can a hb midwife just leave

[mysticmomma]

I'm curious... if during labor, you don't do something the mw wants you to do, like get out of the tub or something, can she drop you as a client?

[Zoo Loo Naturals]

Well, I should hope not! It is after all your birth and you get to do things how you like. A relationship on trust should be built during the pregnancy, but as the consumer you make the final decisions.

[Snowdrift]

I'm also nervous about this. I'm also nervous about what if a homebirth midwife doesn't come? So many birth center/hospital birrth stories start off "I knew I was labor but on the phone they told me that I was too calm/could still talk too clearly/was obviously only in early labor and not to come in, but I went in anyway and was 6 cm and was in full-blown transition five minutes later."

When you're going to them you have the ultimate decision when to show up. With the midwife, if she somehow decides I'm not ready, she could just not come, couldn't she?

[Jilian]

I'm also nervous about this. I'm also nervous about what if a homebirth midwife doesn't come? So many birth center/hospital birrth stories start off "I knew I was labor but on the phone they told me that I was too calm/could still talk too clearly/was obviously only in early labor and not to come in, but I went in anyway and was 6 cm and was in full-blown transition five minutes later."

When you're going to them you have the ultimate decision when to show up. With the midwife, if she somehow decides I'm not ready, she could just not come, couldn't she?

That is why it is really important to have a good relationship with your midwife and to trust her. You also need to take your care into your own hands to a certain extent, you KNOW when something is off. If you know that something is going on and you need the midwife there then you need to really let her know and convey that message. Sometimes people are passive for fear of being rude, in a case like this you need to be firm and persistant.

I guess a midwife could leave a birth but I don't think many midwives would. Again, it goes back to having a good relationship with your midwife and having trust. But anything is possible really.

[Kathryn]

If you tell her to come, she'll come.

[mamaverdi]

While it's possible a midwife could leave, it would leave her open to legal ramifications should anything go wrong.

mv

[Arwyn]

I actually think this is no more (or less, I guess) likely than an OB walking out in the middle of your labor because you were doing something s/he didn't like - which does, rarely, happen! And most OBs are much easier to piss off than most midwives. :)

Seriously, in most cases that would indicate a SERIOUS breech of protocols/lack of good judgment. It is, fortunately, for both OBs and midwives very very rare.

As for when the midwife shows up, here you are MUCH more likely to have a good experience than with a hospital-based care giver. Yea, if the OB doesn't show up, there are nurses there, but geez... Midwives are much better, in general, about 1) recognizing (and helping you recognize) the symptoms of labor and 2) listening to your opinions, feelings, thoughts, and intuitions. Because, for one thing, a mom having a "feeling", however unexplainable or "illogical", of being in labor IS a sign of labor in midwives' eyes. And (and everyone's probably heard this before, but it's worth repeating) super fast (precipitious, where the midwife CAN'T get there in time) labors tend to be really really good, safe ones where it's perfectly ok for mom&al to catch the baby sans midwife!

So yea, those are two things I'm really not worried about. :)

[mwherbs]

I'm curious... if during labor, you don't do something the mw wants you to do, like get out of the tub or something, can she drop you as a client?
I can only think of 1-2 times I have come across this in 22 years- one was at a birth where I was assisting and the other was another midwife who had parents leave the house in labor and then fire her on the phone, she said ok well come back home and she called around to get opinions including from the ob unit and she called an ambulance and transfered over to them and then the parents refused transfer...
with the one I was at the father of the baby was high on something and became physically threatening -- he left and ran into one of the cars in the driveway- came back- right after the birth mom hemorrhaged and went to the hospital we left because dad did not want us around- he got kicked out of the hospital after threatening them several times...
-------------------------In re-reading this it is probably not clear we did not leave mom at home- we took her to the hospital---but normally we don't leave a mom we transfer- we stay with her even then but we did not stay.--------------dad left in labor and came back

[pamamidwife]

the only way I'd leave a birth (and have left a birth) is when I felt personally unsafe. even then, I'd call an ambulance on the way out just to cover my rear. it would be up to the family to decide to refuse it or accept it.

[mysticmomma]

Let me clarify a bit... this came up when we were talking about the sign they post in hospitals that says something to the effect of "if you are in labor, we can't deny you care". I wondered if something like that pertained to a homebirth. Midwives in my area do not carry malpractice insurance, and you sign something to that effect. I guess that means you could take personal action... dunno. I'm not terribly concerned, I love the midwife I've chosen for our next birth. Another thing that fueled this thought process was a homebirth practice in alexandria, va that comes to baltimore require you to get out of the tub for the actual delivery. Now, I didn't choose them for this very reason. If I'm in the tub, and don't wanna get ou t, I want a midwife that is trained and versed in underwater births, not someone who has never done one that is uncomfortable with it. But I thought, what would happen if someoen refused to get out? Could she leave and not be open to litigation?+
+TR+9ish+a

P.S. NAK

[Midwife Kris]

Let me clarify a bit... this came up when we were talking about the sign they post in hospitals that says something to the effect of "if you are in labor, we can't deny you care".

EMTALA: http://www.emtala.com/ is a federal law.

But I thought, what would happen if someoen refused to get out? Could she leave and not be open to litigation?

I would think if a midwife is insistent enough about a woman getting out of the tub that she is willing to terminate care on the spot, there must be a very good reason for it. Are you completely unwilling to get out of the tub for any reason? And would you be willing to sue your midwife over her advice to get out of the tub? Are you talking with your midwife about the scenarios she considers unsafe for being in the water? Maybe knowing those situations in advance would reassure you that she wouldn't just wreck your plans for water labor/birth for simple lack of respect to your wishes.

Kris

[courtenay_e]

I used hypnobirthing while laboring and birthing my two children. My midwife with my second didn't belive I was in active labor because I was too quiet. She said that either she broke my water to "get things going" or she went home (45 minutes away). I was fully effaced and dialated to a 4.5, but calm, quiet, and collected between and during contractions. I told her that if I had wanted my water broken, I would have been seeing an OB. So she left. Took her stuff and left. My husband was furious, my mom was bordering on hysterical, and I was very out of sorts. Luckily, I had maintained a relationship with my CNM from my first birth in case of transfer with this one. I immediately went to the hospital and birthed my son an hour and a half after the homebirth midwife left my house. Without pushing. When I called to tell the CNM the circumstances and that I was coming in, she got, shall we say, a little concerned. She made it to the hospital before I did and was waiting at the doors b/c she was afraid I'd have the baby on the way there.

As to what pp's said, I thought I asked all the right questions. I thought I had a good relationship with the homebirth midwife. I know better now. As for recourse, have a backup and a transfer plan, just in case. Also, we didn't pay her for the birth, as she didn't fulfill her part of the contract. And I tell everyone I know in the "mama's lookin' for a homebirth midwife" world where I live that I certainly don't recommend her. It's unfortunate, as there are very few in the part of the state where I live.

[mysticmomma]

EMTALA: http://www.emtala.com/ is a federal law.

Yes, I know it is a federal law! Thank you for the link. My point is I don't think it applies to HB MW's.

I would think if a midwife is insistent enough about a woman getting out of the tub that she is willing to terminate care on the spot, there must be a very good reason for it. Are you completely unwilling to get out of the tub for any reason? And would you be willing to sue your midwife over her advice to get out of the tub? Are you talking with your midwife about the scenarios she considers unsafe for being in the water? Maybe knowing those situations in advance would reassure you that she wouldn't just wreck your plans for water labor/birth for simple lack of respect to your wishes.

Kris


Re-read my statement. She is not my mw. I did not choose this particular practice because they do not do underwater births at all. So, whenever it is time to push, it is time for me to get out, and I''m not cool with that, so i didn't choose them. This is all hypothetical ponderings.

[Midwife Kris]

Re-read my statement.

Sorry, it still wasn't clear to me. Looked like you picked the better of two but still had worries.

Kris

[cathicog]

I'm also nervous about this. I'm also nervous about what if a homebirth midwife doesn't come? So many birth center/hospital birrth stories start off "I knew I was labor but on the phone they told me that I was too calm/could still talk too clearly/was obviously only in early labor and not to come in, but I went in anyway and was 6 cm and was in full-blown transition five minutes later."

When you're going to them you have the ultimate decision when to show up. With the midwife, if she somehow decides I'm not ready, she could just not come, couldn't she?
Most midwives *hate* missing births, so they would rather err on the side of caution and show up too early. I know *I* would. Many times if a mom sounds "too calm" we get our hiney butts over there in a hurry, cuz those are the ones that will spit a baby out as soon as you walk in the door!! Hope that helps. I don't know a single midwife who would say, well, you don't sound like you are that far along...at least the experienced ones I have seen won't say that. They know better! :)

[BirthTender]

I've done something like this only once, about 20 years ago, I was serving as doula and the father of the baby became very abusive to me & his wife. I encouraged them to go to the hospital earlier than I usually do when working as a doula, and while there, the hospital staff had to call in security to remove him. His wife birthed w/out him in the room, and she seemed very relieved to have him out of the room. Of course, social services got involved to help the mom & babe.

[Veritaserum]

Another hypno-mom here. My mw seemed reluctant to come when I called her since I wasn't in any pain (and never had any pain). She wanted to listen to me through a few contractions on the phone before she came. So I faked it. :lol I had the baby two hours later. She's had much more experience with hypno-moms since then so she's more likely to come as soon as they call her.

[sohj]

Can a midwife leave? Well, a midwife can certainly not even get there in the first place. See this post:

http://www.mothering.com/discussions/showthread.php?p=485869&highlight=midwife#post485869

I posted elsewhere about her, but, that post gives it in a nutshell.

[Individuation]

I'm also nervous about this. I'm also nervous about what if a homebirth midwife doesn't come? So many birth center/hospital birrth stories start off "I knew I was labor but on the phone they told me that I was too calm/could still talk too clearly/was obviously only in early labor and not to come in, but I went in anyway and was 6 cm and was in full-blown transition five minutes later."

When you're going to them you have the ultimate decision when to show up. With the midwife, if she somehow decides I'm not ready, she could just not come, couldn't she?

This happened to someone on MDC. I think she filed a formal complaint against the midwife--she ended up transferring to the hospital and the midwife basically never came. I'll try to find the story.

edited to add: Oh, yeah, that was you sohj. Next time I'll read to the end of thread before I post.

[Snork]

Absolutely a midwife can leave a labouring woman - but not without good cause. If there is a complication and the midwife advises transfer but the mother refuses, midwife explains risks and concerns, and documents the mothers understanding, reasons for refusal and everything that is said, she can walk out and abandon care if she feels her registration is on the line, and the baby/mother's life at risk.

I had a situation once where I SHOULD have walked out, but didnt know that legally I could have and should have. The mother lied to me about her waters breaking, and refused to allow me to perform checks (thats fine) or listen in to the fetal heart - yet earlier in the pregnancy I had established that in my practise I like to listen in hourly in active labour, then after every push in second stage. I noticed mec in the bath - she had refused to allow a light on, but I used my torch to see what was going on, and saw the mec. She then admitted her waters had broken 3 DAYS before and had thick mec ever since. After much discussion she still refused to let me listen in to the baby and stated that she would rather the baby die than transfer to hospital. I should have left then, but the father (a reasonable man) begged me to stay. As she was getting the urge to push, I did. But I called an ambulance - which arrived 5 minutes after the baby. I had to intubate and ventilate that poor little thing all the way to hospital (I was 7 months pregnant myself and the paramedics were not happy with me standing in the ambulance ventilating but I had no choice). The outcome? I reported it to CPS, dad left the mother and sued for custody - he won full custody. The baby girl is now 8 years old and severely brain damaged. I regret not walking out, but part of me is grateful that I was there to ventilate her. At least my consolation is that her dad is grateful I was there - he prefers to have his daughter brain damaged to dead. It was hell going through the investigation that followed. My reputation, my registration and my career were on the line because of that selfish cow of a woman - I was heavily pregnant, my family went to hell and back, as did I. One woman has NO right to ruin my life like that for her own selfish desires. Next time I would walk out.

[SublimeBirthGirl]

The #1 most important decision to make regarding your birth is choice of birth attendant. You have to find someone you can trust in the moment, and someone who respects your right to have information about why she wants things done, etc. I can't imagine a midwife saying "Get out of the tub or I'm leaving" with no explanation. Birth can be unpredictable, and if you can't listen to your midwife in the midst of things and know you're in good hands, why have an attendant there at all (note my siggy and you'll see how I resolved this dilemma!).

[BirthMatters]

Wow, Snork, that is some story. Don't really know what to say, just wanted to validate the story. I'm still apprenticing, stories like this very much help me "keep it real". It's one of those things, if you're a midwife long enough.... fill in the blank.... you'll have a woman with hold information, you'll see just about every complication, you might leave a woman, you'll hold a dead baby.. this is the reality. Sure, the upside is really up, delicious births, beautiful babies, love and miracles, etc. But, there is a down side. That's all. Thanks for sharing.

[BirthTender]

HI, all. In my above post about an abusive situation, I meant to also, interject that when the abuse started in their home, I almost walked out, but instead convinced them to transfer to the hospital earlier than I usually trasnfer in a doula situation.
Sorry, I was unclear.

[BirthTender]

During the initial no-strings-attached consult, I do make it clear that if there is a problem that needs transport and they refuse, that I will pack up my things, call 911 and walk out before 911 arrives. In my Informed doc, which they read before the consult, are my very low transport rates, os it is known that I do not advise transport immediatley for some things, some things as we all know have sorta a wait&/monitor &see approach. Transport situations are discussed in my document, at the initial consult and in the book, Specialy Delivery, which I require all clients to read. Now, what this does, too, ofcourse, is weed out the ones who are not good candidates for me/my service. Thank-God!

[Jada Mae]

During the initial no-strings-attached consult, I do make it clear that if there is a problem that needs transport and they refuse, that I will pack up my things, call 911 and walk out before 911 arrives. In my Informed doc, which they read before the consult, are my very low transport rates, os it is known that I do not advise transport immediatley for some things, some things as we all know have sorta a wait&/monitor &see approach. Transport situations are discussed in my document, at the initial consult and in the book, Specialy Delivery, which I require all clients to read. Now, what this does, too, ofcourse, is weed out the ones who are not good candidates for me/my service. Thank-God!

:notes2: Good point/advice. Thanks for sharing!

[Snork]

Just wanted to share one more story: not really about walking out, but one of my partners who now breaks the contract with the woman antenatally if she seems uncooperative due to what happened: (please keep in mind this and my previous post are the only two bad stories I have out of more than a thousand births :) )

-A woman having her second baby had it in her plan that she didnt want an ecbolic (such as pitocin) for her placenta. That's absolutely fine as we rarely use it without cause anyway, perferring physiological 3rd stage. My partner discussed using it only in case of PPH - the woman expressed that she wouldnt be happy with this either but in an emergency would consent if nothing else worked.

She went into labour at term, spontaneously. I was called in to second during pushing and inevitably arrived only 2 minutes prior to birth. She birthed her baby beautifully, no problems. We waited for the placenta. At about 20 minutes post delivery she heamorrhaged. Heavily. My partner tried to convince her to have the pitocin but she refused. Her mother and husband backed her up. She continued to bleed and refused to allow us to rub her fundus or try to pull on the placenta. She squatted and tried to push it out.

Another ten minutes went by with her bleeding heavily and us begging to use the pitocin. She had lost a litre of blood by then. She also refused to allow an ambulance to be called, once again her mother and husband backing her up. I took them aside and explained we were afraid for her life and she could die. They wouldnt believe me. They insisted she knew her own body and that she knew she could push her placenta out.


At this point my more experienced partner threatened to leave - but we both knew we couldnt in all good conscience do that. These people didnt understand we were not joking, the woman was at extreme risk. As we estimated her blood loss to be 2 litres and still gushing, and she was now unable to remain upright, pale, and not really responsive, we tried to get a blood pressure reading, and pulse - but her family refused to let us. I lost the plot and used my mobile to call an ambulance. I insisted on starting an IV but was physically prevented by the husband. I then phoned the hospital to warn them what was going on. My partner called our other partner for advice - she suggested the police.

The ambulance arrived, but the father refused them entrance. By this time the woman was unconscious but still guarded by her mother. I screamed at her that her daughter was dying and she was letting her - finally she became a little shaken and unsure. I begged to give the pitocin and she was starting to waver, meanwhile my partner had called the police as advised.

The police arrived and "arrested" the woman for attempted suicide (yes she was unconscious but its the only way we could force treatment on her) and arrested the husband for assisting her. At this point the mother moved out of my way. I gave the pitocin and my partner did a manual removal while the paramedics tried to get an IV line in. She had lost 3 litres and arrested on the way to hospital.

She ended up with a hysterectomy and 25 unit blood transfusion. She was in ICU for 3 weeks. All for the want of a simple injection when it was NEEDED.

What did we learn from that? If a woman is very stroppy about something and wont agree to intervention in extreme situations, then dont book her. :(

Luckily the family accepted responsibility and there was no investigation. I think the woman paid a high price for her stubbonness though. :(

[mwherbs]

this is a horrifying story-- I have come across my own unreasonable folks as well but luckily I have usually walked away before hand--

[mamaverdi]

Omg.

[DoomaYula]

While it's possible a midwife could leave, it would leave her open to legal ramifications should anything go wrong.

YEAHHHHHHHHHHHHHHHHH that.

[Apricot]

Because midwifery is legally regulated in my state, any midwife that "just left" would be open to action by the department of health (if someone filed a complaint).
I don't know of any stories of a midwife actually leaving a labor, but it does come up in discussion with clients. If a midwife drops a client prenatally, because of the special circumstances of pregnancy, she needs to make sure the woman has care. So, typically, a letter is sent, and the woman is told that the midwife's care will end in 2 weeks and here is a list of alternative ob/gyns and midwives.
Since labor is not the same situation, the midwife would arrange for a transfer of care, usually by calling an ambulance for transport. The parents could refuse the ambulance, though.

[mendomidwife]

I am a CNM and I would never, ever leave a patient. Period.
But, if I did, it could be construed as Patient Abandoment and I could be held liable.

Carla

[jengacnm]

The #1 most important decision to make regarding your birth is choice of birth attendant. You have to find someone you can trust in the moment, and someone who respects your right to have information about why she wants things done, etc. I can't imagine a midwife saying "Get out of the tub or I'm leaving" with no explanation. Birth can be unpredictable, and if you can't listen to your midwife in the midst of things and know you're in good hands, why have an attendant there at all (note my siggy and you'll see how I resolved this dilemma!).

Thanks, SBG, your comment helps to validate a statement I have made to potential clients. A woman last summer called for a consult and her last birth was fraught with intervention (gest DM, internals, AROM, pitocin). She seemed to want a guarantee that I wouldn't do any of those things. I shared my statistics with her (less than 10% on each of the last three), but told her I couldn't guarantee anything.

She finally said, "Well, I'll just come over from the practice I'm with now, because you can't be any worse than they are, and if it doesn't work out I'm going to have an unassisted birth." I told her that I'd rather she have an unassisted birth than to put me in a position where I think she needs an intervention and she flatly refuses. (Snork, your second story is my worst fear and an example of what I want to avoid. By "needing an intervention" I mean a scenario like this one, not "Don't listen to my baby now" or "I don't want an exam now".)

I also made clear to her that my statement was without snark-unassisted birth is a viable option, and a preferred one for a few women. Had I known of the MDC boards at that time I would have sent her here. As it happens I gave her a short list of books to read (most of which she'd already read), and told her to google "unassisted birth". Hopefully she found her way here.

I never heard from her again, so I would like to think that I gave validation to something she was thinking about but was finding little support for.


:lurk:

Jennifer

[mwherbs]

yep- if my best judgment and hands are tied what am I doing there to begin with? Better to pre-screen---

[Snork]

Because midwifery is legally regulated in my state, any midwife that "just left" would be open to action by the department of health (if someone filed a complaint).
I don't know of any stories of a midwife actually leaving a labor, but it does come up in discussion with clients. If a midwife drops a client prenatally, because of the special circumstances of pregnancy, she needs to make sure the woman has care. So, typically, a letter is sent, and the woman is told that the midwife's care will end in 2 weeks and here is a list of alternative ob/gyns and midwives.
Since labor is not the same situation, the midwife would arrange for a transfer of care, usually by calling an ambulance for transport. The parents could refuse the ambulance, though.

Midwifery is legally regulated here also, however any health professional can refuse care on reasonable grounds: endangering her life or her baby's life and refusing lifesaving intervention is grounds, but it must be documented clearly that the mother and support people were aware of the risks and ramifications. Best of all is if the woman signs that she refuses the intervention recommended and understands her midwife will abandon care. The midwife is then legally protected. As I was in both of my cases: the first was investigated and I was cleared of all culpability but told I should have abandoned care. The second didnt even make it to investigation because the parents admitted what they did.

[pamamidwife]

*delete* clarification already made that I was inquiring about. :)