Midwife Conundrum.....WWYD? - Mothering Forums
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#1 of 21 Old 12-02-2010, 07:34 AM - Thread Starter
 
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I need some help ladies, I don't know what to do

 

I interviewed the top midwife around me a few months back.  Lets call her MW#1. She's written books, been in documentaries, 1500 births, yada yada....I clicked with her instantly.  The only issue is that when you search her name here on MDC, a sad story of a child with CP comes up, and the mom blames MW#1.  I brought it up, even sent the MW the link to respond, and her response was like "I don't know about that", very vaugue, etc.  As was her response to the question "have you ever had any maternal or fetal deaths during birth".....and she was like "None that I can remember", and was kind of laizze faire about it.  I think if something like that happened, I would remember it or be able to say no, absolutely not.  So both of those things irked me, but her credentials kind of outweighed it in my head for a while. And in the meantime I emailed and called her clients for recs, and NOTHING BUT GLOWING recs for her. 

 

So now I am pregnant and want to interview MW#2 and MW#3 to see if they are good fits or if MW#1 is the way to go.  WELL BOTH ARE TAKING LEAVE WHEN I AM DUE!  I don't feel comfy with any of the other local MWs.  In talking to MW2, I shared MW1s response to the CP baby, and she said EVERY MW in the state knows about that case, and without putting her down, implied that her response wasn't right.....

 

so now I am left with a trust issue with MW1 but no other options.  my friend suggested I go talk to her and give her a second chance, and if it doesn't feel right then move on.  The problem is DH is BARELY on board with a HB, and I don't think he'll go for it if its not MW1. 

 

Am I just being to persnickety about her response or is this a real trust issue that could bar a successful birth if she attended?  I know that is more a question that I need to answer, but WWYD?


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#2 of 21 Old 12-02-2010, 12:57 PM
 
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Im wondering if there are some legal issues that keep her from being able to discuss anything related to that case?  It wouldnt be unusual if she is in the middle of a legal battle that her lawyer would advise her not to mention anything about this case to anyone.  Anything she says could easily get twisted and used against her in court...  Even just admitting that this case happened could somehow be twisted into an admission of guilt by some lawyer...

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#3 of 21 Old 12-02-2010, 03:04 PM
 
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I was wondering the same thing as babymango.

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#4 of 21 Old 12-02-2010, 03:46 PM
 
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I would be direct with MW#1. Ask to see her stats and ask her if there is litigation preventing her from being forthright with you.   PM me if you like. 

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#5 of 21 Old 12-03-2010, 08:52 AM
 
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I think I know who are referring to, and while I didn't choose her for my homebirth midwife, I've heard good things.  In her defense, I think it's fair to say that any midwife with 1500+ births is likely to have an occasional unfavorable outcome, simply statistically speaking, so while I think it would be good to seek more clarification/comfort, her experience speaks for itself.

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#6 of 21 Old 12-03-2010, 10:31 AM
 
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Can you find any other birth stories with emergency situations that she has handled well? 

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#7 of 21 Old 12-03-2010, 10:50 AM
 
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If I'm not mistaken, midwives also have codes of client/provider confidentiality.  Not to mention babymango's point.  Even if litigation were long over, the terms of that litigation could bar her from talking about it.  Asking whether she's ever faced litigation might be a better question.

 

That said, no matter what the reputation of a provider, if I knew someone was lying to me, I would have a hard time having them as my provider.  Being willing to admit mistakes is important.  But I would still think it better than going with a hospital birth.  It's a tough spot...


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#8 of 21 Old 12-04-2010, 10:08 PM
 
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Also, just to note, home birth midwives take an incredible risk every time they attend a birth- mostly because if anything happens they are directly liable in a way that Doctors who are protected by hospitals are not. Sometimes things go wrong in birth- and in the hospital they will say 'they did everything they could do'(even if they didn't or if they caused the problem in the first place), in a home birth the midwife is blamed regardless of if she did everything 'right'. Mothers who have children die or have birth injuries are looking for answers through their grief and its easy to blame the midwife. Of course it could have been her fault, but at the end of the day if 99% of her history is glowing and wonderful, that's a pretty great track record. From what it sounds like she is a skilled and great practitioner and may not feel comfortable discussing the case for a myriad of reasons (mentioned above) or for fear of being criminalized further. It's a witch hunt out there from the medical community and home birth midwives are in a precarious position.

I think the bottom line for ALL homebirthing women is to ask yourself: Am I willing to accept the fact that sometimes (rarely) things go wrong in birth and if I am at home will I be comfortable with that choice no matter what?

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#9 of 21 Old 12-05-2010, 01:40 PM
 
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Hmmm...that is difficult.  I think what I glean from your post is not that you're concerned that she had a birth with an unfavorable outcome, but rather that she seemed evasive and not forthcoming.  (Therefore, affecting your emotional connection with her....which is important during labor and birth.)  Even if she were in litigation, I would think she can still address your question with a statement as such.  And I can see how her response about fetal and/or maternal deaths, "None that I can remember" would be off putting.  That wouldn't sit well with me either.  I don't know.  Maybe when she spoke with you she was having an unbalanced day and wasn't representing herself accurately.  I think I would have another talk (not email) with her about it and express those concerns specifically.  All you can do is express yourself and allow her to do the same; try to connect with her about what you're feeling and go from there.


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#10 of 21 Old 12-05-2010, 01:57 PM
 
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Please also keep in mind that she is not at liberty to discuss the care of another client. So, even if you read about a poor outcome here and then brought it up with her to get her side of it, she can't really give you her side of it.


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#11 of 21 Old 12-05-2010, 02:06 PM
 
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Quote:
Originally Posted by cambridgebaby View Post

I think I know who are referring to, and while I didn't choose her for my homebirth midwife, I've heard good things.  In her defense, I think it's fair to say that any midwife with 1500+ births is likely to have an occasional unfavorable outcome, simply statistically speaking, so while I think it would be good to seek more clarification/comfort, her experience speaks for itself.



Yep, this! 



Quote:
Originally Posted by Zangua View Post

Also, just to note, home birth midwives take an incredible risk every time they attend a birth- mostly because if anything happens they are directly liable in a way that Doctors who are protected by hospitals are not. Sometimes things go wrong in birth- and in the hospital they will say 'they did everything they could do'(even if they didn't or if they caused the problem in the first place), in a home birth the midwife is blamed regardless of if she did everything 'right'. Mothers who have children die or have birth injuries are looking for answers through their grief and its easy to blame the midwife. Of course it could have been her fault, but at the end of the day if 99% of her history is glowing and wonderful, that's a pretty great track record. From what it sounds like she is a skilled and great practitioner and may not feel comfortable discussing the case for a myriad of reasons (mentioned above) or for fear of being criminalized further. It's a witch hunt out there from the medical community and home birth midwives are in a precarious position.

I think the bottom line for ALL homebirthing women is to ask yourself: Am I willing to accept the fact that sometimes (rarely) things go wrong in birth and if I am at home will I be comfortable with that choice no matter what?



Yes, any birth, home or hospital, things can go wrong.  Most of the time they don't, but they can.  Birthing babies is risky business for all. 

 



Quote:
Originally Posted by MidwifeErika View Post

Please also keep in mind that she is not at liberty to discuss the care of another client. So, even if you read about a poor outcome here and then brought it up with her to get her side of it, she can't really give you her side of it.


Yes, HIPPA laws may prevent her from even saying that she cared for that person.  I know an ex-midwife, and she still talks about the stress of holding life and death in her hands.  She had no unfavorable outcomes, and yet she still questions some of her decisions.  Just as doctor's get tired and are human, so are midwives.  Sometimes things happen that no one had control of, and HIPPA prevents her from discussing it with you.  It's hard for you to know the whole history (you've probably only heard the side of the OP, the midwife might have a different tale to tell could she tell it).  She may not consider any of her choices wrong, and therefore she didn't lie to you.  I'm sure she considers what happened to the child heartbreaking.
 


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#12 of 21 Old 12-06-2010, 12:07 PM
 
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"Not that I can remember" as a response for if she has had any fetal/maternal deaths?  Honestly I would rather have a hospital birth if my only hb midwife choice was that one.  That's a HUGE red flag for me.  Because she is lying, of course she knows how many fetal deaths she's had, because it's probably only a few.  If she really was doing it for confidentiality, she should have said, I'm not at liberty to discuss specific cases, but I've had X number of deaths, and I can talk to you about the usual causes of fetal death" or something like that.  My midwife told me exactly how many deaths, and the cause of each, I would except nothing less.  The first one I interviewed also told me the exact number and cause.  So I'm not sure I'm getting the confidentiality thing, they didn't give any names or details other than that.  Ina May has it published all of her statistics, down to the details of each fetal death.  I would never trust someone who was so vague, personally. 


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#13 of 21 Old 12-06-2010, 12:11 PM
 
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I also wanted to add that are you sure there are no other midwives who would travel to you?  I'm in RI and I'm using a CPM from MA, and I know there are so many other midwives I could have chosen from.  PM me if you want details about who I'm using. 


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#14 of 21 Old 12-06-2010, 12:41 PM
 
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Quote:
Originally Posted by Zangua View Post

Also, just to note, home birth midwives take an incredible risk every time they attend a birth- mostly because if anything happens they are directly liable in a way that Doctors who are protected by hospitals are not. Sometimes things go wrong in birth- and in the hospital they will say 'they did everything they could do'(even if they didn't or if they caused the problem in the first place), in a home birth the midwife is blamed regardless of if she did everything 'right'. Mothers who have children die or have birth injuries are looking for answers through their grief and its easy to blame the midwife. Of course it could have been her fault, but at the end of the day if 99% of her history is glowing and wonderful, that's a pretty great track record. From what it sounds like she is a skilled and great practitioner and may not feel comfortable discussing the case for a myriad of reasons (mentioned above) or for fear of being criminalized further. It's a witch hunt out there from the medical community and home birth midwives are in a precarious position.

I think the bottom line for ALL homebirthing women is to ask yourself: Am I willing to accept the fact that sometimes (rarely) things go wrong in birth and if I am at home will I be comfortable with that choice no matter what?


ITA with that whole post.


The other thing is that since you sent her a link to discussion of it on MDC, that might make it even more difficult for her to discuss. After all, how can she tell you about "a case of fetal morbidity" WITHOUT revealing private health info (which is a HIPPA violation) since you actually brought up a specific case with her? I feel like I'm not articulating that correctly - but I guess I'm saying, perhaps it's not possible for her to discuss the case with you WITHOUT violating client privacy since you brought up the specific case.

 

I think the fact that you've heard tons of glowing reviews speaks volumes. If she truly were reckless, not trustworthy, etc. word would get out. Natural birth communities, even in big cities, aren't a large group.

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#15 of 21 Old 12-07-2010, 05:12 AM
 
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I have not responded to this thread til now, because of thinking over the very same issues lately...from the point of view of a midwife who is also a member of a midwifery community.  And the confidentiality issue is so important, and can be tricky to navigate.

 

Still, "not that I can remember" is a very strange response to your important question!  Lame, very lame...and just strange.

 

Yes, we can expect that any experienced mw will have seen some transfers of care and some difficult births--perhaps a stillbirth even (of the sort occurring without reason or 'fault').  We can expect that midwives will sit in peer review, as a subject of review and as a reviewer of births with other midwives.  And we can expect realistically that it will not be easy for a midwife to discuss difficult experiences and so forth--partly for reasons of confindentiality, and partly for emotional, personal reasons.  There is no doubt that these things can be tricky for a midwife to navigate!

 

And yet.  If a mw has seen 1500 births, then it is safe to assume that she HAS, indeed, seen some difficult/complicated births.  Birth is still a mystery, and she is merely human dealing in an imperfect world, no matter how skilled she is.  It is safe to assume that from time to time she has exercised less sound judgement than she does, most of the time--whether that resolved well for mom/baby or not.  I would almost expect, just from odds of such things as the occurence of placental abruption or completely unexplained stillbirth, for instance-- that there may have been a birth where the root cause of issues/damage cannot clearly be determined.  It is also safe to assume that she will have been blamed entirely for some things that were either clearly beyond her control, or was cleared entirely of responsibility even if that was not so clear (because birth is still a mystery!).  If she is saying 'not that I remember', then she is just dodging--she may good have reasons for this (confidentiality or litigation) but she is still dodging and this is not ok.  Mws must be honest with their clients, it is important to find some way to give an honest accounting while still respecting confidentiality and the rules of litigation.

 

Midwives carry a heavy load, especially in today's world where people expect miracles from care-providers and everyone is quick to blame someone for anything (parents may not blame a mw, but a doctor might--or another mw, even).  It is indeed very hard to speak of difficult births and what can follow.  Yet in the interests of their own honesty and integrity, mws need to figure out how to speak of the difficult situations.  Also, I believe that mws must learn how to speak of these things partly so new clients know the whole truth about a mw, but also to show hb families that birth is still a mystery that we do not control.  It can be done, without blowing confidentiality.

 

Here is a link to a post I made yesterday.  Our community has not learned how to deal with important ethical matters as you name, and in the case of at least 2 mws here it has meant needless tragedy for some families and a general atmosphere of dodging by families and midwives both. 

 

http://www.mothering.com/community/forum/thread/1283794/homebirth-safety-under-threat-in-mo-and-womynwise-office-closing

 

Bottom line for me, is this: if a mw so experienced is not able to tell you about some hairy-scary births, but acts like such things never happened for her, then she is not being honest.  If a less-experienced mw (having primary'd for less than 200 births, say) says she hasn't seen anything really bad at birth, you could perhaps believe it but then you know that she's never been really tested as a mw.

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#16 of 21 Old 12-08-2010, 07:10 AM - Thread Starter
 
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Ladies thank you so much for your replies. 

 

I am having tea with her tomorrow and pretty much going to ask the same questions over again in a different way, and let her guide the conversation, without me asking "are you not at liberty to talk about this because of HIPPA or litigation?"  I'll let her dig herself out of the Focker broken circle of trust hole or dig herself further in.  When I asked the first time about fetal deaths, she did say she has had clients with micropremie deliveries that did not survive (she didn't attend), and a mom who lost her baby in utero at 38 weeks.  So she did share some, but none that she was present for.  She is super busy, her house was buzzing, she's a little all over the place multitasking, you know, getting me food, asking her assistant for stuff, a client calling who is 40 weeks, so she may have just been frazzled, I just really didn't like the way she looked off and not in my eye.  I am totally comfortable with her having had some unfortunate outcomes, its the unwillingness to be forthcoming or honest about them that gets me, and to me, is yes, vital for the trust I will place in her on delivery day.  I'll let you all know how tomorrow goes.  When I emailed her to make the appt to see her, she was so sweet and caring and that definitely made me feel better. 


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#17 of 21 Old 12-08-2010, 09:58 AM
 
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Can I also add that CP is VERY rarely due to actions during L&D? Of course I can't speak to this case bc I don't know the details, but just as an FYI: CP in an infant must meet 4 very stringent criteria in order to be diagnosed as being directly caused by actions during labor and delivery.  We learned ALLLLLLLL about it very recently in my CNM coursework. Unless a court has found her guilty of negligence and/or malpractice in this case and has ruled based on expert testimony that this CP was caused by her actions during labor, I would not be sure that the CP was "her fault". CP is caused, almost every single time, by hypoxia during pregnancy or sometime during the antepartum periods.

 

Also, it is definitely true that statistically having attended that many births there are GOING to be some deaths and complications. That is birth EVERYWHERE, not just at home. Deaths occur in hospitals, too. 

 

But the most important thing is that YOU are comfortable with your midwife and trust her, so again, go with your gut. And interview several midwives. Go with the one you feel most comfortable with.

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#18 of 21 Old 12-09-2010, 07:00 PM - Thread Starter
 
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thank you again girls for your help, you really did help me sort through my feelings, the CP story, and what to do.  I met with her today and fell in love again, after hearing much better and calmer answers to my hardest questions.  So I have a MW and I am going to homebirth......EEEeeeeeeks!


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#19 of 21 Old 12-10-2010, 05:09 AM
 
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That is just awesome, mama!  I'm so glad you kept your head and followed through in a way that provided you the peace with this decision that is so important.  And I'm so glad to hear that she came through for you.

 

have a wonderful pregnancy and birth thumb.gif

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#20 of 21 Old 12-10-2010, 05:21 AM
 
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Also, How many OBs would say, "Oh yes, I just delivered a stillborn baby/one with severe birth trauma/whatever just last week. Wanna here all about it??"

 

MW1's stats seem really good if there is only one or 2 bad outcomes out of thousands.


Mindie, wife to Mark, not-so-crunchy mom to Dylan (4/04); Devon (6/06); Dorothy (9/07); Derek (12/19/09); Daniel (12/18/10); Newbie D (2/22/12)

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#21 of 21 Old 12-10-2010, 01:05 PM
 
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wohooooooo you go girl! home birth rocks!! wishing you an amazing experience. you deserve it!

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