Originally Posted by lunaliss
As a CNM working on again/ off again at Special Beginnings, I have attended many births of women who were ruptured for days, I think 7 days was the longest it took for labor to start on its own. So that is not true for all CNMs. And it is ALWAYS the client who decides the course of action, never the provider, regardless of the letters that follow his/ her name.
My apologies Melissa, I was responding quickly and didn't detail that SB is the only CNM groups that also has great flexibility on the issue of early rupture of membranes. I know that and teach that in my classes as one of the reasons I really like and refer to SB often. Although I also didn't want antibiotics and used the chlorohexidine wash protocol instead for two births that had early rupture of membranes lasting five and four days prospectively. I don't know that I could have gotten away with that at a birth center.
But I disagree that it is the client who always decides the course of action. I think its fair to say that SB has other backup practice issues with restrictions that women should be aware of. If you get on the backup doctors' radar you could end up like a recent student of mine whose "big baby" ultrasound on a biophysical profile where the couple felt completely coerced (dead and disabled babies were mentioned by the doctor- I hate that!) into an elective cesarean for a baby that turned about to be 1 1/2-2 lbs lighter than the backup doctors insisted it had to be. Of a size I know for a fact has arrived at the birth center on more than one occasion quite successfully. Did the mother feel robbed? Of course. Did she feel she was given a choice? She went in with every intention of saying no and she wanted to stick to her plans, but first she got risked out of the birth center birth she wanted, then had the dead baby card presented over and over. After all the threats had been made and her feeling that the midwives had to back off on their support of her at risk of making the backups angry she felt she was backed into a corner. So its easy to say that we make the calls, but it doesn't happen in a vacuum. I think its unfair to have mamas (especially primips) go into it thinking otherwise.
Another example I was personally involved with was a breech twin multipara who was with SB backup doctors after having her first at SB with the midwives in the birth center and being referred to the doctors by SB with the discovery of the twins. She was beaten down week after week with how she couldn't and shouldn't have a vaginal birth. Calling me in tears, ruined her pregnancy. I encouraged her to move on to Dr. Tchabo at VHC at 8 1/2 months pregnant and she had an awesome vaginal breech baby A and vertex-after-version-between-the-births baby B--with a CPM friend of mine who agreed to doula (I had a very new baby) and keep her home as long as possible and monitor babies and dilation getting her there at a good late labor time. A birth that could not have happened had she stuck with SB backups.
So flexibility of having a solo CPM and the ability to make decision the two of you are comfortable with rather than having an obstetrical model practitioner you don't agree with (as I strongly disagree with the obstetrical model of care) forcing your midwife to recommend things she herself may not agree with because the laws in MD give the OBs too much control over CNMs' rights to practice- for me the benefits of the independent CPM or direct entry midwife make it the right choice for me.
And on these boards I just want women to be aware of ALL their choices whether or not they want to explore them. I absolutely wish that we had legal direct entry midwifery and autonomy of practice for CNM and CPM, but we don't
so women have to go in with eyes wide open and the ability to say no or move on if their needs are not being met with ANY type of caregiver.
That said, SB is number one
on my list of recommended facilities for those mamas who want midwives, but not home births. In a highly imperfect and coercive system it offers the best OOH options in the area.