Homebirth Midwives using cytotec , ethics question, Florida - Page 2

[BeckiCNM]

Originally Posted by mamabearing

So how does one induce labor with a cervix that is not favorable?

I have had great success with foley bulb inductions. No chemicals needed (at least at first - pitocin usually follows).

Sure, there are reasons for induction, but instead of focusing on the best way to induce, I'd rather figure out more ways to avoid it completely. Like getting rid of the "big baby" myth. JMHO.

[mamabearing]

Originally Posted by BeckiCNM

I have had great success with foley bulb inductions. No chemicals needed (at least at first - pitocin usually follows).

Sure, there are reasons for induction, but instead of focusing on the best way to induce, I'd rather figure out more ways to avoid it completely. Like getting rid of the "big baby" myth. JMHO.

those are great points. I agree too that a lot of inductions are done for reasons that are "soft" like macrosomia and I hate to see inductions becoming so common. Labor goes a lot better when it starts on its own.

[Sileree]

Wow. I am just speechless. :

[darsmama]

: No words. Wait, I found some.

nm, they are against the UA

[Human_Being]

Originally Posted by darsmama

: No words. Wait, I found some. nm, they are against the UA

I don't know how to get the mod. to check in about it, but in another thread this by this poster on the same topic was determined not to be against the user agreement since there are no names named. There are many midwives in Central Florida, so this is not maligning one single person...I do not feel its out of integrity in anyway to discuss this.

[triscuitsmom]

First of all... my jaw is on the floor over this... a homeopathic??? Holy man, that needs to stop... preferably yesterday... wow :

Originally Posted by mamabearing

No, obviously I know it has potentially serious risks or I wouldn't want to use it outside of a hospital staffed with an OB OR. I suppose you could say that I know it has dangers ( and I do ) and I want to be prepared to deal with those dangers too. I don't believe in elective inductions but I also believe vaginal birth is safer than cesarean for most people. So how does one induce labor with a cervix that is not favorable? There are times that I think cytotec may be worth the risk ( though I do think it has the highest risk profile of any drug we use to induce labor ) to accomplish a vaginal birth. It has been researched extensively and the risks are known but there are women in whom it is a better alternative than a cesarean. If the research stops supporting that it has it's place I would accept that too.

Frankly, I think even the lowest "risk" birth has enough inherent danger that I would not choose or recommend birth outside of a hospital setting. I am not trying to deny anyone's right to a homebirth, just my minority ( here ) opinion.

I completely disagree about a hospital setting not making a drug less dangerous. There are many many drugs, both used in childbirth or for other indications that have nothing to do with birth, that are only used in hospitals because a hospital has the capacity to deal with risky ( or dangerous ) side effects. You have to weigh the risks ( dangers? ) with the benefits.

Now onto this post. Again : The FDA has strict warnings AGAINST this drug during labour. It is not approved... period. Frankly the fact that a medical professional would so blatently ignore the warnings that it has more power to harm than do good makes me : and a little queasy too.

As for the safety of homebirth, again, your opinion and my own aside (because in this arena opinions are varied, but of little consequence to the fact)... birth in a hospital is statistically less safe for all but high risk cases... I don't see how opinion should be important to making decisions that affects peoples lives...

[mamabearing]

Originally Posted by triscuitsmom

First of all... my jaw is on the floor over this... a homeopathic??? Holy man, that needs to stop... preferably yesterday... wow :



Now onto this post. Again : The FDA has strict warnings AGAINST this drug during labour. It is not approved... period. Frankly the fact that a medical professional would so blatently ignore the warnings that it has more power to harm than do good makes me : and a little queasy too.

As for the safety of homebirth, again, your opinion and my own aside (because in this arena opinions are varied, but of little consequence to the fact)... birth in a hospital is statistically less safe for all but high risk cases... I don't see how opinion should be important to making decisions that affects peoples lives...

It's not a minority of medical professionals using this medication. Yes, its an off label use. However, there is quite a lot of literature that doesn't back up that it has more power to do harm than good, despite what you might generally read if all you read is alternative childbirth literature.

Back to personal opinion, mine is still quite skeptical about this drug in ANY setting. I don't base my decisions on my personal opinion. So I can't just say, no I won't participate in the care of a patient getting cytotec. I will however monitor her with the upmost care and do all I can to make sure she makes an informed decision. I believe the drug can be safely used, but you need smart cautious people to use it, in a hospital setting, on very carefully selected patients, who have been fully appraised of its risks and benefits.

Regarding homebirth, I know that you have probably read things like "Obstetric Myths vs Research Realities" or any number of publications that claim research supports homebirth safety. But the : is unfair, because there are a lot of holes in that research, and I frankly I firmly believe what you think is my "opinion" is fact. I do not doubt that you and many other moms, myself included at one time, believe such books are fact, but I no longer do. What I do know is my stating what I think are the facts here will make me extremely unpopular as a poster, even we probably agree on many other things.

There is a very good thing happening here on this board, at least I find it very heartening, and that is not one person has been anything but appalled by it being used at home, and worse on people who don't even know they are getting the medication.

At least we agree on that.

[MsBlack]

I totally agree that no homebirth midwife should be using cytotec without full disclosure of risk and benefits to parents (or doing anything at all without true informed consent). Of course, I also believe that no birth practitioner should be putting cytotec anywhere near a pregnant or pp woman, either...but that's another discussion.

and I totally agree that it is right to first approach the mw/s doing this where that is possible, or otherwise to find someone closer to said mw/s who will first speak to them. If such person-to-person contact (and/or perhaps a group contact with said mw/s) does not succeed, then yes, it should be brought to the attention of licensing board (or whatever it's called there). To me, being a midwife (or student mw) includes not just a responsibility to obtaining knowledge and skills to provide best care, but also a responsibility (of some kind/degree) to the profession itself...it means willingness to look beyond your own personal business to the good of midwifery--and of course, client safety--on the whole. Dishonest and/or dangerous practices are not good for midwifery or clients!

However....

I have been involved in the matter of a 'risky mw' in my neck of the woods. I started out by telling her myself, after following her for a few weeks with an eye to partnership, that I could not work with her because of certain issues, which I named. At the time, I said I wasn't judging her, and that these things were perhaps only a difference of style--and affirmed that I wanted to remain in contact, work amicably in the community as colleagues providing mutual support, etc. Next thing I know, word came back to me--from someone who heard it from her--that she was saying very nasty things about me to homebirth families. I had just returned to practice at that time, and began meeting many people--her former clients as well as other professionals such as chiros and hb backup OBs, her own former apprentices and doulas--who told me many troubling things about that mw's practice. Next step I took was to communicate with other mws far away about these issues (people who I figured didn't know her personally, to try to minimize drama), to get their view of these practice matters and some kind of advice. All confirmed my views of her riskiness and some urged me to do what I could about it--people who did know her after all, and had themselves in years past also met with her and tried to talk to her about the same things (urging her to get more training, keep up with changes, etc--people who tried to be positive and supportive of her, to no avail whatever).

To make a long story shorter: I'd already tried talking to her myself, next thing I did was try to motivate various others to talk to her...former clients, these other professionals. No way! No one would get involved. Then I decided not to do a thing...mind my own business, not think about it. That worked for almost a year, but then I was basically dragged back into this by being contacted by a chiro who'd treated one of her babies, oy. It was the last straw...and I again tried to motivate help with this issue. This time, a sort of committee was convened, discussions held, and an action was taken (someone agreed to be the spokesperson and go to her).

Anyway...all this is leading to the point that while I totally believed and still believe that someone had to instigate action...and I was willing (reluctantly) for that to be me...I have suffered some of the worst effects from this. It might not make you popular, taking action. Be prepared to be judged, gossiped-about, suspected of ulterior motives. The mws in question will surely spread calumny about you in their own defense...but they will also have supporters who might well help in that work. Still others--who might actually agree with your basic premise--might think that it's just wrong for a mw to mind anyone else's business or do anything that 'might damage midwifery'...or will be just plain too chickensh*t or two-faced to do/say anything about it. Some consumers might believe whatever they hear about you, whether or not they liked or even knew that other mw. And hey, one reason that the med institution is so powerful is that they DO try to keep such secrets, they do close ranks and protect their dangerous own, as a way of protecting themselves/their own popularity and bottom line. No matter that such a choice is unsafe and unethical!

Anyway--I don't mean to be discouraging..and you surely WILL have some support for this. But I do think that you need to be aware that this action does have its pitfalls--I wish someone had warned me how ugly it might get. Can't say for sure that understanding this in advance would have helped--but it sure couldn' t have hurt! Forewarned is forearmed, as they say.

Be brave, and thanks for caring. This work is not for the faint of heart! Especially not this particular part of this midwifery work.

[MsBlack]

Mamabearing--

Well, people do believe what they want to believe, don't they? Far be it from me to persuade you to believe anything you do not care to believe.

But I will say this: if homebirth, non-'medically' assisted birth--birth itself-- was so dangerous, there is no way Earth would have the population it does now. This current population's base was in place *before* birth was medicalized; and even today, the people having the most babies worldwide are those receiving the least medical care.

Also, we humans didn't spring into existence only in the last century. We've been around for quite awhile now. This is why, when considering what to believe about birth statistics/studies, it is so important to me to consider our species partly in terms of a fairly long sweep of history--and certainly from a vantage point that includes regions/peoples well beyond our own backyard.

Statistics lie, or anyway can be made to tell almost any tale that the statistician wants to tell, no matter how loosely connected to realities....and every tale will have it's adherents, just as every Origin Story does. I hope you'll try to keep these things in mind. Intelligent, informed and thoughtful people have most excellent reasons to believe that homebirth is as safe, and maybe safer than medically managed hospital birth.

[triscuitsmom]

Originally Posted by mamabearing

It's not a minority of medical professionals using this medication. Yes, its an off label use. However, there is quite a lot of literature that doesn't back up that it has more power to do harm than good, despite what you might generally read if all you read is alternative childbirth literature.

First off, the fact that it's not a minority does not reassure me at all and I'm sure why you'd think it would reassure anyone. It doesn't sound like it's just one midwife doing it at home either, that doesn't make it better. Also if it were only a few OBs doing unnecessary c-sections there wouldn't be hospitals with 20/30/40+ percent of women delivering through them, even though WHO says 10% max. Not in the minority just means those following a bad practice have more supporters to fall back on, it doesn't actually make it right.

I'm honestly curious about the full consent thing. What does that mean for cytotec? I am honestly asking. Having volunteered, worked, and birthed in a hospital setting I know for a fact that lots of times full consent isn't truly gotten for pitocin (at least around where I've been, but talking to others does lead me to believe it's fairly widespread). Risks are glossed over (if talked about at all). So when you say risks, what do you tell people. Does it include informing them it's not an approved drug and the FDA says a firm no to using it on a pregnant person?

Originally Posted by mamabearing

There is a very good thing happening here on this board, at least I find it very heartening, and that is not one person has been anything but appalled by it being used at home, and worse on people who don't even know they are getting the medication.

At least we agree on that.

Yep, definitely agree, and that's all good

I just want to point out that while I'm shocked and appalled at midwives doing this without patient consent, with a drug not approved for pregnant women, in any setting, but especially in the home, it makes it worse for me that they are midwives (as a student one myself, just because I tend to on a personal level expect a standard that doesn't include this)... but that doesn't make it better that it's done in the hospital, especially since many of the women I've talked to have not been informed of all of the risks, or indeed some of any risks at all. Sad all the way 'round.

[birthgoddess21]

Wow, sorry that some of you thought this discussion was outside the UA. I did not name names just so I could not be accused of maligning anyone.

I do not know where else to talk about this. I do not belong to a physical school, so I do not have a classlike forum in which to talk. My classmates are also distance learners and not many in state. So, they do not have alot to say about this because it does not "hit home".

One Midwife does chart that this med is given, even in the cases where the mother was not told. The other two do not chart it. I have seen it given to induce, not just PPH.

Now, I am feeling defensive. I just want everyone to know I am not lying. I think it is so dangerour and it makes me worried. LMs are getting bad reputations because of stuff like this.

Maybe, I will contact Jennie J- just to get some one on one counsel.

[BeckiCNM]

Originally Posted by birthgoddess21

Wow, sorry that some of you thought this discussion was outside the UA. I did not name names just so I could not be accused of maligning anyone.

I do not know where else to talk about this. I do not belong to a physical school, so I do not have a classlike forum in which to talk. My classmates are also distance learners and not many in state. So, they do not have alot to say about this because it does not "hit home".

One Midwife does chart that this med is given, even in the cases where the mother was not told. The other two do not chart it. I have seen it given to induce, not just PPH.

Now, I am feeling defensive. I just want everyone to know I am not lying. I think it is so dangerour and it makes me worried. LMs are getting bad reputations because of stuff like this.

Maybe, I will contact Jennie J- just to get some one on one counsel.

My interpretation of those responses was that what the previous posters wanted to say as their opinion of these midwives, they couldn't actually say because it would violate the UA. There are rules in the UA against name calling and other offensive language, which would include my personal opinion of these midwives, even if no names are actually being named. I thought the original post was fine - it's just we aren't allowed to use the real words we want to describe our reactions.

I know there are unethical people in every profession, but it is very hard to be fighting for midwifery as a whole when there are those out there doing the very behaviors that legislators and others point out as being why HB and HB midwives are "unsafe".

I don't think it was a comment on you and your part in posting on this. I'm sorry if you took it that way.

[mamabearing]

respectful response

Originally Posted by MsBlack

Mamabearing--

Well, people do believe what they want to believe, don't they? Far be it from me to persuade you to believe anything you do not care to believe. .

Nor I you. That certainly isn't my expectation . I want to add though that when I changed my mind about homebirth it was NOT what I wanted to believe, I had given birth at home and had a great experience, it was evidence and more knowledge of how to evaluate research that changed a belief I actually held dear.

But I will say this: if homebirth, non-'medically' assisted birth--birth itself-- was so dangerous, there is no way Earth would have the population it does now. This current population's base was in place *before* birth was medicalized; and even today, the people having the most babies worldwide are those receiving the least medical care.

Also, we humans didn't spring into existence only in the last century. We've been around for quite awhile now. This is why, when considering what to believe about birth statistics/studies, it is so important to me to consider our species partly in terms of a fairly long sweep of history--and certainly from a vantage point that includes regions/peoples well beyond our own backyard. .

I too believe our species as a whole would survive without modern obstetrics. I think that our species, and almost all species, have a natural rate of waste in reproduction. I think danger to an individual is quite a different thing than danger to a species. All animal species have loss. It's natural and compensated for by the vast majority who survive . However, I do wish to save a mother and baby who for example, have a pregancy complicated by complete placenta previa. I had a mom who was planning a homebirth come for a C/S when she was found to have a previa. I am so glad she is alive, and has her baby, even if their survival is unnatural. I think there is enough natural waste in human reproduction and even in the birth proccess that it is properly labelled dangerous. I think third world countries are a very good example of this too. Yet we seem to draw different conclusions from the same evidence.

Statistics lie, or anyway can be made to tell almost any tale that the statistician wants to tell, no matter how loosely connected to realities....and every tale will have it's adherents, just as every Origin Story does. I hope you'll try to keep these things in mind. Intelligent, informed and thoughtful people have most excellent reasons to believe that homebirth is as safe, and maybe safer than medically managed hospital birth.

I so agree that statistics can be tweaked and are tweaked and discerning the truth from them isn't easy. It requires education and of course not simply reading the "conclusion" without analysis of the study and knowing how a study should be done. I also can assure you that I know very intelligent people I respect who choose homebirth and believe it or not my respect for them and affection remains intact. I once had a baby at home myself and held similar beliefs. My statements about homebirth were not meant as a personal attack on anyone.

I don't want to hijack this thread and I really thought I had sworn of even TELLING anyone on this board I have come to believe homebirth has a level of risk I personally find unacceptable. Because it tends to turn the conversation to that and I am saying something about my beliefs here that I think tends to invalidate anything else I say in many minds? I think brought it up because earlier in the thread someone accused me of knowing Cytotec was ...I don't recall the adjective...but essentially had unacceptable level of risk because I feel it should only be used in a hospital setting. I guess I felt for her to understand my point of view I needed to say I felt that way about all births. Of course, as you say, there are many parts of the world where giving birth near an operating room and blood bank, with emergency medications and tools immediately at hand, isn't even a choice. Despite that the species goes on, but I think only the most strident of people would say that the rate of loss in these countries is desirable because it is natural.

And I do believe, from having known and met homebirth midwives, that it must be a very small small number who would consider cytotec induction at home to be reasonable, or would give any mother ANY drug without the mother's consent. I have never met even one I could imagine would do such a thing and I have met many. I think it is a threat to the legitimacy of homebirth midwives that some are doing this and that the advice to DO something if one is aware of such practices of this is best for the profession is the right advice. I would report a doctor or nurse who gave any medication without the mother's consent without hesitation.

[Reha]

Originally Posted by BeckiCNM

My interpretation of those responses was that what the previous posters wanted to say as their opinion of these midwives, they couldn't actually say because it would violate the UA. There are rules in the UA against name calling and other offensive language, which would include my personal opinion of these midwives, even if no names are actually being named. I thought the original post was fine - it's just we aren't allowed to use the real words we want to describe our reactions.

:

[mamabearing]

for Trisketsmom

You asked if I feel women are given enough informed consent about Cytotec. Like you my observation is they are not. I think there are a fair number of doctors and nurses that do not explain risks and benefits of medications and procedures as well as we/they should and it is a huge area for improvement. I have seen the consent done well but I actually agree with you that every mother should know this is an off label use and there is a risk of uterine hyperstimulation which might not be tolerated by the baby. I also work in a hospital that is fairly progressive and I don't find it hard to believe at all that it might be explained even less well in other places.

I think a good idea would be for ACOG to come out with a consent form something like the VBAC or repeat cesarean consent forms I have seen. Especially because this is a situation where the mother has time to think about it and decide whether she wishes to consent to the medication or not.

[Mama2Xander]

Originally Posted by mamabearing

Regarding homebirth, I know that you have probably read things like "Obstetric Myths vs Research Realities" or any number of publications that claim research supports homebirth safety. But the : is unfair, because there are a lot of holes in that research, and I frankly I firmly believe what you think is my "opinion" is fact. I do not doubt that you and many other moms, myself included at one time, believe such books are fact, but I no longer do. What I do know is my stating what I think are the facts here will make me extremely unpopular as a poster, even we probably agree on many other things.

I don't think that the British Medical Journal is generally regarded as "alternative childbirth literature"

[Mama2Xander]

I used to be an RN, in L&D and in the NICU. I worked in a very busy tertiary care centre. I would NEVER give birth in a hospital unless it was truly medically indicated for a life-threatening condition, such as a cesarean for complete placenta previa.

Complications and dangers are almost always caused by medical intervention. The whole "good thing she was in the hospital, because xyz happened" thing - it probably happened *because* she was in the hospital! I have seen this time and time again (almost on a daily basis, really, when I worked there) and this is why I will never go back to working in a hospital setting. It's sickening really, what some professionals will say - "oh, the epidural is completely safe, you'll be fine" - epidural goes in - baby's heart rate plummets - rush off to OR - "oh, yeah, that often happens with an epidural. Good thing we're here to do the cesarean". I am not making this up, it happened all the time.

I cannot believe that cytotec is still being used by anyone, anywhere, on pregnant women. At least the hospital I worked at had the sense to not use it. I don't think it is really used much in Canada but I could be wrong about that. Where I worked it was *occasionally* used when a baby had died in utero in the second trimester and labour was not starting... but only as a last resort and not in a full term pregnancy. And NEVER with a live baby.

As for the argument that it is cheaper than other induction methods - a) let's start with the fact that our induction rate is way too high to begin with; b) exactly how much is someone's life worth, anyway? I'm sure all of the families of the women and babies who have died due to Cytotec are very pleased to hear that everyone knows of the dangers but keeps using it anyway because it's cheap You want to cut costs? Let's start by reducing the rate of unnecessary cesareans! And inductions! And and and...

[mamabearing]

different conclusions

Originally Posted by Mama2Xander

I used to be an RN, in L&D and in the NICU. I worked in a very busy tertiary care centre. I would NEVER give birth in a hospital unless it was truly medically indicated for a life-threatening condition, such as a cesarean for complete placenta previa.

Complications and dangers are almost always caused by medical intervention. The whole "good thing she was in the hospital, because xyz happened" thing - it probably happened *because* she was in the hospital! I have seen this time and time again (almost on a daily basis, really, when I worked there) and this is why I will never go back to working in a hospital setting. It's sickening really, what some professionals will say - "oh, the epidural is completely safe, you'll be fine" - epidural goes in - baby's heart rate plummets - rush off to OR - "oh, yeah, that often happens with an epidural. Good thing we're here to do the cesarean". I am not making this up, it happened all the time.

I cannot believe that cytotec is still being used by anyone, anywhere, on pregnant women. At least the hospital I worked at had the sense to not use it. I don't think it is really used much in Canada but I could be wrong about that. Where I worked it was *occasionally* used when a baby had died in utero in the second trimester and labour was not starting... but only as a last resort and not in a full term pregnancy. And NEVER with a live baby.

As for the argument that it is cheaper than other induction methods - a) let's start with the fact that our induction rate is way too high to begin with; b) exactly how much is someone's life worth, anyway? I'm sure all of the families of the women and babies who have died due to Cytotec are very pleased to hear that everyone knows of the dangers but keeps using it anyway because it's cheap You want to cut costs? Let's start by reducing the rate of unnecessary cesareans! And inductions! And and and...

First of all, I believe this is the appopriate interpetation of the Johnson and Daviss study.(citation removed, but I do not believe the study is valid) . It will be unpalatable to say the least to people who don't wish it to be true. However, yes, I would agree BMJ is not alternative literature and you have a great point there.


Secondly, I have worked in similar setting to you. And came into them initially with a homebirth mindset. In fact, I didn't even know if I could feel ethically good working as mainstream RN...I saw it as a means to an end initially. I had been a Bradley teacher and had one baby at home. I had been there as support at quite a few friends homebirths too. What you see in your hospital and the conclusions you draw I can't dispute.

I expected to see and come to the conclusions you did. Everyone said I would among my alternative birth friends. But I came to the opposite conclusion. That most bad things just happen not because the hospital did something to make them happen ( especially at the beginning we had a huge percentage of moms who chose to give birth with very little intervention ). I saw the difference in the speed at which an emergency can be responded to and the value of a team of people who all can function in a specific role in that emergency. I also saw the value of the efficiency and skill that a low risk baby who suddenly has an unexpected turn to high risk benefits from in a setting where people have to use resuscitation skills frequently. It's hard for me to understand how a NICU RN could feel otherwise, having seen the when a baby is truly asphyxiated or has lost volume how your whole large team works together, with many more people and tools than can be brought to a homebirth, that you wouldn't think the delay matters or could believe the same level of skill could be attained at home. But I think what you came to believe was the problems you saw were the result of OB interventions and if you really believe that I can see how you would believe why put yourself in a setting you need to be rescued at all.

You obviously saw the hospital you worked in very differently.

Both you and I have been exposed to both sides and been educated on both sides of the issue and have very different opinions.

You said you were suprised Cytotec is still used. I think I said the first time I saw it used that there was NO WAY this drug was going to pass the test of time. I thought anything that worked THAT well was too strong. It certainly didn't turn out to be safe with VBACs! So that we had similar impressions, sort of, except that I think with experience regarding proper patient selection and lower dosing and extreme caution it can be used....with informed consent of course.

But it still is hard for me to comprehend that the very drug that mainstream medicine is most condemned for using is being used at home in some cases. What would one of these midwives tell us was the reason it was ok? And what on earth would they tell us is the reason they would use it without even telling the mom? Have any of the posters who met these people confronted them enough to just ask..."why?"

[georgia]

Hi, everyone I have removed several posts that were in violation of the MDC User Agreement or referenced or quoted a removed post.

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