MW requires cfm/iv? - Page 2

[GOPLawyer]

Originally Posted by MomtoXane

Thanks for all your input! I just switched MW to attempt my first HBAC!!

: YAY!!!! Go, Mama! You CAN do this!!!

[AlexisT]

Originally Posted by GOPLawyer

Wow, yeah, that's a pretty horrible rate, IMO. Maybe better than some but still pretty bad.

actually, that's an excellent rate. the NHS in England (where you have the right to VBAC, though some consultants hate it) has a VBAC rate of 32% (I can't find stats on TOLAC, so can't compute a success rate of attempts). (I was shocked to see how low it was, frankly. The hospital where i gave birth has a VBAC rate of only 19%, lower than the US hospital where I plan to deliver next time!)

MWs will almost always have higher success rates than hospitals because they risk out quicker. OBs have a higher risk caseload.

ETA: The Albany Practice, a famous London midwifery group doing hospital and home birth (57% at home, mixed caseload, but the most high risk cases would have been referred to consultant, and they wouldn't be handling ERCS cases) had 76% standard vaginal births, 19% CS, 5% forceps/ventouse.

[GOPLawyer]

I understand what you are saying and, as I said in my post, I agree that it's better than others. However, a horrendously low bar does not make a better stat "good" IYKWIM.

Not every "high risk" Mama is denied care w/ a HB MW which is yet another reason that a true stat just isn't possible right now.

I remember reading about the study you speak of. IIRC, there were just to many unknown variables to really pull anything concrete from it w/ regard to what we are talking about here.

[maxmama]

Originally Posted by GOPLawyer

Wow, yeah, that's a pretty horrible rate, IMO. Maybe better than some but still pretty bad.

Every MW I've ever heard from had MUCH better rates. Granted, I doubt there are any scientific studies out there to back that up as orgs like the ACOG and the like push MWs underground and fight tooth and nail to take away our right as Mamas (VBAC especially) to birth w/ the MW of our choice. Therefore, it's really impossible to come up with a stat. The question is, therefore, disingenuous.

No, actually a 15% section rate is pretty close to the WHO recommended section rate. And remember, we can't pick and choose our clients.

I do hope you would have some information for me about HBA2C success rates, especially with a J incision. Because I just can't seem to find any anywhere!

I'm glad to know you take your midwife's word on her success rates without verifying them. What kind of law is it that you practice again?

[AlexisT]

Originally Posted by GOPLawyer

I remember reading about the study you speak of. IIRC, there were just to many unknown variables to really pull anything concrete from it w/ regard to what we are talking about here.

Which study? I'm not quoting from any study; these are basic statistics collected by the National Health Service. They're of interest because the NHS lacks the particular medico-legal context that has made VBAC such a minefield in the US. (Notably, OBs/MWs do not carry individual insurance and are employees of the health service; their individual level of exposure is much lower.)

And while not every "high risk mama" is denied care by a HB MW (though most are, since the very definition of midwifery is expertise in normal birth and low risk women), the NHS is a different animal. There are set criteria for risking a woman upwards to OB care. It's an entirely different system. (I gave birth to my daughter in the UK, so I speak from personal experience here.)

[homemademomma]

Originally Posted by GOPLawyer

Wow, yeah, that's a pretty horrible rate, IMO. Maybe better than some but still pretty bad.

Every MW I've ever heard from had MUCH better rates. Granted, I doubt there are any scientific studies out there to back that up as orgs like the ACOG and the like push MWs underground and fight tooth and nail to take away our right as Mamas (VBAC especially) to birth w/ the MW of our choice. Therefore, it's really impossible to come up with a stat. The question is, therefore, disingenuous.

actually, that is a pretty great rate for VBAC success.

[homemademomma]

Originally Posted by AlexisT

MWs will almost always have higher success rates than hospitals because they risk out quicker. OBs have a higher risk caseload.

ETA: The Albany Practice, a famous London midwifery group doing hospital and home birth (57% at home, mixed caseload, but the most high risk cases would have been referred to consultant, and they wouldn't be handling ERCS cases) had 76% standard vaginal births, 19% CS, 5% forceps/ventouse.

exactly! i'm not saying that i am against HBAC (because i am not!), but i think VBACs in the hospital with good care providers can be very successful. you just have to be choosy about your HCP/hospital, just like you should be choosy about your HB/BC midwife!

[homemademomma]

Originally Posted by GOPLawyer

I understand what you are saying and, as I said in my post, I agree that it's better than others. However, a horrendously low bar does not make a better stat "good" IYKWIM.

(sorry for the serial posting! )

what is a good rate for VBAC success, would you say?

[GOPLawyer]

No, actually a 15% section rate is pretty close to the WHO recommended section rate.

For those Mamas that fell into the difference of "close", I would say "close" isn't good enough.

I do hope you would have some information for me about HBA2C success rates, especially with a J incision. Because I just can't seem to find any anywhere!

Curious, why would I have those particular stats if the stats for basic HBACs don't exst?

I'm glad to know you take your midwife's word on her success rates without verifying them.

Really? You know this even though I never mentioned whether or not I've verified them...or that I even have a MW for this birth? I'm impressed!

AlexisT - Yikes...sorry. Too many windows/discussions going on at once on my computer. The comment regarding a study was meant for a different person.

the very definition of midwifery is expertise in normal birth and low risk women

I disagree. I've never heard of such a restrictive definition. For example...here...and here. As I understand it, the pure definition of midwife is simply "with woman".

[AlexisT]

"Expert in normal birth" is something I've heard straight from the mouths of midwives here on MDC.

[GOPLawyer]

First, "normal birth" could easily have been referring simply to vaginal birth. We could throw around the proper application of the word "normal" but really, with some hospitals reaching 40-50% c/s rates, a c/s could almost be classified as "normal". Without proper context, "normal birth" is pretty vague.

Second, the specific referral to "low risk" as you mentioned is, unless I missed it, absent in the links I provided. You also didn't mention it when referring to the MWs here on MDC. Though, again, what defines "low risk"? The risk of UR in the majority of VBACs run about .5-.7%. That means that there is still a 99+% chance that a UR will not happen. Some consider that high risk...others do not.

[AlexisT]

Given the context, it's pretty much indisputable that "normal birth" means an unmedicated vaginal birth. That's what "normal" means on MDC, and that's where the term was used.

[turtlewomyn]

Originally Posted by GOPLawyer

Wow, yeah, that's a pretty horrible rate, IMO. Maybe better than some but still pretty bad.

Every MW I've ever heard from had MUCH better rates. Granted, I doubt there are any scientific studies out there to back that up as orgs like the ACOG and the like push MWs underground and fight tooth and nail to take away our right as Mamas (VBAC especially) to birth w/ the MW of our choice. Therefore, it's really impossible to come up with a stat. The question is, therefore, disingenuous.

Really? When I started care with my HB midwife this summer for an HBAC she provided me with an informed consent and her VBAC succuess rate was 80% and she is one of the best HBAC providing midwives around (I had to travel three hours to get one). Perhaps I should just go to the hospital then, since even the best HB midwife around has such "low" vbac rates.

[maxmama]

[QUOTE=GOPLawyer;12167349]For those Mamas that fell into the difference of "close", I would say "close" isn't good enough.

Curious, why would I have those particular stats if the stats for basic HBACs don't exst?

Oh, just because one might want to know one's risks before choosing a HBA2C with a J incision. Isn't that part of the responsibility of the client? To assess risk and decide which risks one wishes to accept? If there's no responsibility to know about the likelihood or magnitude of the risk, then how is that different from putting all your faith in a paternalistic OB?

[GOPLawyer]

[QUOTE=maxmama;12169933]

Originally Posted by GOPLawyer

For those Mamas that fell into the difference of "close", I would say "close" isn't good enough.

Curious, why would I have those particular stats if the stats for basic HBACs don't exst?

Oh, just because one might want to know one's risks before choosing a HBA2C with a J incision. Isn't that part of the responsibility of the client? To assess risk and decide which risks one wishes to accept? If there's no responsibility to know about the likelihood or magnitude of the risk, then how is that different from putting all your faith in a paternalistic OB?

Hm, really? So, in your other post you asked if I had any stats for you but now you couch the question so as to see if I've properly researched/assessed my own risks for my personal situation. Interesting how things change and true colors are shown.

Lol...sorry, I'm not playing your typical medical CP game. You sure do make a *lot* of assumptions....upon what they're based I can only speculate. However, just because you may or may not be able to accept the fact that I do not have to justify my position to anyone other than myself and that I accept full responsibility for both my baby and myself based upon my own research and experience is really not my problem.

[maxmama]

Nah. Just that if people are going to give advice to other people, it can be helpful if they know how to assess the risks they are advising others on. Choices we make for ourselves often reflect our ability to critically think, and when giving advice to others, critical thinking before advising is a bit of a responsibility.

[GOPLawyer]

Originally Posted by maxmama

Nah. Just that if people are going to give advice to other people, it can be helpful if they know how to assess the risks they are advising others on. Choices we make for ourselves often reflect our ability to critically think, and when giving advice to others, critical thinking before advising is a bit of a responsibility.

LOL...so who gets to judge if the choices made show that ability or not? You? LOL

I'll just leave it at...I'm not really worried about that judgment.