Our midwife lost a breech baby-questions? - Mothering Forums

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#1 of 94 Old 06-08-2011, 01:18 PM - Thread Starter
 
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Our midwife just delivered a breech baby that passed away during the birth.  I am, of course very sad for the family and my midwife, but this also raises concerns on my own behalf.  I am due in a few months and I wondering what questions I should ask to clear my head from the worries associated with this loss.  What questions would you ask? 

The info I know already is that the baby was full term and fine until the birth.  The midwife and mother both knew the baby was breech and agreed on a homebirth.  The mother was healthy and strong.  I hope to eventually be able to talk to the mother, but she may not be ready to talk until after my baby is born which leaves me only the questions I can ask my midwife.  Any suggestions? 


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#2 of 94 Old 06-08-2011, 08:51 PM
 
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That's tough stuff.  I think being empathetic with your MW is a good start.  Ask her how she's doing with it.  And then if appropriate, perhaps ask her if she has any idea what went wrong.  Then just listen.  You'll have a lot to process after that conversation, but then maybe more direct questions can be asked at a future meeting with her.  You deliver babies long enough, you're going to probably experience a (some) bad outcome.  :(

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#3 of 94 Old 06-09-2011, 04:20 AM
 
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Forgive me if this is insensitive to what you are looking for....but i am surprised that she isnt taking some kind of "break" to update her skills, to process what happened, and maybe even some sort of disciplinary hearing through her supervising organization.

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#4 of 94 Old 06-09-2011, 05:02 AM
 
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I would ask "is MY baby breech?" first.  I would ask what went wrong.  I know a woman who lost a surprise breech at home and whose midwife (who did nothing wrong, as far as anyone could tell) immediately passed her clients to her back-up and took 7 months off to get over it and consolidate her skills.

 

It is a difficult conversation to have but she should understand your concern.  I'm sorry this happened.

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#5 of 94 Old 06-09-2011, 06:43 AM
 
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How horrible for all parties involved. I can see where you would begin to question just about everything surrounding your birth. I would think that your midwife would be open to talking in depth with you about any and all of your concerns so that you feel more at ease and comfortable with her. My midwife would have been if anything like this happened. I wouldn't think she would need to take a leave of absence unless she was really personally affected by it. Midwives have an obligation to their clients to be the constant presence from start to finish and I wouldn't expect it unless she was questioning her skills. Breech can be complicated and although there are stellar techniques for breech birth, some midwives are not trained in that particular area PROPERLY particularly due to licensing in certain states. Breech birth should be hands off birth. As her what her standard of care is in the event of a breech birth. If after speaking with her, you just don't feel comfortable with her at your birth, you have time to find a new midwife or be referred to a different one. I had a breech birth Nov.2009 and because my midwife had a breech birth prior to mine, she knew what to do because she researched so heavily about her own birth. Her midwife did not and her baby was not breathing for close to 20 minutes because of lack of proper training and ignorance/ refusal to learn things contrary to standard practice. My birth was beautiful and wonderful and I wouldn't think twice about having another breech birth. But I also know that there are risks associated with breech birth and I assumed those risks by deciding to stay home once my baby's position was found out. I know this sounds cold but the fact is, babies DO DIE during birth. Home, hospital, birth center, field! Mothers die too! For the greater majority, birth is uncomplicated and normal process. But there are certain situations where this just happens and it is really no one's fault. The great thing is that you have time to decide.Now is when I would call and tell her you have some questions and concerns about this birth that you would like to chat with her about. If she is unwilling, definitely find someone else! Alot of times, midwives don't have a back up or assistant that is qualified to do birth alone and her obligation to her clients trumps her personal emotions about this loss. No one expects a Dr. to take a break when he loses a baby (unless maybe a couple weeks for review and they are almost always in the clear) so let's not harp on this midwife. Likely, she did nothing wrong but seek out the facts! And if they aren't given or aren't good enough for you, there are other midwives or avenues available!

 

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#6 of 94 Old 06-09-2011, 08:53 AM
 
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I'm going to say RUN far away from her!! She obviously has no problem taking risks which is a huge red flag!

 

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 I know this sounds cold but the fact is, babies DO DIE during birth.

 

 

Not usually, they don't.


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#7 of 94 Old 06-09-2011, 01:01 PM
 
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No, usually they don't.  But if your only criteria in selecting a CP is that they haven't had a baby or mom die on them, then you're going to be hard pressed to find a CP - CPM/DEM, LM, CNM, OB, FP. shrug.gif

 

OP, please let us know what you find out.  I'm curious.  I'm sorry this is happening right now - I'm sure it's really throwing you off.


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#8 of 94 Old 06-09-2011, 01:57 PM
 
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No, usually they don't.  But if your only criteria in selecting a CP is that they haven't had a baby or mom die on them, then you're going to be hard pressed to find a CP - CPM/DEM, LM, CNM, OB, FP. shrug.gif

 

OP, please let us know what you find out.  I'm curious.  I'm sorry this is happening right now - I'm sure it's really throwing you off.

 

OP, I would find out if this is her first death, and how many births she's attended. The perinatal mortality rate _including_ preemies and high-risk pregnancies is 7/1000. So if she's seen more than one death per 130 births, stay clear. Best of luck.

 

P.S. As her client it's not your job to take care of her.

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#9 of 94 Old 06-09-2011, 02:12 PM
 
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Preemies aren't born at home, so that number would need to be taken out! More than .3 out of 1000 is higher than the hospital. And bear in mind, not all midwives are honest about their numbers! They also aren't falling over themselves to share names and numbers of parents who lost babies because they were incredibly negligent (*cough* breech*cough*).

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#10 of 94 Old 06-09-2011, 02:47 PM
 
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I personally wouldn't continue with a care provider that agreed to a home birth for a breech baby.
Part of home birth is knowing when you need to transfer, labor with a breech is when you need to be in the hospital.
Does she not have privileges to deliver in a hospital?
 

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#11 of 94 Old 06-09-2011, 02:51 PM
 
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Originally Posted by mommato5 View Post

Preemies aren't born at home, so that number would need to be taken out! More than .3 out of 1000 is higher than the hospital. And bear in mind, not all midwives are honest about their numbers! They also aren't falling over themselves to share names and numbers of parents who lost babies because they were incredibly negligent (*cough* breech*cough*).



Oh agreed for sure. I was being generous.


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#12 of 94 Old 06-09-2011, 03:04 PM
 
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I'm going to say RUN far away from her!! She obviously has no problem taking risks which is a huge red flag!

 

 

 

Not usually, they don't.


I'm really confused my your comments.  Birth has risks-no matter where you birth.  It seems to me you think there is some magical way to eliminate the risk, and that is dangerous thinking. 

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#13 of 94 Old 06-09-2011, 03:23 PM
 
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Originally Posted by mommato5 View Post

I'm going to say RUN far away from her!! She obviously has no problem taking risks which is a huge red flag!

 

 

 

Not usually, they don't.



I agree.  I would run.  OP--it is going to be incredibly difficult to find out if the midwife was at fault or not, so if you continue with her, you may end up continuing with someone who did something negligent and dangerous.  Someone who could put you and your babe at risk.   This might just be a terrible tragic event that she was totally not at fault for, but you aren't going to know.  I wouldn't feel comfortable with that at all.   Also, please don't try to contact the mama who lost her baby.  You aren't friends with her, correct?  That wasn't totally clear from your post, so if you are friends, nevermind.  Contacting someone who isn't a friend to quiz her about her loss (or even if it is a friend to do anything other than offer condolensces) would be incredibly insensitive at a time like this for her.  She might want to talk about her story if she felt the mw did something wrong, but she also might be totally horrified by someone meddling in her life that way.  Don't do it. 

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#14 of 94 Old 06-09-2011, 03:33 PM
 
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I'm really confused my your comments.  Birth has risks-no matter where you birth.  It seems to me you think there is some magical way to eliminate the risk, and that is dangerous thinking. 


Yes, birth has risks no matter where you are. But some risks are bigger than others. A midwife who agrees to attend a breech birth at home has shown that she's willing to take on a lot of risk before risking her clients out. If that's what you want, knowing the risks of vaginal breech birth, then fine. But I would be concerned as a mother who wants my midwife to risk me out if I show any signs of increased risk.

 

OP, if you want a midwife who's more cautious and judicious about risking people out, then it would be good to ask your midwife about her criteria for risking people out of homebirth, and how often she does, and under what circumstances. It could be that the mother of the breech baby was dead set on a homebirth no matter what, or it could be that the midwife doesn't recognize that some situations are riskier than others.

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#15 of 94 Old 06-09-2011, 04:00 PM
 
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Wow.. If I ruled out midwives simply because they agreed to take on higher risked births outside of the hospital, I would have missed out on a wonderful midwife for my last birth, a midwife who was among the most experienced and skilled in my area! I have HUGE amounts of respect for her, and her skills. Sometimes its not about "recklessness" but simply a deep respect for a woman's wishes. She's taken on women who for religious reasons, will not accept hospital treatment, even in the most dire of emergencies. She has seen those emergencies.. and dealt with them (she's told me a couple specific stories) with healthy moms and babies. And those high risk moms, to whom hospitals are completely out of the question, are better off with a good midwife than UCing. So hell yeah, I'm sure as heck glad I had a "reckless" midwife, taking on those scary high risk births. It meant she had practice! So when MY baby had an unforeseen complication, (shoulder dystocia) she was on it, and he was unharmed. I might think those women who would rather bleed to death than go to the hospital and have a life saving transfusion are crazy, but its their decision to make, and I respect that. I should clarify that there is a big difference in agreeing to attend a higher risk birth with a mother who has had full informed consent and understands the risks she's taking, and having risks come up in what was previously a normal birth and ignoring signs of emergency, delaying transferring or calling 911 until its too late.. THAT is a whole different kind of "risk taking" and I want to make absolutely clear that I am not lumping the two together. 

 

I cannot speculate if the op's midwife was negligent, because we DON'T know the story. This could be anything from a completely mismanaged birth to one that went perfectly, with excellent heart tones up until the baby came out unexpectedly compromised, 911 called right away, and unsuccessful resuscitation. I'd withhold judgement until I heard the story. 


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I cannot speculate if the op's midwife was negligent, because we DON'T know the story. This could be anything from a completely mismanaged birth to one that went perfectly, with excellent heart tones up until the baby came out unexpectedly compromised, 911 called right away, and unsuccessful resuscitation. I'd withhold judgement until I heard the story. 



I typically operate under the "withhold judgement until I know the story" idea, but not in cases like this.  You and I agree that we don't know the story.  Why put a mother and baby at risk in the name of withholding judgement?  What if the midwife was negligent?  Unless I was 110% certain she wasn't, I would find another midwife.  Not "judging" the midwife would be a LOT less important to me than ensuring my baby's safety, health, and life were protected. 

 

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#17 of 94 Old 06-09-2011, 04:26 PM
 
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Right, my decision to stay with the midwife or find a new one wouldn't be made simply by deciding to give the benefit of the doubt. I meant to say that I, in this thread, am not going to accuse the midwife of being too much of a risk taker without knowing the story. The first step is to ask the midwife to tell the story. Thats not foolproof because we don't know if the story will be stretched/embellished to put the midwife in a better light than she may deserve. I wonder if there was any other professionals at the birth, such as a doula, apprentice, assistant? Asking to speak with them (without the midwife present) could be enlightening as well. If nothing else, to make sure the stories are consistent. A conversation with the midwife is definitely in order.. and then decisions from there. 

 

questions I might ask: (after hearing the story)

-if you could have a "do over" of that labor/birth, what would you do differently?

-Do you have any plans for the future to prevent any other scenarios like this?

-how much breech training have you had? How many have you attended?

-what is your typical "standard of care" while assisting in the delivery of a breech baby?

 


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#18 of 94 Old 06-09-2011, 04:32 PM - Thread Starter
 
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Thanks for the questions and suggestions for things to talk to my midwife about. She delivered my last baby at home and I may not br considered low risk by some standards.
The mother and I are neighbors and aquaintances( sp?). I would not dream of contacting her about this. She has enough going on without me getting involved. That's why I am looking for the right questions for my midwife.
It seems like there's a huge difference of opinion on the safety of a vaginal breech delivery.

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#19 of 94 Old 06-09-2011, 05:03 PM
 
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It seems like there's a huge difference of opinion on the safety of a vaginal breech delivery.


Not really about the safety of vaginal breech delivery, more about where it's done and by whom.

 

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#20 of 94 Old 06-09-2011, 06:02 PM
 
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Wonderful journey of motherhood is not gonna happen with a dead baby. So, no, normally, healthy babies of healthy mothers do not die in childbirth unless the practitioner was incompetent.

 

I would not trust midwife with a breech birth. Ever. And definitely not the one under whose care the baby died.

 

To me, live baby and live mother is everything. I do not care about my experience more than I care about my baby being alive.

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#21 of 94 Old 06-09-2011, 08:53 PM
 
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Wow.  Well, not everyone is privileged enough to get to choose WHERE and HOW their breech babies come into this world.  As someone who was the recipient of a scheduled breech c-section b/c no hospital or birthing center professional would assist w/ my baby's vaginal birth, I can tell you 100% that if I have another breech, it will be born at home w/ a midwife who I have since found who has experience and would assist.  And I would expect to find support for that here on MDC, but, I guess as they say, the times, they are a changing.  Sad, sad, sad.  Disrespect towards the choices of the way other women birth, especially those looking to avoid c-sections, *shaking my head*

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Wow.  Well, not everyone is privileged enough to get to choose WHERE and HOW their breech babies come into this world.  As someone who was the recipient of a scheduled breech c-section b/c no hospital or birthing center professional would assist w/ my baby's vaginal birth, I can tell you 100% that if I have another breech, it will be born at home w/ a midwife who I have since found who has experience and would assist.  And I would expect to find support for that here on MDC, but, I guess as they say, the times, they are a changing.  Sad, sad, sad.  Disrespect towards the choices of the way other women birth, especially those looking to avoid c-sections, *shaking my head*



But it's not disrespecting anyone's choice to state the fact that breech vaginal births are riskier than cephalic vaginal births. Even the Johnson and Daviss study that looked at a huge number of homebirths to try to figure out safety statistics found that 2/80 breech babies died. If you know that it's riskier but still want a homebirth, that's all your choice; it's the mother's job to balance the risks and benefits in her particular situation. I just wouldn't want anyone to think that breech is as easy on babies as cephalic. 

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#23 of 94 Old 06-09-2011, 09:27 PM
 
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I would ask these questions:
Have you done breech births in the past? If so, how many?
The first time you did a breech birth, what type of preparation/training did you have?
Were there any complications during this delivery that were unexpected?
What types of recessitation did you attempt?
How soon did you call 911?
What do you think happened to cause the baby to die? Looking back, do you think there was anything different you could have done to alter the outcome? (assuming still a home birth and not c-section)
Have they determined an official cause of death?
Will this death put your legal status in doubt? (attending breech birth in my state is illegal. Doing so regardless of outcome would cost a MW her liscence.)
How many babies have you lost? What happened in each case?
Walk me through several emergencies (life/death) that you have handled at a labor.
How many times in your practice have you had to dial 911?

I would not automatically DQ this MW and run for someone else. But I will say that if she went into this without loads of experience with breech babies, I would run. Vaginal delivery of breech is both possible and reasonably safe with proper care. But it is high risk, and treating it like it is not would be a red flag for me. If this is the first time she has ever had an emergency, I would run. If, however, she is highly trained, dealt well with a small number of emergencies, and displays a feeling of responsibility and regret for what happened, I would consider keeping her on.

You didn't say, but is your baby breech at this time? Or flipping around a lot? Good luck and I hope the conversation you have with your MW gives you some answers.
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Wow.  Well, not everyone is privileged enough to get to choose WHERE and HOW their breech babies come into this world.  As someone who was the recipient of a scheduled breech c-section b/c no hospital or birthing center professional would assist w/ my baby's vaginal birth, I can tell you 100% that if I have another breech, it will be born at home w/ a midwife who I have since found who has experience and would assist.  And I would expect to find support for that here on MDC, but, I guess as they say, the times, they are a changing.  Sad, sad, sad.  Disrespect towards the choices of the way other women birth, especially those looking to avoid c-sections, *shaking my head*


No, not everyone is able to choose where and how they deliver a breech baby, so many variables are in play with labor and delivery. But all women can certainly plan those things. And I don't feel like anyone isn't supporting the OP, she asked for opinions. I think we are all trying to be helpful. But if being supportive means encouraging a home birth at all costs, I simply can not for I would have the feeling of blood on my hands if something happened to the mother or baby, and that would break my heart. And I don't think anyone is saying she needs to have a c/s either. I, personally, would just deliver with my midwife in a hospital or find an ob willing to deliver a breech.

 


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#25 of 94 Old 06-10-2011, 06:05 AM
 
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I would also ask why she feels she doesn't need a "break" from practice or some time to recover for the experience.

 

For example, with the case of Karen Carr, she had a baby death in September of 2010, a major morbidity in October of 2010, and then another baby death (trapped head/breech birth) in December of 2010 (the birth on which she was convicted of 2 felonies).  I do think her outcomes would have been different if she had paused in September of 2010 and maybe gave some thought to her practices, her willingness to taken on risk, etc.


 

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Quote:
Originally Posted by dogretro View Post

Wow.  Well, not everyone is privileged enough to get to choose WHERE and HOW their breech babies come into this world.  As someone who was the recipient of a scheduled breech c-section b/c no hospital or birthing center professional would assist w/ my baby's vaginal birth, I can tell you 100% that if I have another breech, it will be born at home w/ a midwife who I have since found who has experience and would assist.  And I would expect to find support for that here on MDC, but, I guess as they say, the times, they are a changing.  Sad, sad, sad.  Disrespect towards the choices of the way other women birth, especially those looking to avoid c-sections, *shaking my head*

 

There have been a few extremely hard-learned lessons around the birthing boards here at MDC lately. I don't think it is at all unsupportive to have a realistic discussion about both risks in general, and providers in specific.

 


~ Mum to Emily, March 12-16 2004, Noah, born Aug 2005, Liam, born January 2011, and wife to Carl since 1994. ~
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#27 of 94 Old 06-10-2011, 07:46 AM - Thread Starter
 
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Hi everyone, it's me the OP.
I want to thank everyone who gave thought to my original request for questions to ask my midwife. DH and I are compiling a list to bring up at our next appointment. I, also, appreciate the facts that some of you have supplied. I think with a combination of good questions then facts to base our choices on we will be able to make a wise and informed decision.
If anyone has more facts about breech birth at home and hospital I would be interested... links or references to studies are great, too.
Also, if anyone can think of questions that havent been listed yet please keep them coming.
I don't know the facts surrounding this birth and have only heard 3rd hand about what happened so it is very important for me to sort this out without bothering the mother and her family during this difficult time.
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#28 of 94 Old 06-10-2011, 08:03 AM
 
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I appreciate the discussion here. I feel this has been particularly enlightening, and I appreciate the diversity of views and opinions. I understand the desire and wish for the family to grieve privately, and I wish them all good thoughts. I also think, however; for the sake of openness and disclosure, it would be helpful to let others know who the midwife is or what the practice is called. This is something worthy of discussion for all future clients and certainly the present ones. 

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#29 of 94 Old 06-10-2011, 08:14 AM
 
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Quote:
Originally Posted by calldeville View Post

I appreciate the discussion here. I feel this has been particularly enlightening, and I appreciate the diversity of views and opinions. I understand the desire and wish for the family to grieve privately, and I wish them all good thoughts. I also think, however; for the sake of openness and disclosure, it would be helpful to let others know who the midwife is or what the practice is called. This is something worthy of discussion for all future clients and certainly the present ones. 



And what, exactly, would be your particular motivation for asking for these details?  Forgive me for being skeptical, but there has been a tremendous amount of trolling on MDC.  A user with only 5 posts and a question like this, seems to give me pause.

 

Again, if indeed you are a mom interested in or planning a homebirth, you can understand why the skepticism about sharing this type of information on the internet, that it just *might* be injurious to some.

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#30 of 94 Old 06-10-2011, 08:33 AM
 
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Please also keep in mind that while you have questions you may want to ask the midwife, she may not actually be at liberty to discuss the situation with you. HIPAA and all that good stuff.


Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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