can we have an honest discussion? - Page 3 - Mothering Forums
Forum Jump: 
Reply
 
Thread Tools
#61 of 301 Old 02-22-2011, 02:09 PM
 
IdentityCrisisMama's Avatar
 
Join Date: May 2003
Posts: 10,637
Mentioned: 5 Post(s)
Tagged: 0 Thread(s)
Quoted: 90 Post(s)


Quote:

Originally Posted by labortrials View Post

 I think this entire "honest discussion" requires that everyone assume that we all empathize with Liz and wish that hadn't happened to her.  When it happens to you, it's 100%.  I get that.

 



I do agree and, while I do really appreciate all of the ideas and perspectives on this thread, the fact that this discussion is framed around the death of a child makes the whole conversation challenging.  There is no fault here - it just is the way it is.  


Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
IdentityCrisisMama is offline  
#62 of 301 Old 02-22-2011, 02:16 PM
 
Tumble Bumbles's Avatar
 
Join Date: Oct 2009
Posts: 727
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)



I agree. I've wanted to participate in this thread but given the extremely sensitive nature of it and the OP's very personal, extremely painful experience of which none of us can truly empathize with (only sympathize) unless we've been there -- I don't know as a truly honest discussion can happen. I will say I personally don't believe "home birth" had anything to do with what happened to the OP. I've read the heartbreaking story more than once and I believe based on the only knowledge I have, that it was due to a midwife's gross negligence and refusal to honor a mother's wishes coupled with very real and phyical signs of distress/tranfer-worthy issues (imo) that were present long before anything was done about it [by the midwife]. It's a tragedy yes, but unfortunately negligence and refusal to honor very real signs and the wishes of the laboring mother are in no way exclusive to home birthing and happen in hospitals all the time, with CNM, OBs, and every other manner of health-care provider, insured or not, with all manner of training, resulting in tragedies and losses as well.

 

 

Quote:
Originally Posted by labortrials View Post

Well, if some of you want to treat what I wrote in that manner, go for it.  I thought we were having an "honest discussion."  I apologize if I didn't approach this with a high enough level of empathy.  I think anyone who reads my posts or knows anything about my history would give me the benefit of the doubt.  In fact, I think this entire "honest discussion" requires that everyone assume that we all empathize with Liz and wish that hadn't happened to her.  When it happens to you, it's 100%.  I get that.

 

It's real easy to just JUMP and attack.  Please breathe first.  Thank you.



ElizabethE likes this.

Christ-centered loving wife & mama to 2 miracles! One & one . We live simply and mindfully. Expecting another blessing Feb 2015
Tumble Bumbles is offline  
#63 of 301 Old 02-22-2011, 02:40 PM
 
carriebft's Avatar
 
Join Date: Mar 2007
Posts: 6,947
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Well I think the question becomes, are there complications that occur at home with a CPM present and these complications are not recognized or treated correctly more often than happens in the hospital? Are CNMs more likely to recognize and correctly treat complications? what does the data we have tell us?

 

So, we are starting to see data that hypoxia is more common at home (study out of australia was recently released on this); and that certain kinds of midwives have higher rates than others (i blieve the cdc system shows this- i saw it broken down somewhere, will look it up). If this complication is more common at home and more common with lesser trained midwives, then we should be able to honestly talk about what that data means, kwim? and what can be done to change the situation.

 

Saying it happens at the hospital, too, doesn't do the situation justice. it's just denial I think.

liz-hippymom likes this.

"Parents are simply trustees; they do not own the bodies of their children"-Norm Cohen  Martial arts instructor intactlact.gifhomebirth.jpgnak.gif and mom to 4: DD1 (1/05) DS (7/06) DD2 (5/08) DD3 (2/11)
carriebft is offline  
#64 of 301 Old 02-22-2011, 04:42 PM
 
lizziebits's Avatar
 
Join Date: Sep 2007
Posts: 547
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


 

Quote:
Originally Posted by carriebft View Post

Well I think the question becomes, are there complications that occur at home with a CPM present and these complications are not recognized or treated correctly more often than happens in the hospital? Are CNMs more likely to recognize and correctly treat complications? what does the data we have tell us?

 

So, we are starting to see data that hypoxia is more common at home (study out of australia was recently released on this); and that certain kinds of midwives have higher rates than others (i blieve the cdc system shows this- i saw it broken down somewhere, will look it up). If this complication is more common at home and more common with lesser trained midwives, then we should be able to honestly talk about what that data means, kwim? and what can be done to change the situation.

 

Saying it happens at the hospital, too, doesn't do the situation justice. it's just denial I think.



Yes to all of this.

 

I have no doubt that gross negligence caused a baby to die in this particular scenario.  The question is this: is there a way to make that gross negligence less likely to happen.

 

I also hear a lot of "well, nothing is going to work."

 

We can't expect midwives to have malpractice insurance.

We can't expect all midwives to certified and/or licensed.

We can't expect there to be a standardized level of education for midwives.

We can't have OB back up.

 

It's also frustrating that their really are not a lot of hard numbers to compare home and hospital birth, or homebirth with different types of midwives.

liz-hippymom likes this.

Mommy to two super cute kids.
lizziebits is offline  
#65 of 301 Old 02-22-2011, 05:25 PM
 
Turquesa's Avatar
 
Join Date: May 2007
Posts: 4,050
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 29 Post(s)

 

Quote:
Originally Posted by MegBoz View Post


In other words, I think the attitude towards HB is more a symptom of the prevailing views of American obstetrics. The views need to change first, before HB MWs could be successfully integrated.


I remember reading in Born in the USA about the author's daughter giving birth in Copenhagen, Denmark.  The MW detected fetal distress and consulted with an OB.  They OB was able to give feedback on what to do, and the MW was able to finish attending the birth...safely and vaginally.  Obviously, the doctor was also ready and waiting in the event of an emergency.  Would that we see such collaboration in the US of A!   

Alenushka and ElizabethE like this.

In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
Turquesa is offline  
#66 of 301 Old 02-22-2011, 08:02 PM
 
aphel's Avatar
 
Join Date: Sep 2010
Location: Chicago
Posts: 354
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

How can we expect to have smooth transfers in which Mom is treated respectfully and her wishes honored without having back up OBs? It seems to me that having a prior relationship with an MD at your local hospital would certainly help in facilitating emergency care should it become necessary. Not requiring a midwife to have a back up physician is almost like saying that you are assuming that you won't need one. Or at the very least, that you don't care who is in charge of your birth if you end up needing hospital care. And no matter how fantastic your midwife is, or how 'low risk' you are, you might find yourself needing medical care. I see one side saying that midwives must be integrated into the system for successful care, but then another saying that midwives shouldn't be 'medicalized' and don't need to have working, professional relationships with back up physicians.

 

And as far as the issue of competent care providers, I really don't think that it's fair to leave everything up to Mom. There should be standards when it comes to care providers who deal in life and death situations. A mom should know that a professional midwife has a certain level of education before she decides on a care provider based on personal fit. In the case of CPMs specifically, there is such a wide breadth of experience from one individual to the next.

 

Silverlace - Thanks for sharing your story. I think the path you have taken is quite interesting. And for the record, I feel that CPMs with degrees in midwifery may well be more competent and educated than many other midwives. I really wish all midwives had that formal education, but from what I understand, the PEP review process is much different and not as standardized, leaving room for some (though not all) midwives to have somewhat less experience than others. When the vast majority of one's education comes only from self-learning and training under a preceptor, who truthfully may or may not be truly good at what they do, there is certainly the risk that someone educated in this way may have areas in which their training is lacking. It was also interesting to know that in your experience, graduating CNMs may have attended fewer births than some newly licensed CPMs, although I don't think that attending births is the only important factor in a midwife's training.

 

I, for one, am enjoying this conversation ladies. Thanks to Liz for continuing to use her experience to help us all.


L, student nurse and married to A, my union man. Happy parents to little S!   joy.gif

aphel is offline  
#67 of 301 Old 02-23-2011, 06:32 AM
 
Tumble Bumbles's Avatar
 
Join Date: Oct 2009
Posts: 727
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I don't think saying that tragedies happen in all situations and with all manner of health care providers is 'denial'. It's the truth and to deny that and to suggest mamas and babies are at risk only in home births and if we tightened restrictions, everything would be 'safer' is a bit short-sighted. Educating someone or putting further restrictions on someone clearly doesn't prevent negligence. I'm a stay-at-home mom with only self-learned birthing 'education' and even I saw all the glaring signs a transfer was indicated in the OP's story -- not to mention the fact that the mother wanted to transfer. The very nature of 'negligence' is irrespective of how educated someone is or what title they have. If the question is, 'does having extra education, a back-up OB, more restrictions, and mandatory malpractice insurance prevent negligence'? I would say no, it won't. It may prevent someone of limited experience making an honest mistake, or it may help a mama get transfer care earlier which may lead to better outcomes, but the other consequences of further restrictions are more and more women and midwives feeling trapped and bound by the system and seeking out alternatives that fit their needs -- underground midwives and unassisted birthing situations when they may not be good candidates. We are choosing unassisted birthing for that very reason (although I am a 'good' candidate). I wouldn't hesitate to transfer at any sign of trouble or even on a gut instinct even if everything 'appeared' fine.

 

Quote:

 How can we expect to have smooth transfers in which Mom is treated respectfully and her wishes honored without having back up OBs?

 

We can educate ourselves on our legal rights and use them. In my state, the Patient's Rights is very clear on unlawful treatment of patients and patients are to be treated with dignity at all times. Yes, a back-up OB may help things go more smoothly, but no one need a back-up OB to exercise their legal right of consent/refusal or their legal right to be treated with dignity.

Quote:

 And as far as the issue of competent care providers, I really don't think that it's fair to leave everything up to Mom. There should be standards when it comes to care providers who deal in life and death situations. A mom should know that a professional midwife has a certain level of education before she decides on a care provider based on personal fit. 

 

I agree that a mom should be able to verify a midwife's education before she decides on care and standards when it comes to who can legally practice midwifery,  but I do think it's fair to place the responsibility of a woman's health care choices on the woman making the choices. If we as women want to be treated as competent, educated, sensible people with all the rights and choices that accompany that -- I do think we should be responsible for informing and educating ourselves in the best way possible. I see many women who blindly trust their midwives simply because they share similar philosophies and have a spiritual ~~connection~~. This is dangerous, imo.

 

I'm a respecter of choices and anything that restricts a woman's choice to birth where, how and with whom she pleases is not something I'm likely to support. A myriad of 'sins' have been covered with the health care industry deciding what is 'best' to 'make us safer'. A woman has to be her own advocate and she has to educate herself on all the risks/benefits of what she's decided.  Now some would say, the OP was educated and did all the 'right' things and look what happened. Yes, that's why 'negligence' is a whole different ballgame and I don't believe stricter standards on education or otherwise prevents it. That's why I don't know how useful it is to use her tragedy as a springboard to this discussion.


Christ-centered loving wife & mama to 2 miracles! One & one . We live simply and mindfully. Expecting another blessing Feb 2015
Tumble Bumbles is offline  
#68 of 301 Old 02-23-2011, 06:56 AM - Thread Starter
 
liz-hippymom's Avatar
 
Join Date: Jul 2003
Location: deep in the heart of texas!
Posts: 1,262
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)

"That's why I don't know how useful it is to use her tragedy as a springboard to this discussion."

 

are you saying you don't like that i brought this up? i can't think of a more apt springboard myself. many people on here seem to be enjoying this open discussion. i think it is as honest as it can be, sorry that you don't agree.

 

and to this

"If the question is, 'does having extra education, a back-up OB, more restrictions, and mandatory malpractice insurance prevent negligence'? I would say no, it won't."

 

no malpractice insurance may not prevent, but it certainly helps with costs associated with a providers negligence. ( why i brought up my two friends with brain damaged infants)


mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
liz-hippymom is offline  
#69 of 301 Old 02-23-2011, 09:21 AM
 
lizziebits's Avatar
 
Join Date: Sep 2007
Posts: 547
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


 

Quote:
Originally Posted by Tumble Bumbles View Post

I don't think saying that tragedies happen in all situations and with all manner of health care providers is 'denial'. It's the truth and to deny that and to suggest mamas and babies are at risk only in home births and if we tightened restrictions, everything would be 'safer' is a bit short-sighted. Educating someone or putting further restrictions on someone clearly doesn't prevent negligence. I'm a stay-at-home mom with only self-learned birthing 'education' and even I saw all the glaring signs a transfer was indicated in the OP's story -- not to mention the fact that the mother wanted to transfer. The very nature of 'negligence' is irrespective of how educated someone is or what title they have. If the question is, 'does having extra education, a back-up OB, more restrictions, and mandatory malpractice insurance prevent negligence'? I would say no, it won't. It may prevent someone of limited experience making an honest mistake, or it may help a mama get transfer care earlier which may lead to better outcomes, but the other consequences of further restrictions are more and more women and midwives feeling trapped and bound by the system and seeking out alternatives that fit their needs -- underground midwives and unassisted birthing situations when they may not be good candidates. We are choosing unassisted birthing for that very reason (although I am a 'good' candidate). I wouldn't hesitate to transfer at any sign of trouble or even on a gut instinct even if everything 'appeared' fine.

 

 

But why not? If negligence is, as I understand it, failure to do what another person (in this case, midwife) would reasonably do in the same situation, then I think all of those things could have potentially have changed the outcome in the birth we're discussing.

 

If the midwife was not as educated about birth as she is reasonable expect to be as a midwife, more education could have prevented the negligence. Certification/licensing would insure that her education was up to standards.

 

If the midwife was nervous about transferring because of how she might be received, then a pre-existing relationship with an OB would remove that fear, and prevent the negligence.


And no, malpractice insurance would not prevent negligence. But it would offer, as Liz has repeatedly pointed out, some financial assistance for the family who has lost a baby or who has to car for a baby whose injuries were caused by negligence.

liz-hippymom likes this.

Mommy to two super cute kids.
lizziebits is offline  
#70 of 301 Old 02-23-2011, 10:30 AM
 
MegBoz's Avatar
 
Join Date: Jul 2008
Location: Baltimore, MD
Posts: 2,125
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

 

Quote:
Originally Posted by IdentityCrisisMama View Post

 the fact that this discussion is framed around the death of a child makes the whole conversation challenging.  


Oh, I personally wasn't considering that the basis of the discussion at all. The original post stated, "Can we have an honest discussion about how to #1 make sure the providers we choose are competent , and #2 how to improve flaws that are *currently* in the US homebirth system.."

I wasn't putting it into the context of any one individual outcome - but rather discussing the US HB system in aggregate.

 

Quote:

Originally Posted by aphel View Post

How can we expect to have smooth transfers in which Mom is treated respectfully and her wishes honored without having back up OBs? It seems to me that having a prior relationship with an MD at your local hospital would certainly help in facilitating emergency care should it become necessary. Not requiring a midwife to have a back up physician is almost like saying that you are assuming that you won't need one.


I disagree with that last sentence. As I've said, where I live, there are 8 hospitals with L&D in only 40 min drive! Certainly it's reasonable for a HB MW to take on clients within such a radius, if not even larger. It's totally unreasonable for me to expect her to have relationships with OBs with priviledges at every single one of those hospitals. Not only that, but if you have to transfer in labor, most OBs don't come in when called - they come in when it's their 'shift' - so you get whoever is on shift at the time anyway, so having a relationship with an OB doesn't even mean you'll get to see that very same OB in case of transfer.

 

I personally have taken it upon myself to establish & maintain a relationship with the CNMs at my transfer-hospital (although my CPM does have a good relationship with 2 CNMs in the practice & I think even one of the 6 or so OBs.) My MW has also encouraged me to maintain this relationship. Although it's somewhat clandestine - they don't write it in my folder officially that I'm planning an HB because some of the OBs in the practice might give them a hard time about it. So as far as those OBs know, if I'm at the hospital in labor, that was the plan all along.

 

Again, I don't think it's bad to have MWs integrated into the medical care system. Clearly that's the ideal & it contributes to safety. It's a model that works wonderfully in Europe. BUT-- I think it's a bad idea to integrate MWs into the current broken US system.

 

It already has happened - MWs and FSBC closing up because of lack of OB backup. There's no way you can deny the fact that requiring "official" OB backup would drive some MWs out of business AND would restrict the practice of those remaining (i.e. no VBAC, no breech, no twins at home, etc.) & currently, HB is often the ONLY option in many areas for women to attempt vaginal breech, VBAC, or VBAMC.

 

So those of you advocating OB backup - do you think a "relationship" is sufficient, or there should be some sort of formal practice agreement? As I said, my CPM has a decent personal relationship with 2 CNMs at my transfer hospital, and I think one OB. But it's not "official." I believe I've read that for an OB to act as official HB MW backup actually impacts his malpractice insurance! And, again, considering many OBs won't do VBAC because of the insurance costs, I can't imagine many OBs would be willing to officially backup a HB MW who does HBAC.

MegBoz is offline  
#71 of 301 Old 02-23-2011, 11:06 AM
 
mylilmonkeys's Avatar
 
Join Date: Oct 2010
Posts: 932
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I was going to make a similar point to MegBoz's last paragraph.  There is a vast difference between a "back-up OB" and having an open working, collaborative relationship with mainstream providers, whether they are CNMs, FPs who do OB, or OBs.  I honestly don't think it is too much to ask for a midwife to investigate area hospitals and try to form relationships within the many communities she works.  The midwife I use and have worked with had at least 4-5 colaboratory relationships covering the communities I assisted her with, which was only the northern half of her range, when I worked with her.  There doesn't need to be a regulation to force midwives to do so, they should do so out of need to provide their clients with the best possible care throughout pregnancy and in case of transport.  Say a mama has a UTI requiring antibiotics in pregnancy?  Where is a CPM going to get the prescription?  If you have a collaboratory physician, it only takes a phone call, rather than expecting the mom to see another provider for another culture and then get the meds she need, hopefully before the infection spreads to the kidneys or cause preterm labor.  If a transport is needed, the contact can be called and see if they will come in. 

 

In many states that have required an official back-up arrangement, they require a physician who has reviewed the midwife's protocols, and are willing to be legally tied to her.  They can make demands of the midwife which counter the Midwife's Model of care, because their necks are on the line for her, too.  The choices for families are significantly restricted because of this.  

 

For midwives who participate in their state midwifery organizations, there can be a lot of power within the org to establish appropriate and wise standards among the midwives of the community.  There should be an agenda item in every state to discuss creating collaboratory arrangements, figure out how the midwives who have successfully made such arrangements have done it, share resources for midwives whose communities overlap, etc.  If you are in the process of choosing a midwife, I would place priority on finding out if your midwife actively participates in the org or if she is isolationist.  That answer there can tell you a lot about her priorities.


Mom to eight!!  Our twin girls arrived 3-3-2011.

mylilmonkeys is offline  
#72 of 301 Old 02-23-2011, 12:37 PM
 
IdentityCrisisMama's Avatar
 
Join Date: May 2003
Posts: 10,637
Mentioned: 5 Post(s)
Tagged: 0 Thread(s)
Quoted: 90 Post(s)

This discussion has me curious to read more about laws in different states.  I went to the Mana site - are there other good sites to look this stuff up?  I wanted to read about the Florida system but a Google search mainly brings up Liz's blog and this thread.  Any good links for the Florida laws/regulations?  What about California and Maryland?  


Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
IdentityCrisisMama is offline  
#73 of 301 Old 02-23-2011, 01:38 PM
 
AustinMom's Avatar
 
Join Date: Jul 2008
Posts: 896
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

"...#2 how to improve flaws that are *currently* in the US homebirth system."

 

I would say to ensure that if a transport is needed to transport, and this comes from the MWs of course, and they need to not 'fear' how they will be treated, (which I honestly don't think happens if a true transport is needed where I am at) have a good relationship (not necessarily official 'back up') with OBs in area, and if the mom is in the position of refusing to transfer she needs to call 911 and say, 'we are going'.  I don't think it's okay to let a baby die or a mama suffer. 

 

I think requiring that a MW ALWAYS bring a back up.  Not just a Doula, but a licensed back up.  Some other professional that she can bounce ideas off of, and who can recognize dangers if the primary MW doesn't.  Obviously if the back up MW doesn't get there in time, this is different, or if you only have 1 MW to choose from, know that you are taking a risk in only having one MW there, and decide for you if that is safer and if you are willing to take that risk as opposed to hospital birthing.

 

As a system, I don't think CPM and CNM are solely what we should judge MWs on.  I think it is too general, and a it's a mamas responsibility to choose a MW based on her credentials, not limiting it to only those two. 

 

I don't think there is much *we* as mamas can do.  I think the majority of how to improve the overall birth system in the US needs to come from OBs and hospitals right now.  I think this will have a nice effect on the HB system and strengthening the relationship between OOH birth and in hospital birth. 

AustinMom is offline  
#74 of 301 Old 02-23-2011, 01:47 PM - Thread Starter
 
liz-hippymom's Avatar
 
Join Date: Jul 2003
Location: deep in the heart of texas!
Posts: 1,262
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B24-7

floridas midwifery rules/regulations


 

Quote:
Originally Posted by IdentityCrisisMama View Post

This discussion has me curious to read more about laws in different states.  I went to the Mana site - are there other good sites to look this stuff up?  I wanted to read about the Florida system but a Google search mainly brings up Liz's blog and this thread.  Any good links for the Florida laws/regulations?  What about California and Maryland?  

from here http://sweetchildbirth.com/site/services/
 

"Florida law mandates that Medicaid and Insurance cover the services of Licensed Midwives.'


mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
liz-hippymom is offline  
#75 of 301 Old 02-23-2011, 01:50 PM - Thread Starter
 
liz-hippymom's Avatar
 
Join Date: Jul 2003
Location: deep in the heart of texas!
Posts: 1,262
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)


Quote:
Originally Posted by AustinMom View Post

".

 

I don't think there is much *we* as mamas can do.  I think the majority of how to improve the overall birth system in the US needs to come from OBs and hospitals right now.  I think this will have a nice effect on the HB system and strengthening the relationship between OOH birth and in hospital birth. 



yeah.um, if "we' wait on OBs to change homebirth we will grow old and die before anything happens except outlawing of midwifery.

it is most certainly up to midwifery consumers to change things.

"Never underestimate the power of a small group of people to change the world.  In fact, it is the only way it ever has."  Margaret Mead


mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
liz-hippymom is offline  
#76 of 301 Old 02-23-2011, 02:51 PM
 
aphel's Avatar
 
Join Date: Sep 2010
Location: Chicago
Posts: 354
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I think my point got a little lost, which is probably my own fault for not expressing it too well. What I was trying to say, regarding OB backup, is that not having a backup physician leaves the mother very vulnerable to ending up with a physician who does not share her beliefs and views regarding birth and postpartum care. And TumbleBumbles, you are very right about patients having the right to be treated with respect, and they absolutely have the right to a say in their care, and they deserve thoughtful and compassionate care from any and all providers, whether it be someone they chose or not. But when you are dealing with pregnancy and birth, there are so many different views and practices, even among OBs. It just seems to me that having a low-intervention, natural childbirth and breastfeeding friendly physician to turn to in case urgent care is needed would better guarantee a safe and satisfactory experience for the mom and her family (and the midwife!).

 

And yes, I do think that a physician should be an official "back up", and that that physician (or a previously chosen/ agreed upon alternative) should be on call for emergencies. The fact that many physicians feel unable to do this due to legal culpability/insurance concerns is understandable and unfortunate, and something that should indeed be addressed. In a perfect world, physicians would be rewarded, not punished, for providing fall back care for midwives and the women they serve.

 

I understand that midwives and FSBC are having to stop providing services due to lack of physician back up, but I'd like to think the answer would be to make that back up easier to get, less risky for doctors to provide, instead of just simply not requiring it.

 

AustinMom, I think a HB MW having a trained professional besides a doula as an assistant is also a fantastic way to help ensure better safety. I think it can be difficult for a single individual to have the burden of decision making (aside from Mom).


L, student nurse and married to A, my union man. Happy parents to little S!   joy.gif

aphel is offline  
#77 of 301 Old 02-23-2011, 03:53 PM
 
CBEmomma's Avatar
 
Join Date: Oct 2010
Location: MN/IA
Posts: 213
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by liz-hippymom View Post





yeah.um, if "we' wait on OBs to change homebirth we will grow old and die before anything happens except outlawing of midwifery.

it is most certainly up to midwifery consumers to change things.

"Never underestimate the power of a small group of people to change the world.  In fact, it is the only way it ever has."  Margaret Mead



I totally agree. I don't see OBs changing things anytime soon. It would be nice if they would just change their attitude (not all OBs have a bad attitude, so I'm only talking about the ones that do) and would provide back up care to Midwives. I know where I live they will do back up care, but for the mom not the MW. That's a start.


~Attatchment and Natural Parent from instincts not from books to my 2 boys~ Childbirth Educator & Placental Encapsulation Professional
homeschool.gif familybed2.gif homebirth.jpgribbonpb.gif
CBEmomma is offline  
#78 of 301 Old 02-23-2011, 04:53 PM
 
IdentityCrisisMama's Avatar
 
Join Date: May 2003
Posts: 10,637
Mentioned: 5 Post(s)
Tagged: 0 Thread(s)
Quoted: 90 Post(s)


Quote:
Originally Posted by liz-hippymom View Post

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B24-7

floridas midwifery rules/regulations


 

from here http://sweetchildbirth.com/site/services/
 

"Florida law mandates that Medicaid and Insurance cover the services of Licensed Midwives.'



Thanks, Liz.  I do better as a thinker if I just focus on one little issue and try to read up on that.  I got to thinking about insurance.  I remember a news story from a while back where the last free-standing birth center in Manhattan was essentially shut down because their malpractice insurance became unavailable.  

 

I did find this under the first link:

 

"64B24-7.013 Requirement for Insurance.

(1) Except as provided herein, applicants for licensure, applicants for licensure reactivation, and applicants for licensure renewal shall at the time of application submit proof of professional liability insurance coverage in an amount not less than $100,000 per claim, with a minimum annual aggregate of not less than $300,000 from an authorized insurer as defined under Section 624.09, F.S., from a surplus lines insurer as defined under Section 626.914, F.S., from a risk retention group as defined under Section 627.942, F.S., from the Joint Underwriting Association established under Section 627.351(4), F.S., or through a plan of self-insurance as provided in Section 627.357, F.S."  

 

It seems pretty clear that FL requires MW to carry liability insurance.  Do you (or anyone) know how the state regulates the availability of affordable insurance?  

 

 

A thought that comes up for me when it comes to back-up care from a specific OB is that in a larger city and in a true emergency transfer situation - you are going where the ambulance takes you...or at least that's how I understand how it will work in my city.  During my first birth (in a small town) a back-up in the local hospital would have been awesome!  I asked my MW here how *emergency* transfer works and she said we essentially call the ambulance and go where they choose.  How does everyone feel about that situation?   

 


Mama to DD September 2001 and DD April 2011 *Winner for most typos* eat.gif
IdentityCrisisMama is offline  
#79 of 301 Old 02-23-2011, 04:55 PM
 
mommato5's Avatar
 
Join Date: Feb 2007
Location: Ohio
Posts: 612
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

 

 

 

This, to me, sounds like one of those blaming things. Not cool. All mothers ask questions and interview their midwife before hiring. What can people do to make sure potential clients know about a midwife's history before making the mistake of hiring her?? Mine had multiple deaths under her belt and I didn't know. I had no clue. She never once said "Oh, BTW, I've went in front of the grand jury a few times for some infant deaths". I would of RANNNNNNNNNN!! Instead, I'm in the same club Liz is in and my baby is yet another baby lost due to her. You don't KNOW that they will do anything until something happens and they either drop the ball or save the day.

 

 

As far as the initial questions of this thread, how do we make sure our providers are competent?  It's up to the mom.  It's being a homebirth mom and well educated on birth (as most HB moms are) and really submitting to that trust in your CP.  So I think part is trusting your CP and submitting to that trust, which I'm sure some moms have a hard time with.  If their MW says, let's go to the hospital, you need to go.  (not saying this was your case, but I know it does happen).  Sometimes you have to get out of that warm tub for an exam.  Sometime you have to go walk around the neighborhood in the heat of transition because baby is high.  You have to trust them.  BUT, how do you know you SHOULD trust them is the real question.  They can have all the credentials in the world and still not be the best in that complication that the 1/2% of women run into.  I think it's about knowing that your CP WILL transfer if something comes up.  So maybe ask a scenario question: "How would you handle a labor who is GBS+ has a slight fever, but otherwise feeling fine, water has been broken 12 hours?"  "How would you handle a mama who has been in labor for 24+ hours and is getting exhausted?"
 
 

Mommy to ds12, dd11, ds8, ds6, dd4, ^dd^ HB Loss, and dd 1
mommato5 is offline  
#80 of 301 Old 02-23-2011, 05:01 PM
 
mommato5's Avatar
 
Join Date: Feb 2007
Location: Ohio
Posts: 612
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by carriebft View Post

Well I think the question becomes, are there complications that occur at home with a CPM present and these complications are not recognized or treated correctly more often than happens in the hospital? Are CNMs more likely to recognize and correctly treat complications? what does the data we have tell us?

 

So, we are starting to see data that hypoxia is more common at home (study out of australia was recently released on this); and that certain kinds of midwives have higher rates than others (i blieve the cdc system shows this- i saw it broken down somewhere, will look it up). If this complication is more common at home and more common with lesser trained midwives, then we should be able to honestly talk about what that data means, kwim? and what can be done to change the situation.

 

Saying it happens at the hospital, too, doesn't do the situation justice. it's just denial I think.



Yay, I figured out how to do this right, finally!

 

Carrie, If you go to CDC Wonder, click on linked birth/death records 2003-2005. Then control for birthplace, mothers aged 20 to 34, full term infants in singelton pregnancies, COD, and attendant.

CNM's do have better rates than anyone!


Mommy to ds12, dd11, ds8, ds6, dd4, ^dd^ HB Loss, and dd 1
mommato5 is offline  
#81 of 301 Old 02-23-2011, 06:36 PM
 
lunarlady's Avatar
 
Join Date: Jan 2010
Posts: 1,330
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think the biggest thing that would help improve midwifery practice is the oversight of an impartial board of professionals whose job it is to review all home births and watch for errors in judgement, mistakes that could end badly, and, of course, what went wrong when birth goes bad. Power to remove licensure, asses damages, and publish results would be included.

The problem with this in the US is that HB is attended by a few, passionate and deeply committed MW who are working under fear of legal prosecution in some states, or worry that the few protections they have under the law may be removed if outcomes are bad. It is easy to critique a stranger, harder by far to be honestly judgmental of a sister in arms who fights for HB at your side. So who sits on this board? And who pays?

CD'ing, homebirthing, milk making school teacher. Supporting my family on my income and trying to get out of debt in 2013!
lunarlady is offline  
#82 of 301 Old 02-24-2011, 05:45 AM
 
mommato5's Avatar
 
Join Date: Feb 2007
Location: Ohio
Posts: 612
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Unfortunately, in the US, the "boards" are nothing more than fellow midwives. I'm not sure how many have read transcripts or listened to audio on Liz's blog, but she was basically told babies die in the hospital too and the midwife slapped on the hand. For me, the "board members" gave us a hard time about trying to have a peer review. The midwife told me she volunteered for one, but I never heard about it. Obviously, mine caused several deaths (with police involvement) and then multiple stillbirths in the months leading up to my daughter's birth/death. If she was still practicing then, the board didn't care. They're all buddy/buddy and the most important thing is having midwives practicing, NOT the families affected when something goes wrong.

 

I say if you want boards, they should have actual professionals who are not friends with these midwives. It would make a HUGE difference in the way families are received and midwives are disciplined.


Mommy to ds12, dd11, ds8, ds6, dd4, ^dd^ HB Loss, and dd 1
mommato5 is offline  
#83 of 301 Old 02-24-2011, 07:42 AM
 
kythe's Avatar
 
Join Date: Dec 2007
Location: Tucson, AZ
Posts: 608
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I've really enjoyed this thread, I think it has been very informative.
Quote:
Originally Posted by mommato5 View Post

Unfortunately, in the US, the "boards" are nothing more than fellow midwives. I'm not sure how many have read transcripts or listened to audio on Liz's blog, but she was basically told babies die in the hospital too and the midwife slapped on the hand. For me, the "board members" gave us a hard time about trying to have a peer review. The midwife told me she volunteered for one, but I never heard about it. Obviously, mine caused several deaths (with police involvement) and then multiple stillbirths in the months leading up to my daughter's birth/death. If she was still practicing then, the board didn't care. They're all buddy/buddy and the most important thing is having midwives practicing, NOT the families affected when something goes wrong.

 

I say if you want boards, they should have actual professionals who are not friends with these midwives. It would make a HUGE difference in the way families are received and midwives are disciplined.


I wonder how much this attitude of protecting midwives at all costs has to do with how few midwives are practicing. Midwives are practically an endangered species. Many clients are also very defensive of all midwives, in the sense that we don't want to see one receiving negative attention when their absence represents fewer choices for us in birth. It becomes easier to turn a blind eye to problems rather than risk giving midwifery a bad name.

Compare this with nursing. When nurses hear "the state board", there is an immediate repect of their role in our licensure. If a nurse is investigated by the state board for an allegation of misconduct, that individual knows they must be as careful and thorough with their defense as possible because there is a very real possibility of having your license placed on probation, suspended, or revoked.

But this isn't just because of strict standards or neutral parties on the board. Nurses number in the hundreds of thousands per state. There will be no nursing shortage for putting one out of commission, we can be easily replaced. There is a midwife shortage already, and this encourages a certain protection of midwives even in situations where a different professional would be disciplined.
kythe is offline  
#84 of 301 Old 02-24-2011, 09:17 AM
 
aphel's Avatar
 
Join Date: Sep 2010
Location: Chicago
Posts: 354
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I fear sometimes that people feel like criticizing a midwife is tantamount to criticizing the practice of midwifery in general.
 

Quote:
Originally Posted by kythe View Post


I wonder how much this attitude of protecting midwives at all costs has to do with how few midwives are practicing. Midwives are practically an endangered species. Many clients are also very defensive of all midwives, in the sense that we don't want to see one receiving negative attention when their absence represents fewer choices for us in birth. It becomes easier to turn a blind eye to problems rather than risk giving midwifery a bad name.

L, student nurse and married to A, my union man. Happy parents to little S!   joy.gif

aphel is offline  
#85 of 301 Old 02-24-2011, 10:06 AM
 
MovingMomma's Avatar
 
Join Date: Apr 2004
Location: Eastern North Carolina
Posts: 2,340
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I've been following this thread with interest.

 

We have a case in my state right now (CPMs are not licensed, CNMs can legally attend HBs w/OB backup) where a CPM was arrested for practicing (either midwifery or medicine, I'm not clear on which) without a license.  The Friends of Midwives organization is using the case as a springboard to campaign for legislation to license CPMs (it's not a new effort, they've been working hard to gain licensure for years).  Organizers are saying the particulars of the case don't matter, what matters is that if CPMs were already licensed in the state, she would be subject to whatever review, censure, etc. the legislation puts in place and not charged criminally.  

 

No longer speaking of the specific current situation in my state, while laws surrounding medical licensure for various medical professions may provide some protection for said professionals, they are still subject to laws covering assault & battery, for example.  So a patient who is subject to a vaginal exam without consent may have more than one avenue of recourse: complaint to the medical boards and actually filing charges of assault, battery, etc.  


-Shannon, momma to H reading.gif 8/03, N heartbeat.gif 9/06, & P homebirth.jpg 8/11, missing S brokenheart.gif born at 11 wks 1/09 

 


 
   

MovingMomma is offline  
#86 of 301 Old 02-24-2011, 10:50 AM
 
AustinMom's Avatar
 
Join Date: Jul 2008
Posts: 896
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


 

Quote:
Originally Posted by mommato5 View Post

 

 

 

This, to me, sounds like one of those blaming things. Not cool. All mothers ask questions and interview their midwife before hiring. What can people do to make sure potential clients know about a midwife's history before making the mistake of hiring her?? Mine had multiple deaths under her belt and I didn't know. I had no clue. She never once said "Oh, BTW, I've went in front of the grand jury a few times for some infant deaths". I would of RANNNNNNNNNN!! Instead, I'm in the same club Liz is in and my baby is yet another baby lost due to her. You don't KNOW that they will do anything until something happens and they either drop the ball or save the day.


Um....the question was 'how do we make sure our CPs are competent?' and speaking honestly, yes, I feel it's your responsibility as a mom to ask if the MW you are interviewing has had a fetal demise, and what that situation was.  I ALSO think it's the MWs responsibility to tell her future mamas this.  I'm not saying you deserved to have your baby die because you didn't ask this.  Not, I'm simply saying to add this to the list of questions you'd ask a CP (OB or MW) to help understand their competency.

 

The whole foundation of MW care is that of informed consent.  I think part of that is because most women who want a HB/MW want to take back their birth and all the responsibility for it.  I think it is.  That's just me.  That's me being honest.  I think that if you are not able to make those really big decisions in labor (like most mamas) then you need to trust you CP that they can.  And to find out how much you can trust them, I do think it's important to ask them how often they have a baby die, or how often they have APGARs less than 7 at 1, and 5 min, how often they have to do CPR on a baby.  How often they have to administer Pit or have hemmorages.  That's stuff I think the MW should openly discuss (as most of mine did by handing me a printed paper on all those stats) and if they don't the mom needs to ask. 
 

Quote:
Originally Posted by liz-hippymom View Post





yeah.um, if "we' wait on OBs to change homebirth we will grow old and die before anything happens except outlawing of midwifery.

it is most certainly up to midwifery consumers to change things.

"Never underestimate the power of a small group of people to change the world.  In fact, it is the only way it ever has."  Margaret Mead



I think for any real change to happen OBs need to really change their view of MWs.  I don't know if there really is MUCH more we can do to help this shift.  I think if we continue to show how MWifery is safe, with a licensed, well trained MW, who has a relationship with OBs or back-up, and if she doesn't to be much much more cautious than one who does.  Meaning the first sign of fetal distress either in pregnancy or labor, a transfer is then taking place.  If a symptom (such as bright bleeding, meconium, post term, etc) takes place, then to transport or transfer care then at that sign.  Not take any chances.  We all know that communication between a transfering MW and the OB being transferred to is not good upon transfer.  So, don't wait to transfer when you have multiple signs of concern.  Now IF you have a good relationship like my MWs did, or official back up, obviously it may be safer to take more 'risk'.  But I think that should be up to the mom.



Quote:
Originally Posted by mommato5 View Post

Unfortunately, in the US, the "boards" are nothing more than fellow midwives. I'm not sure how many have read transcripts or listened to audio on Liz's blog, but she was basically told babies die in the hospital too and the midwife slapped on the hand. For me, the "board members" gave us a hard time about trying to have a peer review. The midwife told me she volunteered for one, but I never heard about it. Obviously, mine caused several deaths (with police involvement) and then multiple stillbirths in the months leading up to my daughter's birth/death. If she was still practicing then, the board didn't care. They're all buddy/buddy and the most important thing is having midwives practicing, NOT the families affected when something goes wrong.

 

I say if you want boards, they should have actual professionals who are not friends with these midwives. It would make a HUGE difference in the way families are received and midwives are disciplined.

I totally agree.  I think a lot of MWs fear that a knock against a specific MW is a knock against Midwifery as whole so they become defensive.  Then when you add on the bonds and relationships on the board, it's not okay.  I think just like Dr.s shouldn't treat family members due to emotional close relationships that can inhibit good care, a MW should not be judged by her friends.  That just shouldn't happen. 
 

AustinMom is offline  
#87 of 301 Old 02-24-2011, 12:13 PM
 
ssmathis's Avatar
 
Join Date: Nov 2009
Posts: 2
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Wow, ladies!  Thank you for the calm, informative discussion.  It has been very insightful.  Although there have been some disagreements, the information and opinions are definately helpful for those of us looking to make our own choices in homebirth, to advocate for midwifery in our own communities, and and help make homebirth more safe.  Thanks!

 

Stacy

ssmathis is offline  
#88 of 301 Old 02-24-2011, 01:56 PM
 
CBEmomma's Avatar
 
Join Date: Oct 2010
Location: MN/IA
Posts: 213
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I think one thing with MWs is that they get defensive because if there is a homebirth gone wrong (no matter if baby/mom dies or not) then the media and everyone else take that and over dramatize it and turn it into "see homebirths are HORRIBLE!!!!!". I see that all the time when it comes to Midwifery and homebirth.


~Attatchment and Natural Parent from instincts not from books to my 2 boys~ Childbirth Educator & Placental Encapsulation Professional
homeschool.gif familybed2.gif homebirth.jpgribbonpb.gif
CBEmomma is offline  
#89 of 301 Old 02-24-2011, 02:57 PM
 
MegBoz's Avatar
 
Join Date: Jul 2008
Location: Baltimore, MD
Posts: 2,125
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by aphel View Post

I understand that midwives and FSBC are having to stop providing services due to lack of physician back up, but I'd like to think the answer would be to make that back up easier to get, less risky for doctors to provide, instead of just simply not requiring it.


I totally agree. So the question is, "What can be done to make it easier for HB MW to get OB backup?" 

And I think the answer is that is really, really tough. I think it requires - to use a cheesy phrase - a paradigm shift. With ACOG being vehemently opposed to OOH birth on the whole, I have trouble seeing it being easier for HB MW to get OB backup. So many things would have to change in American obstetrics.

 

Quote:
Originally Posted by IdentityCrisisMama View Post
I asked my MW here how *emergency* transfer works and she said we essentially call the ambulance and go where they choose.


Personally, according to Google, I'm 14 min drive from the closest hospital and 19 min drive to my preferred hospital - I told my MW then even in an emergency, maybe that meant we could still go to the preferred place, since that is such a small difference. NOPE! She said if you try to insist they take you anywhere but the closest hospital - you can be fined! (According to her EMT daughter.) So yeah, you have to go where ambulance takes you when you dial 911.

 

 

Quote:
Originally Posted by lunarlady View Post

I think the biggest thing that would help improve midwifery practice is the oversight of an impartial board of professionals whose job it is to review all home births and watch for errors in judgement, mistakes that could end badly, and, of course, what went wrong when birth goes bad. Power to remove licensure, asses damages, and publish results would be included.
 

 

Is this what is done for MDs? I don't even know - just asking. If it has been found to be effective - especially in other countries with much better healthcare systems than the US - then maybe it is the way to go.

 

Although as for the 'loyalty' thing & not wanting to punish your friends, that's a problem with OBs too! (Per "Born in the USA" by Marsdan Wagner, MD.)

MegBoz is offline  
#90 of 301 Old 02-24-2011, 03:31 PM - Thread Starter
 
liz-hippymom's Avatar
 
Join Date: Jul 2003
Location: deep in the heart of texas!
Posts: 1,262
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)


Personally, according to Google, I'm 14 min drive from the closest hospital and 19 min drive to my preferred hospital - I told my MW then even in an emergency, maybe that meant we could still go to the preferred place, since that is such a small difference. NOPE! She said if you try to insist they take you anywhere but the closest hospital - you can be fined! (According to her EMT daughter.) So yeah, you have to go where ambulance takes you when you dial 911.

 

 

 

Is


 

umm not here. having had an emergency 911 transfer at my homebirth. we were asked where we should go. i wish they would have taken us to the nearest hospital- then i would have been able to hold my baby in death. instead we were taken to separate hospitals, 30 minutes away...


mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
liz-hippymom is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off