlack's post: yes, yes, yes!!!!!

I have had the problem of being too honest with potential clients, and have not gotten hired. I have had people ask for references from clients, and I wanted to give professional ones instead- it is easy to find happy clients. And I have known mw's who are too busy to give good care. But, women are often swayed by the manipulative, smooth talking person who makes them feel good.

How about this- instead of trying to control a midwife's practice when you don't have a procedure for that in place, teach women to make better choices. Isn't that one of the underlying principles of midwifery care anyway?
post #12 of 14
Bryonyvaughn,
I am replying to your OP on this thread.
I have been a member of MMA for several years and on the board. I have had several private conversations with women who were cared for by that midwife. The ones who told me their stories had tried to get someone to believe them that care was substandard. Locally and nationally they were asked (by their report) not to make waves, perhaps they misunderstood, etc.
I cared for a family who's baby was in special care as little as 4-5 years ago. The midwife was only doing births for special repeat clients. Although the baby ultimately was OK, it spent several days in the hospital with aspiration pneumonia for sugar water given by spoon by the midwife.
Did you know that there have only been 3 CPM's who have had credentials revoked? One was the midwife you refer to and one of the other two was her apprentice.

I would love to see this whole issue addressed at a MANA conference. We need to find a way to help the midwives whose practice is dangerous and as I have been reminded by an ethicist that we are complicit in the midwives' actions if we know and don't say or do anything. Yet, as a profession we seem afraid to address this for fear of exposing the problems w/i our profession. I think we need to do this for exactly this reason. Isn't this part of the old boys network we dislike so much, that other physicians know the dark side of their colleagues practices and no one says anything?

Consumer organizations like BirthNetwork are a good start but there is a basic assumption that everyone has the discretion to tell when what a midwife or physician says is not necessarily what they do. It is classism to assume that everyone has the same level of eduction or sophistication to sort through action vs. words.

What happens if a consumer group states a midwife or physician is not what they seem and attempt to censure them? The provider is free to ignore them and disparage the group's knowledge of the midwife's practice, or that of unhappy former clients.

If state midwifery groups do not have policing power or the ability to force a stop to practice with a dangerous midwife, then who can consumers turn to for resolution? This is where legalization comes in. The state would have the power to force a change to safer practice or cessation.

I'm putting away my soapbox for now.
post #13 of 14
awesome post, mothercat. thank you!
post #14 of 14
Thread Starter 
Thank you all for your input. I understand how this could be an uncomfortable discussion when raised by someone violated by one of your own. I appreciate your thoughtful replies.

I have decided to write a "purge letter" for myself. When that's done I will consider revising it to send to my former MW. Beyond this I will contact a few board member of the Michigan MWs Association (my former MW's only credentialing organization), to ask about their peer review process and, if they seem receptive, spilling the beans. If they are interested in covering up, IMO unethical and even criminal, behavior, I won't waste my limited time and energy with them.

I've also been invited to attend a talk/discussion for doulas, MWs, and MW apprentices, assistants and students on the topic of treating women with a history of sexual abuse. I like this because the majority of women there are motivated to help rather than dominate already scarred and wary women. I was raped but my experience at the hands of the ER staff was far more dehumanizing, dismissive, and relationship-wise socially twisted than the rape itself. I think my experience of my MW habitually acting against my person without telling me, let alone getting my consent, during labor, birth, and post-partum has given me insight in how a MW can build trust with these mothers and work *with* them in a healthy manner. I look forward to taking my experience and making a positive contribution to attendants and birthing women alike.

Take gentle care,
~BV
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