Mothercat--
I don't what, if anything, complainers to the state mw-support org know about what happens after they complain about a mw. This org does not solicit consumer complaints, does not front itself as any kind of 'agency' dealing with the midwives--they mainly concern themselves with legislative efforts and connecting consumers w/mws when possible. But they will make space to hear complaints when consumers call for that purpose.
Bridgett--
It would be nice to think that bad practice weeds itself out, as you say. In theory, this should be true, it would make good common sense. And I think in human history--when communities were smaller and distances between them greater so that any mw/healer/etc could be known much more thoroughly than today by their client-base--that such weeding was more effective and common. But in today's world, and especially in a state where mws are few, and where there is little by way of active 'homebirth culture' from which families might learn enough info, standards and even 'gossip', it is sadly NOT true at all that natural weeding will occur--at least not in a timely fashion.
What if a mw is the ONLY mw around? Then, people might go to her and take their chances, because they so want a homebirth--even if they suspect/know that her practice is not exactly 'best'. Even if they don't like her much, because they feel safer with some mw present than they would w/UC or hospital birth. Or what if that mw is good at casting aspersions of pernicious types on the one or two others who may be available "she does not believe in god" or "that one seems to care a lot about the money"...as one client said to me, of the comments heard from one mw about me: 'she said things that would see to it that no Christian family of modest means would even CONSIDER calling you'. But that guy had met her and simply didn't like her...he decided he should meet me anyway.
What if the family really doesn't know much about standards for homebirth care, doesn't know much--for instance--about herbs, and simply trusts whatever the midwife does/says? People can get away with a lot of stuff, just by 'acting certain'--and consumers in general have been trained to respond to Doctorly Certainty. I've been surprised to see how readily this is transferred to their mw. It might be a long time, if ever, before it is discovered that that Certainty is not backed up by real knowledge...meaning that it could be a long time, if ever, before a family realizes that adverse things were actually caused (or at least contributed to) by their mw. Families might believe that if something went 'wrong' in any way, it was either unavoidable or their own fault; I know a mw who is quite good at 'helping' fams believe, in such adverse things, that it was either 'god's will' or something the mom did wrong. And if a mw is the only mw that people know of...they might be very slow to understand the mw's part in their birth outcome--they think 'midwife' means the same about all mws, everywhere, until they meet another mw, or are otherwise exposed to new information.
Also, birth works quite well, with or without a mw or other trained professional present, most of the time. So, any mw, no matter her knowledge and skill, is quite likely to gain fans just because 'most' of her births go fine. And let's face it, a couple of generations of medicalized birth has left most folks fairly expectant of emergencies and disasters at birth--it often does not occur to them that the kind of care and/or provider has a big hand in this. Since many people really don't understand that birth is designed to work and most often does work even without help, and believe (as they were socialized to believe) that it is care providers who 'make it go right', even an ignorant mw could be seen as quite good, just by having more good outcomes than bad. In my talks w/fams, I've found that often they are prone to accepting a mw without question who has been recommended by a friend. But of course, with most births, it really doesn't matter if there is a mw present--it's at that fewer number of complicated deliveries where a mw's knowledge and skills are really needed.
Not to mention that in a largely rural practice, especially if a mw will travel long distances, complaints and poor outcomes can be hidden fairly easily. The mw might become persona non grata in one isolated neighborhood...but people in the town 2hrs away never hear of this. This is compounded quite a bit when dealing with Plain populations, who will not share their news with anyone outside the plain communities, and also are the most likely to accept an outcome as 'god's will'...even if they have their questions/doubts. They are not supposed to 'judge'.
There is a lot I could say on this--I've dealt with it here, one of the saddest and most stressful things I can imagine since I generally urge families who contact me, to contact other mws before deciding whom to hire. I generally want to see midwifery flourish, and will reach out to other mws for peer time and mutual support....I believe in midwifery, and especially in an illegal state where we are few, I think we need each other! And to understand that a certain mw is practicing in a harmful way--and to figure out what to do about it--is awful. But I will leave it with only one more point:
I am not trying to save people from themselves, not at all. What I hope to help deconstruct in my lifetime--to 'save people from', I suppose it can be said--is the careful and assiduous conditioning that leads people to trust care providers without question. This goes for ALL care and service providers, not just mws/docs. I don't want people to assume anything or blindly trust me, anymore than they do any provider, but to be informed, alert and savvy consumers. It is, in the end, that kind of consumer who will do the 'weeding' and see to standards. Standards is a word I hate, by the way--and I'd have to say that midwifery should not be 'standardized' in most ways....what I mean is, referring for instance to mwherbs' note on the 'episiotomy mw', that it is better for all concerned if consumers understand a range of opinions on possible practices, are aware generally that it's best to look into a mw's practices/protocols to judge for themselves if those practices are both safe in general, and acceptable to themselves in particular.
And besides--*I* want to be saved from consumers' assumptions and ignorance as well! *I* do not want to be hired on the basis of assumptions or blind trust, do not want to be anybody's she-ra/godlike one who is ultimately relied upon as the 'savior' or 'maker' of birth outcomes. Nor do I want to be judged by the yardstick of a dangerous mw who may be not at all like me in most ways.
