Friend's baby died...attempted homebirth then transfer :( Need some encouragement - Page 3 - Mothering Forums
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#61 of 118 Old 08-08-2011, 07:16 PM
 
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Exactly. I think we all know where we can go to get the "other side" on homebirth.... which is EVERYWHERE else outside of the homebirth forum on mothering. It is exhausting and sad to find people digging up old posts and trying to start big debates on the safety of homebirth in a place that used to be more supportive. I come to mothering for "fluff" reading. I have no interest in having big debates or have people tell me that I am choosing the wrong thing for my children when I am coming to the homebirth forum to discuss it.
 

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2. The Homebirth Forum on MDC used to be a place where women found refuge in the non-judgmental company of like-minded moms.  They would come here to support each other and answer each others' questions (e.g. birthing pool or no?  What to do with older siblings?)  This was not the place where people questioned or debated their decision to have their babies at home.   

Frankly--and I know I'm in the minority here--I miss that format.  That's not to say that I'm against debating the home birth issue; I do it all of the time, especially on websites with the right context for it. 

 

But some of the frustration coming from other posters could be over how this forum has gotten so debate-dominated when that didn't use to be the case.  A number of anti-homebirthers have migrated over here.  That's nothing new.  I've also seen pro-vax doctors post on the vaccination board, for example.  I don't know what it is about this site or the Natural Family Living lifestyle...perhaps it threatens those who don't espouse it.  Whatever the reason, there seems to be a missionary-like drive among some individuals to preach to us, convert us, change us, fix us....

 

That may explain why some of us regulars are feeling on edge lately.  loveeyes.gif



 


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#62 of 118 Old 08-08-2011, 07:19 PM
 
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Thank you Turquesa, you put that better than I could have.


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#63 of 118 Old 08-08-2011, 07:31 PM
 
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 Actually, I came across this thread while randomly browsing and since I gave birth just two years ago and had to make a decision on where to birth and thus understood the OP's dilemma a bit, I dropped by. What's odd about that?

 

Concerning maternal mortality in Wisconsin, here's a paper on the subject: http://www.hawaii.edu/hivandaids/Pregnancy-Assoc_Deaths_and_Preg-Related_Deaths_in_Wisconsin.pdf 

 

Leading cause of death were embolism and hemorrhage....both of which is something a midwife attending a homebirth would not be able to treat adequately.

 

 

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Uhmm....since when is being interested in a wide variety of subjects from wooden toys, vaxing, drinking water quality, birth, schools, missing breastfeeding, dealing with a kids temper tantrums and recommendations for good baby slings unusual for the mother of a two year old?

 

I share (which, btw. is a two way street....) my experiences and the information I have access to with other moms who are interested in the same things I am, but which might have different experiences and information so I can expand my horizons.

 

Sharing experience and information with others, especially if these aren't something we've run across before, is very important I feel, because ideas that have been put to the trial by others and withstood the test are something we can base the decisions in our lives on. This is, if I'm not mistaken, perfectly in accordance with the MDC guidelines that state that moms should come here "... with a desire to examine, discuss, and learn".

 

As for you accusing me of "...preaching an agenda", I'm a bit baffled. There have been other people here in this thread, engaging in a vivid and interesting discussion, adding there own to cents from the other side of the spectrum, with lots of links to information they felt supported their viewpoint (e.g. Turquesa or MidwifeErika), and I don't see you accusing them of "....preaching an agenda".

 

Don't you think that's a bit of a double-standard on your part?

 

In addition to all that, I believe that MDC guidlines state that posts should be "respectful, and courteous".

 

And somehow, I think that you and Paigekitten barging in here only to accuse me of "...preachin an agenda" does NOT fall under the heading of "respectful and courteous".....tiphat.gif

 


The odd thing is posting it on a old thread.  My understanding of internet and forum courtesy would be to start a new thread referencing information from the old one you wanted to discuss.  As for it being a double standard, maybe, but it's also the homebirth forum.

 

And as a woman with a history of PPH, I only hire midwives with the equipment and medicines and experience to treat it.  They also have a great deal of the equipment you listed, that you may not expect, such as an incubator, oxygen, resuscitation equipment.  The rest, just a few minutes drive at the hospital, which I happen to be lucky to have.  I grew up in a town with a hospital that included a maternity ward, but if any big emergency happened they had to get a helicopter to the next closest hospital.  It's that kind of thing you don't see when you are comparing just straight up numbers with miniscule differences. It's not possible to see all the variables, such as traffic, distance, training and experience of the care providers, equipment available.

 

And off the top of my head I can think of one woman I know personally who walked into the ER as her baby was crowning for a planned hospital birth because it was such an unexpectedly short labor, and another who was planning a birth center birth but went to use her mother in law's bathroom while visiting and had her baby.  So precipitous labors, that result in a birth in a location not planned or prepared for does not seem so news worthy or unlikely to me.

 

ETA:  Just remembered an online friend who had an unplanned UC on her toilet as her MIL was on the way to watch their kids so they could head over to the hospital because she had just started labor.


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#64 of 118 Old 08-08-2011, 08:00 PM
 
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Originally Posted by Turquesa View Post

The Homebirth Forum on MDC used to be a place where women found refuge in the non-judgmental company of like-minded moms.  They would come here to support each other and answer each others' questions (e.g. birthing pool or no?  What to do with older siblings?)  This was not the place where people questioned or debated their decision to have their babies at home.   

Frankly--and I know I'm in the minority here--I miss that format.  That's not to say that I'm against debating the home birth issue; I do it all of the time, especially on websites with the right context for it. 

 

But some of the frustration coming from other posters could be over how this forum has gotten so debate-dominated when that didn't use to be the case.  A number of anti-homebirthers have migrated over here.  That's nothing new.  I've also seen pro-vax doctors post on the vaccination board, for example.  I don't know what it is about this site or the Natural Family Living lifestyle...perhaps it threatens those who don't espouse it.  Whatever the reason, there seems to be a missionary-like drive among some individuals to preach to us, convert us, change us, fix us....

 

That may explain why some of us regulars are feeling on edge lately.  loveeyes.gif


yeahthat.gif

 


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#65 of 118 Old 08-08-2011, 08:30 PM
 
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Originally Posted by Turquesa View Post

Kanna, I can't keep up with your posts!  I'll try to respond to your points, but there's so many that I hope you understand if I don't address every last one of them.  Here is my response and no mas for today.  redface.gif

 

 

 

 

 

It’s funny….everytime somebody here makes the factual statement that babies die in hospitals as well as at home, they get jumped on for lacking compassion.  I don’t think they do, and I don’t think you do.  Yes, agreed.  Babies die at home, babies die in hospitals. 

 

 

 

Very true.  But there’s no proof that 15 minutes is something to brag about.

 

I’m wondering….why perform an intervention (crash cesarean, in this case) with much proven harm and very few proven benefits?  As a physician, you will have an ethical obligation to provide evidence-based care in which, quantitatively speaking, benefits outweigh risks.  Based on the available evidence, a fifteen-minute decision-to-incision crash cesarean doesn’t seem to fit this criteria.

 

 

Agreed.  In cases of CONFIRMED fetal distress, (i.e. verified through auscultation and not just determined by electronic fetal monitor), a cesarean is necessary and saves lives

 

 

 

First of all, my condolences for your mother. 

 

As Lisa mentioned, being in a hospital is no guarantee, and by your reasoning, shouldn’t we all just make hospitals our permanent residence?  You never know when something could go wrong, right?  And you wouldn’t have to worry about the traffic….

 

The slippery slope to this line of reasoning CAN go a little far if we're not careful enough to reign it in. 

 

 

 

 

So how many of these do you think that my midwives may have had? 

 

I don’t know what your understanding is of midwifery care in the U.S., but my CPM/CNM team carried all of the equipment necessary for urgent and immediate situations.  They monitored my baby by auscultation (more accurate and evidence-based that EFM), carried drugs such as anti-hemorrhaging agents (which I did end up needing), neonatal rescucitation equipment (which I also ended up needing with my first), I.V. fluids (used with my first),  and AED. 

 

The rest, as you admitted, is overkill.  BUT I will say that if it makes you feel psychologically comfortable to have those on hand, it’s definitely your right.  And I hope that when you are a physician, you advocate for the reforms necessary to improve maternity care (unless it’s not nearly as abysmal in Germany as it is in the U.S.)

 

If you’re looking for sterility, however, you’d be a great homebirth candidate. ;-)  My MW’s were meticulously clean, and I got to avoid the very real danger of hospital-acquired infection.  http://www.safepatientproject.org/content_type/state_disclosure_report/

 

Oh, and you may be delighted to learn that my MW and her apprentice were available at all hours to demonstrate breastfeeding and nappy changes.  Both the birthing center and my home were equipped with those big, comfortable chairs, and I had round-the-clock breastfeeding advice. 

 

Some of the other amenities that you name are personal preferences and not necessarily life-saving (MANY U.S. hospitals don’t have NICU onsite but still have maternity departments).

 

Unfortunately, in the U.S., we have a strong movement of doctors and their supporters trying to dictate women’s birthing choices in part by fighting against licensure for midwives.  Without licensure, MWs can’t carry this equipment.  So women are either manipulated/coerced into hospitals, or they end up choosing the more dangerous situation of  ill-equipped and unregulated midwives.

 

Finally, my MWs worked with an AWESOME back-up doctor.  You see, not all doctors are in agreement, and this one totally supported women’s autonomy and the option of homebirth for low-risk women. 

 

 

 

 

 


LOL, don't worry, I'll slow down after this. Spending some free time on the web is fun...but there is something like too much of a good thing. I need to slow down a bit. wink1.gif

 

The studies you dug up do seem to indicate that for fetal distress, if you get the cesarean done in about 30 mins, that's fine, and I think that's something worth considering. If you know you can do things speedily but WITHOUT getting hectic, that's worth a lot, since trying to get to the 10-15 min margin would probably also increase the risk of errors occuring, and as you said, crash c-sections ARE more dangerous than regular ones, so staying somewhere around the 30 min margin will probably contribute to making them safer. smile.gif

 

As for traffic being a risk factor for delaying transfer, I think that's something that needs to be evaluated on a case to case basis. How far away do you live? What's the worst the traffic can get? Are there any "accident prone" points on the route? What condition are the roads in? How long will it take the paramedics to get to the house?, etc.

Seriously, if the residence or the birthing centre is just across the road from the hospital or something, then even I believe the it won't affect transfer time much. But if you live a bit further away or part of the route is known for some serious traffic jams, then its a wholle different kettle of fish.

 

 

I think, I would have felt pretty safe with your CNM/CPM team (not totally as safe as at a hospital, but very close). You sound well-equipped and well trained and like you provide good service to boot. But going by the threads / sites I've read, there are midwives (especially DEMs or unlicensed midwives, which you can find e.g. in Oregon) that are not nearly as well equipped and not nearly as well trained. You said it yourself: there's a lot of equipment that you can't handle if you're not licensed.

 

Also, they lack routine in some areas, e.g. putting in an i.v.. With some women, even on a good day, it can be hellishly difficult to find a vein. Now add shock from blood-loss and without a lot of expertise, it's highly unlikely you'll be able to put in that i.v.. Finding a vein in babies can be tough too. If you don't find a peripheral vein to put an i.v. in, you might have to put in a central line, and how many midwives can do that?

About the fetal heart monitoring, do you have links to studies that compare its accuracy to that of EFM? Sounds like interesting info!

I've found a study that talks about the decrease in neonatal mortality due to EFM, but couldn't find something comparable for intermittent auscultation. http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf

 

As for sterility, it's not something I'd require for a normal, vagina birth (the birth canal itself is so full of bacteria, and many women lose some stool giving birth, sterility would be kinda pointless). I only need sterility if I need something that midwives usually don't provide: a C-section.

When it comes to germs and birth, I'm less worried about hospital infections and more worried about the ordinary ones: GBS, Staph (makes an ugly pneumonia in neonates), E.Coli, etc.. I don't have data comparing the the 2 (hospital aquired infections vs. infections aquired at home) for neonates, but if you have a link to a study / studies, again, I'd love to see it.smile.gif

 

The satisfaction with maternity care here in Germany is pretty high and from what I gather, our hospitals and OBs are a lot more mother/child oriented than US docs, but I can't really make a call on that, since I haven't actually had a chance to experience the US system. As you can tell though, I was pretty happy with my hospital birth and felt well cared for (in some instances downright pampered).

 

Most hospitals here in Germany don't have a NICU either, so yeah, going for one that had one was just me.

 

I think licensure for midwives in the US would be a good thing, but I think it would need to be combined with a more rigourous standard for the education of midwives. I think requiring all midwives that get licensed to have CNM status in order to do so would be a good move. Here in Europe, there is no CPM / DEM equivalent and from what I've heard about the entry requirements and the NARM test they need to pass, I do feel they are under-qualified for a job where things can go south fast.

 

 

 

 


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#66 of 118 Old 08-08-2011, 08:53 PM
 
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Originally Posted by MidwifeErika View Post

Exactly. I think we all know where we can go to get the "other side" on homebirth.... which is EVERYWHERE else outside of the homebirth forum on mothering. It is exhausting and sad to find people digging up old posts and trying to start big debates on the safety of homebirth in a place that used to be more supportive. I come to mothering for "fluff" reading. I have no interest in having big debates or have people tell me that I am choosing the wrong thing for my children when I am coming to the homebirth forum to discuss it.
 

 


I wasn't actually digging for anything when I came across this post. I didn't even notice how old it was until I started writing that first comment.

 

The thread might be a year old, but if you're scrolling down a list of topics, it's just a tiny nudge of the mouse away.

 

As for being grumpy about getting dragged into debates when you actually wanted to relax a bit and feel comfortable, I empathize. I guess it's like going out to the beach, looking forward to some lazing around in the sun, reading a good book....and then a bunch of very loud party makers move in on the bit of sand next to yours, loud music blaring...and on top of that, they start giving you grief about your choice of literature.

 

I'm sorry if I've been contributing to that. I debate for relaxation (not the only thing I do to relax, but one of them) and since I'm new and totally unfamiliar with MDC until a short while ago, I'm still in the "figuring out how things are done around here" phase. And since some of the first things I stumbled upon were discussions, it looked to me like they were fairly standard on MDC (which I didn't question, since I'd see similar stuff in other websites....Maybe I should add that the moderators seemed focused on keeping the tone a bit softer than in other forums, but I did get the impression that debating stuff in a friendly manner was perfectly o.k.).

 

Me, I want to make good choices for me and my kids. I'm pretty certain the info I'm basing on is pretty solid. But I also know about the Dunning-Kruger effect, so I'm aware that I might be mistaken about that. So places like this one are a sounding board for me. I look for things that will challenge my beliefs and my knowledge, so that, if necessery, I can adapt them to make a better basis for my choices.


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#67 of 118 Old 08-08-2011, 09:11 PM
 
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The odd thing is posting it on a old thread.  My understanding of internet and forum courtesy would be to start a new thread referencing information from the old one you wanted to discuss.  As for it being a double standard, maybe, but it's also the homebirth forum.

 

And as a woman with a history of PPH, I only hire midwives with the equipment and medicines and experience to treat it.  They also have a great deal of the equipment you listed, that you may not expect, such as an incubator, oxygen, resuscitation equipment.  The rest, just a few minutes drive at the hospital, which I happen to be lucky to have.  I grew up in a town with a hospital that included a maternity ward, but if any big emergency happened they had to get a helicopter to the next closest hospital.  It's that kind of thing you don't see when you are comparing just straight up numbers with miniscule differences. It's not possible to see all the variables, such as traffic, distance, training and experience of the care providers, equipment available.

 

And off the top of my head I can think of one woman I know personally who walked into the ER as her baby was crowning for a planned hospital birth because it was such an unexpectedly short labor, and another who was planning a birth center birth but went to use her mother in law's bathroom while visiting and had her baby.  So precipitous labors, that result in a birth in a location not planned or prepared for does not seem so news worthy or unlikely to me.

 

ETA:  Just remembered an online friend who had an unplanned UC on her toilet as her MIL was on the way to watch their kids so they could head over to the hospital because she had just started labor.


The thread may be old, but it's also only a tiny nudge down the page with my scroll button away from the newer posts.

 

As for this being the homebirth forum....it doesn't say "PRO homebirth" forum. Just homebirth. Meaning it's not necessarily evident for a newbie that topics should be limited to positive things about homebirth in this particular forum. Especially not if the OP of the thread expressed doubts about her choice to have a HB.

 

And yes, precipitous labour happens. But Wisconsin has about 70.000 births per year. If only percent of all these births (=700) were somewhere in a car along the roadside, I'm fairly certain there'd be more in the news about it. And it is news worthy, otherwise there wouldn't be articles like this one: http://www.620wtmj.com/news/local/126088408.html

 


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#68 of 118 Old 08-08-2011, 09:39 PM
 
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Originally Posted by MidwifeErika View Post

A few things:

*Other for attendant is not unlicensed midwife, they would be listed under "other midwife". The license was not available until the middle of 2007. The act passed in 2006 and honestly was in the works LONG before the poor outcome that you mention.... that was not the reason for the license coming about. The license came about because midwives pushed for it to be available. So, anyhow, "other midwife" is the category that lists anyone who checks the box on the birth certificate that they are a non-CNM midwife this absolutely, for sure, includes non-licesned/non-CPM midwives. One does not have to be licensed to check that box or be a CPM (I have filed Wisconsin birth certificates) So, "other" could be a friend or partner or complete stranger. It could be the taxi cab driver bringing a woman to the hospital.

 

For location, "other" would include babies born in the car, along the highway, in a shopping mall, a girl having a baby in her high school bathroom stall, etc. It would not be a safe assumption that all these births were in the few birth centers and clinics that do births in the state.

 

Another point is that you would not add the numbers together, you would average them. So, if one group has a rate of 6.something and another has 4.something you cannot add those together and get a higher rate yet out of 1000 births. That would be your rate for 2000 births so then you would need to divide it by 2. Or, the most accurate rate would be to add and divide them up based on the actual numbers of births that happened in each location to get to 100%..... not sure if I am making total sense here as I am getting a bit sleepy. Anyhow, sorry, your math is just wrong.

 


 


Thanks for clearing that bit about "other" up. So for the "birth attendant" bit, it'd be more acurate to strike it completely from the equation.

For locations, for better accuracy a percentage of the total needs to be added, since it does contain birth centres, even if they make up a smaller percentage than initially  thought.Since neither of us has data on what for a percentage that would be, I guess we can leave it at that. tea6.gif

 

And you're right, I did miscalulate when I added "other midwives" to "other". It should have been divided by 2. Given though that it probably wasn't appropriate to add "other" to other midwife" in the first place, I think it's not that relevant to the conclusion either though:

 

"VB" with "other midwive" and "residence" still have a higher neonatal mortality rate than "delivery method = all" with "hosptial" and "Medical doctor".

 

I DO believe that women should have as many choices as safely possible where giving birth is concerned.

But I also believe that in the "other midwife" / "residence" group, it might be a good idea to put some more effort into further lowering neonatal mortality.

 

I think requiring the CPM's to upgrade to CNM could be a good step in the right direction.


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I think requiring the CPM's to upgrade to CNM could be a good step in the right direction.


I happen to think CPMs can be highly qualified, highly experienced, and highly capable of handling emergencies without having to study nursing before studying midwifery.  I also am very happy to live in a state that allows non-licensed midwives to practice, because women who desire different levels of care, different personalities have SO many more options to choose from then other states here in the U.S.  Just because I am looking for certain requirements in my care doesn't mean that everyone else wants those same things.  I think care providers need to be upfront about where their expertise and training lie, and parents need to know enough to ask the right questions and make sure they are getting the right care provider for their needs.  None of that is benefited by a blanket requirement.  Once you start legislating these things you start forcing women who don't want certain interventions into accepting them, for example a mother risking out of midwifery care by law and having to choose between an unwanted and possibly unnecessary hospital birth and no care during birth at all, something less likely to happen if you live in a place that allows unlicensed midwives to practice, in addition to licensed midwives AND CNMs.

 

I think a better solution would be individual states choosing stringent standards for CPM and DEM training so that when women WANT that kind of care they understand what level of competence they are getting.  For example, compare the standards for licensing DEM's in California and Oregon.  There's a lot more assurance of a skilled trained provider in Oregon just by looking at the credentials.


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Quote: "I happen to think CPMs can be highly qualified, highly experienced, and highly capable of handling emergencies without having to study nursing before studying midwifery."

 

I think so too. But I also think that (unlike with CNM's) it is possible for a CPM / DEM / unlicensed midwife to get away with practicing even though she has only limited qualifications, not much experience and is badly prepared to handle emergencies.

 

Quote: "I think care providers need to be upfront about where their expertise and training lie, and parents need to know enough to ask the right questions"

 

Something you encounter a lot when trying to educate yourself about the subject of homebirth, is "Birth is natural. Trust Birth". For a parent, who is trying to educate himself about birth, this might lead to the belief that complications are unlikely and that if at all, they occur mainly in the hospital because of interventions e.g. as in this post: http://erinmidwife.com/2011/03/31/if-i-were-at-home-i-would-have-died/

 

So if a parent starts to "trust birth", being a medical lay person, they might never realize how serious complications can be and what the management of such complications requires. If that parent interviews a midwife about her credentials, that parent might be more focused on the midwives credentials where the normal birthing process and the after-care are concerned, but he or she might be less insistent about the midwife's ability to handle emergency.

 

Basically, I feel that your approach might place more responsiblity on the parents for vetting the credentials of their midwife than they can be reasonably expected to handle.

 

Implementing stringent standards for training for CPMs and DEMs sounds like a good idea that could contribute to solving that problem. But it will only work if the different levels of training are made transparent and comparable for parents.

Maybe a kind of catalogue that lists the different levels of training and an explanation of what the training enables the CPM / DEM to do?

And an official certification of the level of skill / competency a specific CPM / DEM has reached?

 


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#71 of 118 Old 08-08-2011, 11:02 PM
 
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I also believe that in all aspects of maternity care we should always, always, always be looking to be improving out outcomes. Regardless of birth location or attendant. I don't know that the CNM being the required credential is the answer to this. If we were going to go based on the Wisconsin website, for example, the rates for death in births in a residence came up as follows:

MD: 2.07/1000

CNM: 4.85/1000

Other midwife: 1.87/1000

 

Now, obviously, there is so much missing information that it is quite difficult to base any sort of policy-making decisions on this ;) Who knows why these numbers came out this way. I just don't know that making the CNM into the only credential is the right answer.

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I think requiring the CPM's to upgrade to CNM could be a good step in the right direction.



 


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#72 of 118 Old 08-08-2011, 11:02 PM
 
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wow, so much stuff here, hard to know where to start.

 

Medical school is an exciting time, so much new info, so much of it presented as if it is completely handed down from above, so much faith in the med school faculty, and so little real world experience with how a well-educated skilled midwife performs.

 

yes, c-sections are better than infant or maternal death.  But that is a false comparison.  It isn't one or the other as a general matter.

 

re:  c-sections not being a big deal.  oh how this makes me insane to read this!  Have you experienced yet in med school attending a patient with placental accreta where the placenta grows outside of the uterus through a c-section scar and takes over other organs?  It can kill a mother and baby even in the best hospital.  it is almost unheard of unless a woman has had a previous c-section.  Do doctors add that into the risk profile for the first c-section?  almost invariably not. 

 

More and more is being learned about the importance of vaginal delivery.  It improves newborn lung function by pressing fluids out of the lungs.  It sets up the newborns intestinal flora, and therefore its immune system, for those early months (babies born vaginally have their mothers intestinal flora, babies born by c-section have the flora of the hospital, skin, etc.  not good for immune system and might even have implications for autism, etc.).  Hormone levels of mother and baby are disturbed by c-section, resulting in post-partum depression, breast-feeding difficulties, lack of bonding etc.  And on and on.  Do docs tell mothers about these issues when they are "planning" their c-sections?  Nope.

 

So although a c-section is of course a better alternative then death, that should only be the measure when c-section was the only alternative to death.  That is very rarely the case, and certainly nowhere like the 30% of hospital births.  It is like saying "having your leg amputated is better than dying from gangrene" and then amputating the legs of 30% of people who come in with a leg rash, without even confirming that it is an invasive disease.

 

Home birth, if attended by a good midwife is a way to drastically reduce your chances of having an unnecessary c-section, and all of the nightmares that come along with that, not to mention a way to avoid all the other harmful hospital interventions.  I do think that midwifery should have more quality control, because an incompetent midwife stains the entire child birthing world.  But assuming a midwife with a lot of experience and skills, one of the most important of which is seeing trouble before it gets too late, home birth is a safe option.  

 

Don't let the docs in the little world of the med school close your eyes to the reality.  :-)

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#73 of 118 Old 08-08-2011, 11:54 PM
 
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I'm so sorry, I understand. My MDC DD club had a couple of late term losses, and it was rather frightening ot me. Even though, like you said, a completely different situation. It doesn't matter, when you are pregnant it can become very personal in more than a way of just having enormous sympathy for someone else.

Hugs to you and many wishes for a safe birth.

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Originally Posted by SaveTheWild View Post

wow, so much stuff here, hard to know where to start.

 

Medical school is an exciting time, so much new info, so much of it presented as if it is completely handed down from above, so much faith in the med school faculty, and so little real world experience with how a well-educated skilled midwife performs.

 

yes, c-sections are better than infant or maternal death.  But that is a false comparison.  It isn't one or the other as a general matter.

 

re:  c-sections not being a big deal.  oh how this makes me insane to read this!  Have you experienced yet in med school attending a patient with placental accreta where the placenta grows outside of the uterus through a c-section scar and takes over other organs?  It can kill a mother and baby even in the best hospital.  it is almost unheard of unless a woman has had a previous c-section.  Do doctors add that into the risk profile for the first c-section?  almost invariably not. 

 

More and more is being learned about the importance of vaginal delivery.  It improves newborn lung function by pressing fluids out of the lungs.  It sets up the newborns intestinal flora, and therefore its immune system, for those early months (babies born vaginally have their mothers intestinal flora, babies born by c-section have the flora of the hospital, skin, etc.  not good for immune system and might even have implications for autism, etc.).  Hormone levels of mother and baby are disturbed by c-section, resulting in post-partum depression, breast-feeding difficulties, lack of bonding etc.  And on and on.  Do docs tell mothers about these issues when they are "planning" their c-sections?  Nope.

 

So although a c-section is of course a better alternative then death, that should only be the measure when c-section was the only alternative to death.  That is very rarely the case, and certainly nowhere like the 30% of hospital births.  It is like saying "having your leg amputated is better than dying from gangrene" and then amputating the legs of 30% of people who come in with a leg rash, without even confirming that it is an invasive disease.

 

Home birth, if attended by a good midwife is a way to drastically reduce your chances of having an unnecessary c-section, and all of the nightmares that come along with that, not to mention a way to avoid all the other harmful hospital interventions.  I do think that midwifery should have more quality control, because an incompetent midwife stains the entire child birthing world.  But assuming a midwife with a lot of experience and skills, one of the most important of which is seeing trouble before it gets too late, home birth is a safe option.  

 

Don't let the docs in the little world of the med school close your eyes to the reality.  :-)


*clears throat*

 

Quote: "Medical school is an exciting time, so much new info, so much of it presented as if it is completely handed down from above, so much faith in the med school faculty, and so little real world experience with how a well-educated skilled midwife performs."

 

Am I interpreting something into your post or are you really being quite a bit condescending?

 

And acutally, the "info", at least for me, is anything but new. I finished med school and graduated and the only reason I'm not working at a hospital right now is because I got pregnant and decided to be a SAHM for a bit before starting work at a hospital. And while I want to go into internal medicine and not OB/GYN, and am in Germany to boot, I've had a look at the practical education young doctors get in the States and I tell ya, it's nothing to sneeze at. They work about 80 hours a week and this is what the programs look like: http://www.uphs.upenn.edu/pahedu/gme/ob.html#program

 

Also, I'm not worried about the "well-educated skilled midwives". I had wonderful midwives at the hospital that gave excellent care. It's the not-so educated, rather less skilled midwives that don't know how to handle emergencies that I'm worried about, and I believe that is a legitimate worry.

 

Another thing: I NEVER claimed that c-section was "no big deal" for EVERY mother. I said that there are women out there, who are fine with their c-section and others that are not. No more, no less. Yes, you can feel traumatized by a c-section. But it's not like it's a law of nature: Get a c-section = be traumatized. It's perfectly possible for moms to have the outcome: got a c-section = everything is fine.

 

If the c-section is elective, then the doctor HAS TO by LAW to mention the (at that point scientifically proven) risks.If placenta accreta in further pregnancies is one of them, it needs to be mentioned, just like an increased risk of uterine rupture. Otherwise any woman developing placenta accreta could sue him for malpractice and his insurance would drop him her like a hot potato.

If the c-section is non-elective (=necessary to save the life of mother and/ or child), then the possibility of maybe developing p.a. is moot, since the lives of mother and child take precedence over that.

 

I do not agree with your statement that "...c-section... should only be the measure when c-section (is) the only alternative to death."

C-sections should be done when death seems LIKELY.

I don't think a doc could get away with it if he told a grieving mom who just lost her baby intra-partum "Well, I knew your baby could die...it certainly was a possibility, since we saw some signs of trouble. But I decided to go with the vaginal birth anyway, since I wasn't CERTAIN that your kid would die if we tried it vaginally. He might have survived. And then you would have had some benefits, like less problems breastfeeding and I wanted to give you a chance at that. But now, I guess you don't have to worry about breastfeeding and such, since you have no baby after all....".

I'm sure that kind of explanation wouldn't go down well with the mom. I'm also fairly certain that she would sue that doc to the ends of the world (I would). And she'd be right to do so.

In questions of life and death, especially the life and death of a baby, people tend to minimze risks as far as possible, and in the case of c-sections that sometimes prefering to be safe....rather than sorry.

 

One statement however, that I fully, heartily and totally agree with is that "I do think that midwifery should have more quality control, because an incompetent midwife stains the entire child birthing world."  (and if you look at my posts before, you'll find that I also agree that homebirths with a skilled and competent midwife (and short transfer times) is safe too).

 

I think that one way to improve accountability would be to require midwives to carry malpractice insurance. If something happens (dead or handicapped baby due to midwife negligence), then the money will go a long way to help parents taking care of a handicapped child or take some time off to deal with their grief if the child died). Also, it's a motivation NOT to be negligent if you want to keep practicing as a midwife.

 

Another one would be stricter sanctions if a midwife IS negligent.Here's an example of a midwife acting with negligence and the organisation supervising her (OHLA) not doing much about it: http://oregonmidwifereviews.blogspot.com/2011/08/what-you-dont-know-about-jennifer.html

 

*g*

 

And if it were my goal to go through the world with closed eyes, then I wouldn't be on this thread debating stuff with you guys, now would I? 

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Basically, I feel that your approach might place more responsiblity on the parents for vetting the credentials of their midwife than they can be reasonably expected to handle.

 

It's not terribly difficult to look up state code for licensure requirements for midwives, or to point blank as a midwife questions about birth outcomes, and experience in emergencies in her practice.  And quite frankly, that IS my responsibility as a parent and a patient.

 

Just as "trust birth" get's thrown around a lot, so does the assumption "trust doctors".  I'm more from the camp of "question everything and make my decisions from there."  And it should be my right to do so and wide-spread sweeping legislation of homebirth isn't the solution.

 


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#76 of 118 Old 08-09-2011, 12:34 AM
 
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Couldn't agree more. And if you look at her posting history, this isn't the only resurrected thread she's preaching her agenda on. 



I noticed this as well.


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#77 of 118 Old 08-09-2011, 12:42 AM
 
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If the c-section is elective, then the doctor HAS TO by LAW to mention the (at that point scientifically proven) risks.If placenta accreta in further pregnancies is one of them, it needs to be mentioned, just like an increased risk of uterine rupture. Otherwise any woman developing placenta accreta could sue him for malpractice and his insurance would drop him her like a hot potato.

If the c-section is non-elective (=necessary to save the life of mother and/ or child), then the possibility of maybe developing p.a. is moot, since the lives of mother and child take precedence over that.

 

I do not agree with your statement that "...c-section... should only be the measure when c-section (is) the only alternative to death."

C-sections should be done when death seems LIKELY.

I don't think a doc could get away with it if he told a grieving mom who just lost her baby intra-partum "Well, I knew your baby could die...it certainly was a possibility, since we saw some signs of trouble. But I decided to go with the vaginal birth anyway, since I wasn't CERTAIN that your kid would die if we tried it vaginally. He might have survived. And then you would have had some benefits, like less problems breastfeeding and I wanted to give you a chance at that. But now, I guess you don't have to worry about breastfeeding and such, since you have no baby after all....".

I'm sure that kind of explanation wouldn't go down well with the mom. I'm also fairly certain that she would sue that doc to the ends of the world (I would). And she'd be right to do so.

In questions of life and death, especially the life and death of a baby, people tend to minimze risks as far as possible, and in the case of c-sections that sometimes prefering to be safe....rather than sorry.

 

One statement however, that I fully, heartily and totally agree with is that "I do think that midwifery should have more quality control, because an incompetent midwife stains the entire child birthing world."  (and if you look at my posts before, you'll find that I also agree that homebirths with a skilled and competent midwife (and short transfer times) is safe too).

 

I think that one way to improve accountability would be to require midwives to carry malpractice insurance. If something happens (dead or handicapped baby due to midwife negligence), then the money will go a long way to help parents taking care of a handicapped child or take some time off to deal with their grief if the child died). Also, it's a motivation NOT to be negligent if you want to keep practicing as a midwife.

 

Another one would be stricter sanctions if a midwife IS negligent.Here's an example of a midwife acting with negligence and the organisation supervising her (OHLA) not doing much about it: http://oregonmidwifereviews.blogspot.com/2011/08/what-you-dont-know-about-jennifer.html

 

*g*

 

And if it were my goal to go through the world with closed eyes, then I wouldn't be on this thread debating stuff with you guys, now would I? 

 

Informed consent in the U.S is a HUGE joke, and women are subjected to emergency c-sections, sometimes caused by the actions of doctors themselves.  It's the very argument that performing a c-section is the safer option against potential lawsuits that has c-section rates in this country so crazy high.

 

And the exorbitant cost of malpractice insurance is the very thing putting qualified midwives out of business!

 

As for the link about Andulaz, I was fully aware they had deaths from negligence in their practice when researching my birth choices in 2007, so once again, the information is there, even in the blog they give the contact information for OHLA.  That link was certainly nothing new.

 

If we are going to talk about quality control, how about more increased accountability from the OB's for the poor outcomes from unnecessary interventions?  Why single out midwives?

 

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#78 of 118 Old 08-09-2011, 12:43 AM
 
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Responding internally in quote box in this color.

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Originally Posted by Kanna View Post

Am I interpreting something into your post or are you really being quite a bit condescending?

 

A bit condescending, yes.  mischievous.gif  Seemed appropriate under the circumstances (i.e. your posts came across as you trying to "teach" us all about the real risks of home birth from your "medical" perch when many of the folks here have many many years of training, experience, etc.)

 

I've had a look at the practical education young doctors get in the States and I tell ya, it's nothing to sneeze at. They work about 80 hours a week and this is what the programs look like: http://www.uphs.upenn.edu/pahedu/gme/ob.html#program

 

I am very familiar with US medical training and don't think it is shoddy, but they are teaching OBs to be surgeons, not labor and delivery experts.  I would absolutely go to a US trained OB to have uterine surgery, or even an emergency c-section if one was necessary, but not for a normal vaginal delivery.  They aren't trained in that and frankly that isn't their interest in most cases. 

 

Also, I'm not worried about the "well-educated skilled midwives". I had wonderful midwives at the hospital that gave excellent care. It's the not-so educated, rather less skilled midwives that don't know how to handle emergencies that I'm worried about, and I believe that is a legitimate worry.

 

I actually agree with this statement.  But lumping them all together in a "homebirth is unsafe" attitude is harmful.  And I absolutely don't agree, if your are trying to suggest this, that "in-hospital" midwives are more skilled than "out of hospital" midwives.  Homebirth midwives handle labor from beginning to end with one woman and learn inately how labor progresses, how to see a problem coming down the road, how to avoid letting small issues turn into big ones.  Hospital based midwives are often forced by the reality of L&D wards to act basically the same way an OB does.  The nurses do most of the laboring time and the midwife is there for the delivery only. 

 

Another thing: I NEVER claimed that c-section was "no big deal" for EVERY mother. I said that there are women out there, who are fine with their c-section and others that are not. No more, no less. Yes, you can feel traumatized by a c-section. But it's not like it's a law of nature: Get a c-section = be traumatized. It's perfectly possible for moms to have the outcome: got a c-section = everything is fine.

 

I am not talking about emotional trauma, though I don't downplay how devastating it can be.  I am talking about actual damage to the mother and baby (and future babies). Even if not immediate (e.g. the c-section is a success and the mother feels fine) there can often be long term negative health effects from c-sections that are rarely discussed within a hospital setting (because they are generally balanced against the possible mortality of mother or baby, even when, in most cases, it was never a life or death situation.)

 

If the c-section is elective, then the doctor HAS TO by LAW to mention the (at that point scientifically proven) risks.If placenta accreta in further pregnancies is one of them, it needs to be mentioned, just like an increased risk of uterine rupture. Otherwise any woman developing placenta accreta could sue him for malpractice and his insurance would drop him her like a hot potato. If the c-section is non-elective (=necessary to save the life of mother and/ or child), then the possibility of maybe developing p.a. is moot, since the lives of mother and child take precedence over that.

 

See, but distinguishing between "elective" and "non-elective" is very squishy.  More often than not what happens here is 1) labor starts and is going fine but too slowly for hospital protocol, 2) mother is put on pitocin, 3) mother needs spinal anesthesia to cope with pain, 4) mother put on monitor, 5) monitor detects distress (often/usually falsely) 6) "non-elective" c-section performed.  However in many of those situations there was no distress and the c-section was entirely unnecessary, but the mother still has to face all the "undisclosed risks".

 

Also, informed consent is a joke. Often the docs themselves aren't aware of all the risks or new research, etc.  They basically give the risks of anesthesia and infection and other of the most obvious stuff, but the idea of an OB taking the time to talk to a laboring mother about the possible bonding, breastfeeding, hormonal, lung development, gut flora development in c-section vs. vaginal babies.  .... not going to happen.

 

and in the case of c-sections that sometimes prefering to be safe....rather than sorry.

 

Sure, easy enough to say, but again, why cut off 100 people's legs to save 1 leg?  In the US the c-section rate is approaching 30%. It is unjustifiable based on the real risk profile.

 

I think that one way to improve accountability would be to require midwives to carry malpractice insurance. If something happens (dead or handicapped baby due to midwife negligence), then the money will go a long way to help parents taking care of a handicapped child or take some time off to deal with their grief if the child died). Also, it's a motivation NOT to be negligent if you want to keep practicing as a midwife.

 

Fear of liability is one of the reasons so many unnecessary and proven useless and harmful (e.g. monitoring) practices occur.  Adding that to midwives is not going to be a real problem solver. 

 

I think that legitimizing the profession and making the steps to getting a license clear would help.  If pregnant women had access to a bigger pool of qualified midwives they wouldn't have to resort to the bad ones.  But I do believe there should be more supervision of inexperienced midwives.  There is no excuse for bad medical care, no matter where it comes from.

 


 

 

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I noticed this as well.


...and are you now going to accuse me of lying, when I tell you that I DON'T have an agenda and that I'm NOT here to preach? Because I've stated that in previous comments that

 

a)

As a mother or a two year old, I'm interested in a wide variety of subjects ranging from from wooden toys, vaxing, drinking water quality, birth, schools, missing breastfeeding, dealing with a kids temper tantrums and recommendations for good baby slings...which, if you've taken a look at my posting history, should be something you've notice.

 

b) The thread might be a year old, but if you're scrolling down a list of topics, it's just a tiny nudge of the mouse away.I didn't even notice the darn thing was a year old when I clicked on the link and only noticed when I was writing my first comment (and trying to figure out when the OP was due). It's similar for other threads.

 

I look for stuff I find interesting, not stuff that is "new".

 

c) There have been other people here in this thread, engaging in a vivid and interesting discussion, adding there own to cents from the other side of the spectrum, with lots of links to information they felt supported their viewpoint (e.g. Turquesa or MidwifeErika), and I don't see you accusing them of "....preaching an agenda".

 

Don't you think that's a bit of a double-standard on your part?

 

d) I'm someone who likes sharing experience and information with others, especially if its information and experiences I haven't come across before, because I feel that ideas and beliefs that I hold have to be put to the trial by others in order for them to be something I can base my decisions and my way of living on. If those ideas and beliefs that I have withstand this "trial of fire", I will keep them. If they don't, then I discard them, for they have proven that they aren't "solid ground to stand on".

 

This is, if I'm not mistaken, perfectly in accordance with the MDC guidelines that state that moms should come here "... with a desire to examine, discuss, and learn".

 

e) In addition to all that, I believe that MDC guidlines state that posts should be "respectful, and courteous".

And somehow, I think that you barging in here only to accuse me of "...preachin an agenda" does NOT fall under the heading of "respectful and courteous".

 

From Turquesa's and MidwifeErika's posts I understand why the "old" MDC'ers might be a bit on the edge, but quite frankly, so going by some of the posts in this forum I'm NOT under the impression that this is a community that deserves to be called fair, repectful or welcoming to newbies.

 

You just charge in, slinging around accusations, without trying to talk to people and find out more first.

 

 


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A bit condescending, yes.  mischievous.gif  Seemed appropriate under the circumstances (i.e. your posts came across as you trying to "teach" us all about the real risks of home birth from your "medical" perch when many of the folks here have many many years of training, experience, etc.)

 

I've had a look at the practical education young doctors get in the States and I tell ya, it's nothing to sneeze at. They work about 80 hours a week and this is what the programs look like: http://www.uphs.upenn.edu/pahedu/gme/ob.html#program

 

I am very familiar with US medical training and don't think it is shoddy, but they are teaching OBs to be surgeons, not labor and delivery experts.  I would absolutely go to a US trained OB to have uterine surgery, or even an emergency c-section if one was necessary, but not for a normal vaginal delivery.  They aren't trained in that and frankly that isn't their interest in most cases.

 

Also, I'm not worried about the "well-educated skilled midwives". I had wonderful midwives at the hospital that gave excellent care. It's the not-so educated, rather less skilled midwives that don't know how to handle emergencies that I'm worried about, and I believe that is a legitimate worry.

 

I actually agree with this statement.  But lumping them all together in a "homebirth is unsafe" attitude is harmful.  And I absolutely don't agree, if your are trying to suggest this, that "in-hospital" midwives are more skilled than "out of hospital" midwives.  Homebirth midwives handle labor from beginning to end with one woman and learn inately how labor progresses, how to see a problem coming down the road, how to avoid letting small issues turn into big ones.  Hospital based midwives are often forced by the reality of L&D wards to act basically the same way an OB does.  The nurses do most of the laboring time and the midwife is there for the delivery only. 

 

Another thing: I NEVER claimed that c-section was "no big deal" for EVERY mother. I said that there are women out there, who are fine with their c-section and others that are not. No more, no less. Yes, you can feel traumatized by a c-section. But it's not like it's a law of nature: Get a c-section = be traumatized. It's perfectly possible for moms to have the outcome: got a c-section = everything is fine.

 

I am not talking about emotional trauma, though I don't downplay how devastating it can be.  I am talking about actual damage to the mother and baby (and future babies). Even if not immediate (e.g. the c-section is a success and the mother feels fine) there can often be long term negative health effects from c-sections that are rarely discussed within a hospital setting (because they are generally balanced against the possible mortality of mother or baby, even when, in most cases, it was never a life or death situation.)

 

If the c-section is elective, then the doctor HAS TO by LAW to mention the (at that point scientifically proven) risks.If placenta accreta in further pregnancies is one of them, it needs to be mentioned, just like an increased risk of uterine rupture. Otherwise any woman developing placenta accreta could sue him for malpractice and his insurance would drop him her like a hot potato. If the c-section is non-elective (=necessary to save the life of mother and/ or child), then the possibility of maybe developing p.a. is moot, since the lives of mother and child take precedence over that.

 

See, but distinguishing between "elective" and "non-elective" is very squishy.  More often than not what happens here is 1) labor starts and is going fine but too slowly for hospital protocol, 2) mother is put on pitocin, 3) mother needs spinal anesthesia to cope with pain, 4) mother put on monitor, 5) monitor detects distress (often/usually falsely) 6) "non-elective" c-section performed.  However in many of those situations there was no distress and the c-section was entirely unnecessary, but the mother still has to face all the "undisclosed risks".

 

Also, informed consent is a joke. Often the docs themselves aren't aware of all the risks or new research, etc.  They basically give the risks of anesthesia and infection and other of the most obvious stuff, but the idea of an OB taking the time to talk to a laboring mother about the possible bonding, breastfeeding, hormonal, lung development, gut flora development in c-section vs. vaginal babies.  .... not going to happen.

 

and in the case of c-sections that sometimes prefering to be safe....rather than sorry.

 

Sure, easy enough to say, but again, why cut off 100 people's legs to save 1 leg?  In the US the c-section rate is approaching 30%. It is unjustifiable based on the real risk profile.

 

I think that one way to improve accountability would be to require midwives to carry malpractice insurance. If something happens (dead or handicapped baby due to midwife negligence), then the money will go a long way to help parents taking care of a handicapped child or take some time off to deal with their grief if the child died). Also, it's a motivation NOT to be negligent if you want to keep practicing as a midwife.

 

Fear of liability is one of the reasons so many unnecessary and proven useless and harmful (e.g. monitoring) practices occur.  Adding that to midwives is not going to be a real problem solver. 

 

I think that legitimizing the profession and making the steps to getting a license clear would help.  If pregnant women had access to a bigger pool of qualified midwives they wouldn't have to resort to the bad ones.  But I do believe there should be more supervision of inexperienced midwives.  There is no excuse for bad medical care, no matter where it comes from.

 

 


Actually, NO, I'm not trying to "preach". I enjoy debating (which, granted, is not something everybody likes to do as a pastime). I seriously like getting to the bottom of things. And yes, since the majority of my experience on the subjects at hand is in the medical field, and since that's the information I've had access to so far, of course that's going to be my starting point. But by debating with others, I learn and expand my horizons:

 

I've learned about the kind of equipment american CNM's carry around with them.

I've learned about the recent change of atmosphere here on MDC and how it has been affecting members and about the atmosphere that was there before the change.

I've learned about the connection between c-sections and placenta accreta.

I've learned about about time frame in which crash c-sections should be done.

 

What have you learned?

 

As for OB's versus midwives: the way it sounds (and I can't really make a call on that, because, you know: german. In Germany.) american OB/Gyns could use a refresher course in normal birth. The best people to teach that "course", I think would be midwives. I also think, that at least some american CPMs need further training on "what can go wrong during birth" and how to handle that. The best people to teach that course ? OB/ Gyns.

Now, I think both sides in this whole homebirth vs. hospital birth in the US have closed up their forts and shut their doors.

I feel that if any positive progress is to be made, with better outcomes for caregivers and above all patients, OBs and midwives will have to start talking again to each other and will have to find some middle ground.

 

Concerning the next point: what I'm trying to suggest is that "in hospital" midwives in GERMANY (which are roughly equivalent to CNM's) are more skilled than AMERICAN "out of hospital" CPM midwives. But then (assuming they have the same years of practice) even in the US, a CNM is likely to be more skilled than a CPM / DEM, no?

In Germany, we don't have CPM's or DEMs and our midwives ARE required to carry malpractice insurance.

 

In the L & D department where I gave birth, my entire labour was overseen by a midwife, with the OB only popping by every once in a while to check on me and in the end to help with getting DD out, because she was BIG and we needed an episiotomy and a suction cup (circumference of the head was 38 cm and she weighed 4,8 kg....and no, it was not gestational diabetes, she just has really tall ancestors on both sides of the family....she was 60 cm long too). Actually, BY LAW births are overseen by midwives. The doctor is only allowed to assist birth without one present in case of an emergency (§ 34 Abs. 1 HebG).

 

As for the information about risks / benefits and necessity of c-sections: I think you need evidence based information materials (flyers, website etc.) for moms AND docs.

Not mentioning stuff like placenta accreta and risk of uterine rupture in future births in an elective c-section is NOT o.k. and also other, a bit more minor, negative effects should be mentioned (lung development, gut flora...) and how they are treated when they occur (e.g. uterine rupture - possible hyterectomy).

 

Concerning the squishy border between elective and emergency c-section: yep, I too feel that doctors are pushed to opt for a c-section earlier and are not doing enough to avoid c-section. And if midwives can offer lower c-section rates AND neonatal mortality rates that are equivalent or better than those of OBs, it would be a total hot-seller. Actually, I think there are already some areas where CNMs have achieved that, but "other midwives" (hello Wisconsin....) are still a bit away from that mark.

 

On the c-section rate being unjustifiable by the real risk profile: we're not talking gangrenous legs here. We're talking dead babies and inconsolate, grieving mothers that just finished decorating the nursery. It's not something that even has a remote chance in hell getting judged based on the real risk profile.

If there's something that can be done to save every last baby and there's no risk stacked against it that is equivalent to the horror of an intrapartum death, then people will want to see it done.

 

Also, if what you do (e.g. monitoring) is evidence based and you have the research to back what you practice, then even if something out of your control goes wrong it'd be pretty hard to make you liable. In order for a liability suit to stick, I believe you must have been negligent in some way...which you're not if your're practicing according to scientifically accepted standards.

 

Quote:

I think that legitimizing the profession and making the steps to getting a license clear would help. ... I do believe there should be more supervision of inexperienced midwives.  There is no excuse for bad medical care, no matter where it comes from."

 

Im a 100 % with you on this one.

 

"The price of being the best, is having to BE the best"

 

- Terry Pratchett -

 

http://authors.citatepedia.com/by.php?a=Terry+Pratchett

 

 


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#81 of 118 Old 08-09-2011, 04:48 AM
 
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Informed consent in the U.S is a HUGE joke, and women are subjected to emergency c-sections, sometimes caused by the actions of doctors themselves.  It's the very argument that performing a c-section is the safer option against potential lawsuits that has c-section rates in this country so crazy high.

 

And the exorbitant cost of malpractice insurance is the very thing putting qualified midwives out of business!

 

As for the link about Andulaz, I was fully aware they had deaths from negligence in their practice when researching my birth choices in 2007, so once again, the information is there, even in the blog they give the contact information for OHLA.  That link was certainly nothing new.

 

If we are going to talk about quality control, how about more increased accountability from the OB's for the poor outcomes from unnecessary interventions?  Why single out midwives?

 


As far as my experience goes (anecdata, I know) informed consent is taken seriously here in Germany. You have to talk to the patient, draw pictures if necessary, there are information sheets for every little thing that you have to go through with the patient, you tell patients if you're about to do something and explain why if they ask and if they say no (and nobody's life is threatened) you're not allowed to do it.

Are there any initiatives yet in the US that work on improving informed consent? And on educating doctors, patients, etc.?

 

As for malpractice: overseas, american citizens (including patients) are known to be unbelievably trigger-happy when it comes to suing others. In order to change that, you'd need to change american culture....which is basically feasible (after all, suffragettes got the public to accept women's vote), but a VERY tough job.

 

Geman midwives have to carry malpractice insurance (though their starting situation is a bit different than yours) and they're still in business.

 

I feel that american midwives have a strong lobby amongst american women and if they can improve safety for mothers and babies to rates that are equal or better than those of OBs, and if they ALL carry insurance (reducing the likelihood that the insurance will have to pay since the risk is lower than it is now and spread over more people, lowering it further) then they should be able to pressure insurances to lower premiums into an acceptable range.

 

Also, carrying malpractice insurance is about providing quality and customer protection to clients and since I'm under the impression that midwives are a VERY patient-centristic, protecting their patients and seeing to it that they're cared for even if something goes wrong should be in their interest.

 

As for Andaluz, this is not about the information of their negligence being new to the midwife community.

 

This is about the question if they got off too lightly. I certainly think so.

 

The civil penalty seems like a pittance to me, considering that we're talking about the death of a baby and instead of having her licensed revoked or at least suspended for a REALLY long time, after being responsible for the death of not one but TWO dead babies within just two years, instead she goes on to expand her practice and opens another birth centre. If that had been my child that died, it would have felt like a slap in the face to see the culprit get off with nothing more than a small fine and some additional "homework". I'd certainly wouldn't feel like OHLA was actually doing something serious to hold negligent midwives accountable.

 

Concerning accountability of OBs for the negative consequences of unnecessary interventions, that's certainly something that needs to be done. I'm not familiar enough with the american system though to know how something like that would be done.....but I highly suspect that it'll involves suing someone. wink1.gif

 

 


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#82 of 118 Old 08-09-2011, 05:05 AM
 
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I also believe that in all aspects of maternity care we should always, always, always be looking to be improving out outcomes. Regardless of birth location or attendant.


 


,truedat.gif

 

I'm wondering....it there a thread somewhere in the midwives forums addressing this issue? Because if there isn't one yet, I think it definitely would be worth starting one!

 

(Don't worry....I wouldn't post on that one. wink1.gif I figure I lack the qualification to discuss acutal measure to resolve the problem because a) I'm not a midwife and b) I'm not even American)

 


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#83 of 118 Old 08-09-2011, 05:39 AM
 
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It's not terribly difficult to look up state code for licensure requirements for midwives, or to point blank as a midwife questions about birth outcomes, and experience in emergencies in her practice.  And quite frankly, that IS my responsibility as a parent and a patient.

 

Just as "trust birth" get's thrown around a lot, so does the assumption "trust doctors".  I'm more from the camp of "question everything and make my decisions from there."  And it should be my right to do so and wide-spread sweeping legislation of homebirth isn't the solution.

 


I don't agree. First of all, not all parents are research savvy. Some people don't use the internet and finding out that kind of information with the 'net is work enough. Doing it without, when you know little about where to start and what to look for.....difficult.

 

Second, I did a bit of searching, just to see how well it would go.

 

I found the website of the medical board of california ba googling "state code for licensure requirements for midwives" and what I found on their site was a bit too much on the side of legalese and not very informative on top of that.

 

http://www.medbd.ca.gov/allied/midwives.html

 

The next links weren't much better either:

 

http://www.pacode.com/secure/data/049/chapter18/chap18toc.html 

http://www.azdhs.gov/als/midwife/

 

I tried googling for "good midwife" and the results were equally unsatisfying and un-informative.

 

http://www.associatedcontent.com/article/5661498/choosing_a_midwife_five_qualities_of.html?cat=52

 

http://www.ncbi.nlm.nih.gov/pubmed/17042821

 

This one was the best I found:

 

http://cfmidwifery.org/midwifery/faq.aspx

 

...and it mentions how "The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes." and that "Your choices are going to be dependent on several criteria: the legal status of midwifery in your state, the kind of midwife you're looking for, and the availability of midwives in your area. Here are some suggestions" and that "The hallmark of the Midwives Model of Care is respect - for the mother and baby, for the family, for the birth process itself."

 

But finding something about the complications that can arise during birth and how different midwives are equipped to handle it and how it's a criteria that should be checked for when looking for a good midwife? As far as I could tell: zilch. Not exactly "informed consent" enabling, is it?

 

....and this one, I found a bit counter-informative if you're trying to check out if your midwife is truly as competent as she claims she is:

 

http://www.mothering.com/community/forum/thread/1265590/austin-faith-beltz-a-good-midwife

 

To quote MDC policy: "Positive healthcare provider reviews are welcome. Please use careful language when responding to or soliciting a review. We do not wish to host negative remarks or comments about practitioners, practices, hospitals or healthcare centers that might cast them in a negative light and which would present liability concerns for you and for Mothering. Negative comments that are verifiable facts of public record or court ruling are acceptable."

 

This kind of policy makes it darn difficult to get a good, critical look at a midwife, will make people reluctant to post about it if they heard stuff went wrong at the midwifes parctice.....and I figure a lot of expecting moms come to MDC for advice about exactly this kind of thing.

 

One more thing: YOU are from the " camp of "question everything and make my decisions from there."" Not everybody is.

Some people are a lot more trusting and if the are told by someone who was introduced to them as a "professional" that there's not reason to worry, then they will rely on that professional's opinion.

Some people are shy and have a difficult time questioning someone they perceive to be of greater authority.

 

It seems callous to me to condemn these people to risking their lives and the lives of their babies in the hands of incompent midwives, because they lack the research skills and are more trusting or shy than you to question what they're being told.


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#84 of 118 Old 08-09-2011, 08:00 AM
 
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Kanna, one quick point before I proceed with my busy day: The EFM study that you referenced makes no mention of a comparison group to auscultation (bolding my own). 

 

Quote:
In the regression analyses, the primary exposure variable was EFM status during labor (yes vs no).

 

Quote:
Additional secondary analyses were conducted. We compared the distribution of having operative vaginal or primary cesarean delivery based on EFM status.

 

I will try to read it more thoroughly during my baby's nap this afternoon (I just briefly perused the section on methodology), but if it's the study I'm thinking of, it was industry-funded and compares EFM to no EFM at all.  In the context of our debate, we'd need to see how it compares to auscultation. I'll post more later on the research supporting auscultation.

 

 


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#85 of 118 Old 08-09-2011, 09:30 AM
 
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Kanna, one quick point before I proceed with my busy day: The EFM study that you referenced makes no mention of a comparison group to auscultation (bolding my own). 

 

 

 

I will try to read it more thoroughly during my baby's nap this afternoon (I just briefly perused the section on methodology), but if it's the study I'm thinking of, it was industry-funded and compares EFM to no EFM at all.  In the context of our debate, we'd need to see how it compares to auscultation. I'll post more later on the research supporting auscultation.

 

 


We definitely need more input before coming to any viable conclusions.


Actually, I was a bit pressed for time myself when I wrote that comment. I had time enough to google for a paper on the subject, to get us started and came across this one, which seemed as good a starting point as any....but nope, I haven't gotten around to looking at it in depth either yet.

 

I'm wondering....maybe this subject is worth starting a new thread over?


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#86 of 118 Old 08-09-2011, 10:37 AM
 
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...and are you now going to accuse me of lying, when I tell you that I DON'T have an agenda and that I'm NOT here to preach? Because I've stated that in previous comments that

 

a)

As a mother or a two year old, I'm interested in a wide variety of subjects ranging from from wooden toys, vaxing, drinking water quality, birth, schools, missing breastfeeding, dealing with a kids temper tantrums and recommendations for good baby slings...which, if you've taken a look at my posting history, should be something you've notice.

 

b) The thread might be a year old, but if you're scrolling down a list of topics, it's just a tiny nudge of the mouse away.I didn't even notice the darn thing was a year old when I clicked on the link and only noticed when I was writing my first comment (and trying to figure out when the OP was due). It's similar for other threads.

 

I look for stuff I find interesting, not stuff that is "new".

 

c) There have been other people here in this thread, engaging in a vivid and interesting discussion, adding there own to cents from the other side of the spectrum, with lots of links to information they felt supported their viewpoint (e.g. Turquesa or MidwifeErika), and I don't see you accusing them of "....preaching an agenda".

 

Don't you think that's a bit of a double-standard on your part?

 

d) I'm someone who likes sharing experience and information with others, especially if its information and experiences I haven't come across before, because I feel that ideas and beliefs that I hold have to be put to the trial by others in order for them to be something I can base my decisions and my way of living on. If those ideas and beliefs that I have withstand this "trial of fire", I will keep them. If they don't, then I discard them, for they have proven that they aren't "solid ground to stand on".

 

This is, if I'm not mistaken, perfectly in accordance with the MDC guidelines that state that moms should come here "... with a desire to examine, discuss, and learn".

 

e) In addition to all that, I believe that MDC guidlines state that posts should be "respectful, and courteous".

And somehow, I think that you barging in here only to accuse me of "...preachin an agenda" does NOT fall under the heading of "respectful and courteous".

 

From Turquesa's and MidwifeErika's posts I understand why the "old" MDC'ers might be a bit on the edge, but quite frankly, so going by some of the posts in this forum I'm NOT under the impression that this is a community that deserves to be called fair, repectful or welcoming to newbies.

 

You just charge in, slinging around accusations, without trying to talk to people and find out more first.

 

 



lol... I said five words.  If that makes you feel that I'm "charging in, slinging accusations", I'm sorry.  

 

It's just that MDC is generally supportive of homebirth, as well as the decision to not vax, etc.  I read this entire thread, and it made me go back to look at other threads you had posted in, simply because I found it odd that you dug up this old post.  In doing that, I found that you had gone back to a few older posts, several of which dealt with homebirth and vaccination.  I'm sorry if some of us feel like you may have a bit of an agenda, but it is what it is.  I don't think I'm being rude at all... just pointing out that I noticed you had done that too.

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#87 of 118 Old 08-09-2011, 10:40 AM
 
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As far as my experience goes (anecdata, I know) informed consent is taken seriously here in Germany. You have to talk to the patient, draw pictures if necessary, there are information sheets for every little thing that you have to go through with the patient, you tell patients if you're about to do something and explain why if they ask and if they say no (and nobody's life is threatened) you're not allowed to do it.

Are there any initiatives yet in the US that work on improving informed consent? And on educating doctors, patients, etc.?

 

As for malpractice: overseas, american citizens (including patients) are known to be unbelievably trigger-happy when it comes to suing others. In order to change that, you'd need to change american culture....which is basically feasible (after all, suffragettes got the public to accept women's vote), but a VERY tough job.

 

Geman midwives have to carry malpractice insurance (though their starting situation is a bit different than yours) and they're still in business.

 

I feel that american midwives have a strong lobby amongst american women and if they can improve safety for mothers and babies to rates that are equal or better than those of OBs, and if they ALL carry insurance (reducing the likelihood that the insurance will have to pay since the risk is lower than it is now and spread over more people, lowering it further) then they should be able to pressure insurances to lower premiums into an acceptable range.

 

Also, carrying malpractice insurance is about providing quality and customer protection to clients and since I'm under the impression that midwives are a VERY patient-centristic, protecting their patients and seeing to it that they're cared for even if something goes wrong should be in their interest.

 

As for Andaluz, this is not about the information of their negligence being new to the midwife community.

 

This is about the question if they got off too lightly. I certainly think so.

 

The civil penalty seems like a pittance to me, considering that we're talking about the death of a baby and instead of having her licensed revoked or at least suspended for a REALLY long time, after being responsible for the death of not one but TWO dead babies within just two years, instead she goes on to expand her practice and opens another birth centre. If that had been my child that died, it would have felt like a slap in the face to see the culprit get off with nothing more than a small fine and some additional "homework". I'd certainly wouldn't feel like OHLA was actually doing something serious to hold negligent midwives accountable.

 

Concerning accountability of OBs for the negative consequences of unnecessary interventions, that's certainly something that needs to be done. I'm not familiar enough with the american system though to know how something like that would be done.....but I highly suspect that it'll involves suing someone. wink1.gif

 

 


My personal experience of informed consent has been signing acknowledgements that by refusing xyz, I put myself at risk.  I have had VERY few experiences where the actual risks of accepting a procedure were adequately explained to me beforehand (actually, I can't think of one in any personal situation with a medical provider).  I know this has been the experience of many many other American women.

 

As for malpractice insurance, it would be nice if midwives were able to protect themselves and still provide affordable care for the women they serve.  If midwives all started carrying malpractice insurance, they would need to start charging more for their services. Already the cost of paying cash for a homebirth makes a qualified birth attendant unattainable for some. It's not always as clear cut as providing quality and protection, you can't provide quality care if no one can afford your care to begin with.

 

And I agree, American's are trigger-happy on lawsuits, and I personally believe it is not in our best interests.



Quote:
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I don't agree. First of all, not all parents are research savvy. Some people don't use the internet and finding out that kind of information with the 'net is work enough. Doing it without, when you know little about where to start and what to look for.....difficult.

 

Second, I did a bit of searching, just to see how well it would go.

 

I found the website of the medical board of california ba googling "state code for licensure requirements for midwives" and what I found on their site was a bit too much on the side of legalese and not very informative on top of that.

 

http://www.medbd.ca.gov/allied/midwives.html

 

The next links weren't much better either:

 

http://www.pacode.com/secure/data/049/chapter18/chap18toc.html 

http://www.azdhs.gov/als/midwife/

 

I tried googling for "good midwife" and the results were equally unsatisfying and un-informative.

 

http://www.associatedcontent.com/article/5661498/choosing_a_midwife_five_qualities_of.html?cat=52

 

http://www.ncbi.nlm.nih.gov/pubmed/17042821

 

This one was the best I found:

 

http://cfmidwifery.org/midwifery/faq.aspx

 

...and it mentions how "The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes." and that "Your choices are going to be dependent on several criteria: the legal status of midwifery in your state, the kind of midwife you're looking for, and the availability of midwives in your area. Here are some suggestions" and that "The hallmark of the Midwives Model of Care is respect - for the mother and baby, for the family, for the birth process itself."

 

But finding something about the complications that can arise during birth and how different midwives are equipped to handle it and how it's a criteria that should be checked for when looking for a good midwife? As far as I could tell: zilch. Not exactly "informed consent" enabling, is it?

 

....and this one, I found a bit counter-informative if you're trying to check out if your midwife is truly as competent as she claims she is:

 

http://www.mothering.com/community/forum/thread/1265590/austin-faith-beltz-a-good-midwife

 

To quote MDC policy: "Positive healthcare provider reviews are welcome. Please use careful language when responding to or soliciting a review. We do not wish to host negative remarks or comments about practitioners, practices, hospitals or healthcare centers that might cast them in a negative light and which would present liability concerns for you and for Mothering. Negative comments that are verifiable facts of public record or court ruling are acceptable."

 

This kind of policy makes it darn difficult to get a good, critical look at a midwife, will make people reluctant to post about it if they heard stuff went wrong at the midwifes parctice.....and I figure a lot of expecting moms come to MDC for advice about exactly this kind of thing.

 

One more thing: YOU are from the " camp of "question everything and make my decisions from there."" Not everybody is.

Some people are a lot more trusting and if the are told by someone who was introduced to them as a "professional" that there's not reason to worry, then they will rely on that professional's opinion.

Some people are shy and have a difficult time questioning someone they perceive to be of greater authority.

 

It seems callous to me to condemn these people to risking their lives and the lives of their babies in the hands of incompent midwives, because they lack the research skills and are more trusting or shy than you to question what they're being told.


I went to the California state website and searched midwives and came up with a list of links, including how to look up licensed midwives in the state.

 

http://www.ca.gov/CaSearch/Default.aspx?type=All&search=midwives

 

On the Oregon.gov site searching for licensed midwife came up with plenty of information including the text of the state code regarding licensure.

 

http://oregon.gov/search_results.shtml?cx=005482606056434223770%3Auq7asij-tbc&cof=FORID%3A10&ie=UTF-8&q=licensed+midwife&siteurl=oregon.gov%2F

 

The U.S. is HUGE.  The way search engines work you aren't going to get state specific and provider specific information with general search terms.

 

I think the barriers you mention to finding a good midwife are true.  I think they apply for every single medical profession in the U.S.  I suspect most people just got to whoever their insurance covers, with little thought to whether or not that provider is a good fit for them or has a history of providing poor care. 

 

Also, I found a couple studies regarding the safety of homebirth in general with a CPM that I figured I'd share, just because I think they are very interesting.

 

http://www.cmaj.ca/content/early/2009/08/31/cmaj.081869.short

 

http://www.bmj.com/content/330/7505/1416.full?ehom


I love Edward and we love our Libby (8/07) waterbirth.jpg and 'Nana' (05/09 )h20homebirth.gif and Eowyn (11/11) waterbirth.jpg  We are having a blast bfinfant.giffemalesling.GIFfamilybed1.gifcd.gif and homeschool.gif.

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#88 of 118 Old 08-09-2011, 11:02 AM
 
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lol... I said five words.  If that makes you feel that I'm "charging in, slinging accusations", I'm sorry.  

 

It's just that MDC is generally supportive of homebirth, as well as the decision to not vax, etc.  I read this entire thread, and it made me go back to look at other threads you had posted in, simply because I found it odd that you dug up this old post.  In doing that, I found that you had gone back to a few older posts, several of which dealt with homebirth and vaccination.  I'm sorry if some of us feel like you may have a bit of an agenda, but it is what it is.  I don't think I'm being rude at all... just pointing out that I noticed you had done that too.


*sigh*

 

Yes, it was only 5 words....but you were the 3 person in 2 days implying I was an EBIL doctor kidnapping the thread and holding it for ransom because it was apparently my goal to brainwash everybody with a world-view that differed from mind. And non of you were particularly polite either.

 

But yeah, apology accepted.

 

Hint for the next time something like this happens:

 

Turquesa went about it a whole lot better I feel. She wrote: "I find it interesting that you resurrected this thread after over a year.  You must feel passionate about this topic." See? Non-confrontational, friendly and still she got to ask me whyeverfore I was latching onto this thread.

 

To lay any remaing doubts you might have about me to rest:

 

Yes, homebirth and vaccination are things that interest me.

 

Homebirth because I gave birth to years ago and had to decide on where to do it and to me the decision to do it at the hospital was something I knew I wanted right from the start and I'm curious about what leads other people to make a different choice.

 

Vaccination because our family is vaxed to the max (I traveled abroad and so I'm even immunized against Yellow Fever, Rabies, different forms of meningits rampant in Asia....) and we're doing fine, but I'm aware that that's just anecdata, and since (as a doc) I DO get asked by friends and aquaintances about the pros and cons of vaccination, I felt I needed a more in depth knowledge than the one I already had.

 

Also, if you've taken a look at my posting history, you'll have noted that I posted across a wide range of topics (circing and Montessori got added today to other subjects ranging from how to bf while lying down to recommendations of natural wooden toy producers here in Germany).

 

And yes, I feel that it IS rude to just point at someone and shout "HA!!! I'm fairly certain you're only here because you have an ebil, ebil underlying agenda and on top of that you probably want to talk down to us to bolster your tiny crippled ego".

 

The old saying "Innocent until proven guilty" still holds, and darn it, if you were wondering about my motives, would it have been too much to just plain politely ASK about them, like Turquesa did, instead of jumping to conclusions and wildly pointing fingers first?

 

As for MDC being supportive of HB: Going by the moderators words of "... with a desire to examine, discuss, and learn".I somehow was under the impression that "supportive" did NOT equal "we will not discuss debate the fine points, ever".


fly-by-nursing1.giffamilybed1.gifteapot2.GIFfemalesling.GIFfuzmalesling.giflearning.gifgeek.gif

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#89 of 118 Old 08-09-2011, 11:41 AM
 
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I just wanted to say to SaveTheWild, you sound like you will be brilliant doctor--I hope if my next delivery goes south I will get someone like you!

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#90 of 118 Old 08-09-2011, 11:48 AM
 
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Quote:
Originally Posted by Kanna View Post



 

And yes, I feel that it IS rude to just point at someone and shout "HA!!! I'm fairly certain you're only here because you have an ebil, ebil underlying agenda and on top of that you probably want to talk down to us to bolster your tiny crippled ego".

 

 


If you read all of that, from my "I noticed this as well"... I'm not really sure what to tell you.  Maybe you're looking to feel attacked?  I don't know... shrug.gif

 


Xzavier - 9 REPlaySkateboard04HL.gif    Julien - 5  modifiedartist.gif   Jayce - 3  moon.gif    Jaxon - 18mos  jog.gif

 

Hoping for a babygirl.gif in November!

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