The price of being the best.....is having to BE the best - Or: On how to make Homebirth even safer (Initial quote by Terry Pratchett) - Page 4 - Mothering Forums

Forum Jump: 
Reply
 
Thread Tools
#91 of 107 Old 08-21-2011, 09:12 AM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

 

Taking a look at the current education of CPM's. Part I

 

I wanted to know more about how CPM's are actually trained and certified. Midwife Erika was kind enough to post a link to the Candidate Information Bulletin over at NARM (= the folks that test and certify CPMs) so I could look it up:

 

http://narm.org/entry-level-applicants/entry-level-download-application-files/

 

It's got 78 pages and so I won't be able to go through it all in one go, but I'll read up on it bit by bit and post the parts I find interesting, together with my thoughts.

 

For everybody stumbling new into this thread: Yep, I'm biased and skeptical and not a midwife or an OB and I know it. I'd be delighted if you read up on the CIB too and shared your point of view, so anyboy reading this thread can get a more balanced picture. wink1.gif

 

Page 5

 

On how a future CPM may acquire her knowledge:

 

"Certified Professional Midwife (CPM) may be educated through a variety of routes, including

  • programs accredited by the Midwifery Education Accreditation Council (MEAC)
  • the American Midwifery Certification Board (AMCB)
  • apprenticeship education
  • and self-study"

 

This is the first part I have a major problem with. Apprenticeship to just ONE midwife will expose a future CPM to only a limited set of knowledge and experience. OB's train with a wide variety of other doctors and they also get a look at other specialties, so they are exposed to a broader range of practices and know-how. Not saying a CPM would have to rival a doctor in that area, but darn, a midwife should be exposed to more than just ONE other midwife (I suspect some of them do…but probably not all of them).

Come to think of it, doing a stint at the hospital would be a GREAT idea. They'd get a better feel for medical procedures and emergency situations. I know I had to do a stint at the hospital here in Germany for my EMT training, and I learned a TON that I wouldn't have learned otherwise.

 

Hospital's a good place to practice putting i.v.'s in too.  I know putting an i.v. in is a skill a midwife has to learn and she needs to prove she knows how to do it…but (question to the midwives out there) how much does she actually get to practice that skill? And how often does she have to re-train in order to keep fit in that skill? Trying to put in an i.v. in a mom whose blood-pressure is crashing is NOT a good time to practice putting in i.v.' s when the last i.v. you put in was 5 years ago….

 

Also: Self-study? Sorry, but I find that one totally unacceptable. Of course EVERYBODY has to do a LOT of studying on their own. But as a main means of acquiring knowledge, it is severely lacking. If you misunderstand something or if you fail to make an important connection between different things that you've learned, there HAS to be someone to correct and assist you.

 

And YES, I know study is only part of it. CPM's are examined and tested afterwards. But a test can only do so much and I know tons of people who studied and crammed hard for tests, only to forget most of what they learned in a few weeks afterwards.

 

Education has to be SOLID if it is to hold water for emergencies and the years to come.

 

 

Page 6

 

"NARM recognizes that the education of a Certified Professional Midwife (CPM) is composed of didactic and clinical experience. The clinical component of the educational process must be at least one year in duration and equivalent to 1350 clinical contact hours under the supervision of one or more preceptors. The average apprenticeship which includes didactic and clinical training typically lasts three to five years. The clinical experience includes prenatal, intrapartal, postpartal, and newborn care by a student midwife under supervision."

 

1350 hours of clinical contact is very, very little. A doctor who's only training to be an OB will work about 80 hours if not more per WEEK in the first year (internship) alone.

 

http://www.faqs.org/faqs/medicine/education-faq/part2/section-4.html

 

Which basically means that, where clinical experience is concerned, an OB in training will have more clinical experience in 18 weeks of working than a CPM gets in 3 to 5 years. (I know it can be just one year…but the average is still 3-5 years…).

 

I feel that CPM's need more clinical experience in those 3-5 years than just 1350 hours. Not as much an OB does, but still….1350 hours (=18 weeks clinical contact) seems very little, especially considering that most of that time will NOT be spent handling emergencies.

 

 


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

Kanna is offline  
#92 of 107 Old 08-21-2011, 09:20 AM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

 

Just came across this post that some of you might find interesting too. It's the insight of an affiliated Bradley Method Natural Childbirth teacher in Northern California, sharing her view on the necessity of improving the safety of midwife attended births:

 

http://mamabirth.blogspot.com/2011/08/why-natural-birth-community-must-not.html

 


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

Kanna is offline  
#93 of 107 Old 08-21-2011, 10:04 AM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:

Originally Posted by Right of Passage View Post

How would being exposed to altered and interferred with birth teach midwives what normal birth looks like? If they never see it, they'll never recognize it. If you learn to always yank on a baby's head during birth you'll think not doing so was some sort of flawed birth. Seeing normal birth is what teaches normal birth. Just like a normal penis is an intact one, yet if you only see circumcised penises the intact one looks wrong and you have to fix it. Or breastfeeding is what's normal, but if you only see bottlefeeding, it's breastfeeding that's wrong. I could go on and on.

 

I think the point is that while midwives definitely have to learn how to handle "normal" births from other midwives, they also have to learn how emergencies are handled: pre-eclampsia, placentia praevia, post-partum hemorrhage, cord prolapse, shoulder dystocia, neonatal resucitation, how to put an i.v. in, how to recognize shock and fetal distres....and all these are things they are MUCH more likely to learn at a hospital than at a "normal" homebirth.

 

As a side note I think the NARM exam is very entry level at a minimum. I don't understand what having a bachelors proves for a midwife. And yes, a&p, microbiology, etc are things midwives should be very knowledgable about, but passing a class doesn't mean the student has retained the material.

 

...and THAT's why I think that CPM's need very rigorous exams and frequent re-certification.

 

And what clinical work would a midwife need? .... I'm racking my brain to understand how applying casts, assisting in surgery, etc is relavent to midwifery. 

 

The things you mentioned are NOT the ones a midwife should be required to learn how to handle at a hospital. I find though that learning how all the "abnormal" and emergency stuff that can come up during a pregnancy or during birth however IS something a good midwife needs to know.

 

... What NEEDS to happen is parents need to be the primary caregivers, midwives and doctors need to follow parent's orders.

 

This sounds VERY unrealistic to me.

 

Becoming a midwife or an OB takes YEARS of study. INTENSE study.

 

And a parent (who usually has to hold down a job besides) is supposed to aquire that kind of knowledge in less than 9 months?

 

And to a degree where that parent can actually JUDGE the skill and care level of other people who spent years learning and practicing in that field?

 

And so they can direct OB's / midwives in the care they are to give?

 

Sorry, but that is NOT feasible.

 

People hire professionals (ranging from car mechanics to lawyers, midwives and doctors) because professionals are expected to have expertise and experience in that area that lay people DO NOT and which lay people CANNOT HOPE to aquire in a reasonable amount of time and with a reasonable amount of effort.

 

To me, the credo that "parents need to take responsbility" to the extent that they need to be able to tell a good midwife from a bad one (but which might be quite good at portraying herself as "good") looks a lot like victim blaming.

 

In my ears "Well, if she didn't want her baby to die during birth, she should have done a better job at checking her midwife's credentials" sounds a LOT like "Well, if she didn't want to get raped, she shouldn't have worn that short skirt".

 

You don't ask a woman to "own" their rape....and you shouldn't ask a grieving mother to "own" the death of her child at the hands of a negligent midwife.

 

(Strangely enough, this kind of "victim blaming" is something both homebirth advocates AND homebirth opponents do, and this baffles me to no end.)

 


 

 


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

Kanna is offline  
#94 of 107 Old 08-22-2011, 03:22 PM
 
Right of Passage's Avatar
 
Join Date: Jul 2007
Location: The abyss of grief
Posts: 2,334
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

You missed the point. This has nothing to do with victim blaming, and I'm actually offended.

The birth, pregnancy, and baby belong to mom. Many doctors and midwives step in like birth and pregnancy belong to them and they are the ultimate decision makers. This is WRONG. Mom is the true care provider, no one can gestate her baby for her, no one can force her body to absorb the nutrients in her food, or the exchange of oxygen/co2 in her lungs, no one can make her placenta provide everything the baby needs except what her body naturally does. Women have been taught to distrust their intuition and connections with their babies and bodies and instead trust the "professionals" and put the responsiblity entirely hands of "professionals." This is really unfair to doctors and midwives.  Doctors and MWs need to play their role as hired consultants, they are experts in what can go wrong(doctors moreso than MWs), they are experts in technology that is available, and a select few are actually experts in normal(typically MWs). Their information is invaluable.

 

The difference in the professionals you speak of is they deal with man made problems, not physiology. My body cannot naturally produce a living will or rental agreement for example, it can however grow and birth a baby without intervention. Women need to take back their role as primary care giver, as the rule setter, as the decision maker. For example just today a dear friend had a urine culture come back positive for GBS, the doctor she saw called her and told her "you have nothing to worry about, we won't let you deliver vaginally anyway" when did it become doctor's choice (at 10 weeks!) that it would be cesarean delivery? She put her foot down, took her records, and fired the doctor. (It was a last straw, they also labeled her high risk because of her age, she's 29)

Add to that how often is it shared that women are fustrated they weren't heard, that they thought something was wrong, but the doctor didn't think so, so nothing was done and things turned out bad. Why are the decision makers(moms) ignored? Why are the rule setters(moms) told nothing was wrong? Shouldn't worries be investigated? If a pregnant woman says something feels wrong, shouldn't a health care consultant be thorough enough to rule out something being wrong or validate mom's feelings when they do find that something was wrong?

Storm Bride likes this.

bf.jpg Sami brokenheart.gif, wife to jammin.gif, mama to reading.gif Tate 10/14/05, moon.gifKaleb 12/17/07, angel.gifcandleflicker2.gif Bram 3/13/10-11/17/12, mischievous.gif Alden 2/1/12, pos.gif October 2014
 homeschool.gifvbac.gifuc.jpg 

Right of Passage is offline  
#95 of 107 Old 08-22-2011, 04:08 PM
 
Turquesa's Avatar
 
Join Date: May 2007
Posts: 4,058
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 30 Post(s)

Kanna, I wanted to juxtapose and address two points that you made.

 

First:

 

Quote:

 

Originally Posted by Kanna View Post
 

Not much time right now, so I'm kinda grabbing the next best statistics. Feel free to do some more research on your own:

 


Maternal mortaliy

 

US 17/1000

Germany 7/1000

 

http://chartsbin.com/view/lac

 

neonatal mortality

 

US 4/1000

Germany 2/1000

 

http://chartsbin.com/view/1451

 

The second quote comes in the context of responding to why you care so much about this issue:

 

 

Quote:

Originally Posted by Kanna View Post


Because I accidentally stumbled across a few stories of HB deaths in the US and they seriously upset me, especially since stuff like that is virtually unheard of over here

 

 

 

Did you know that 0.67% of babies in the U.S. are born in homebirths?  Yet the stats you cite show that neonatal mortality is DOUBLE in the U.S. what it is in Germany!  I understand your concern about that fact. I'm concerned, too, as is anybody with a conscience. 

 

I already explained in Post #107 of our previous thread that our system is set up so that those scary homebirth anecdotes that you saw make the newspaper....and preventable neonatal deaths in hospitals never will. 

 

So consider this: If every homebirthed baby in the U.S.--100% of that 0.67%--died as a result of a CPM-attended homebirth, it wouldn't come CLOSE to explaining that inexcusable 4/100,000 statistic.  (Doctors will often get defensive and explain this away by blaming the victims; we childbearing women are all old and fat and poor and high-risk.  eyesroll.gif  But it still doesn't explain why as such a highly industrialized nation alleged to have the "world's best health care," we have ranked alongside Malta and Slovakia.)

 

Now consider this.  In that Johnson and Daviss study that has been tortured within an inch of its life.....NO woman in 2000 died in childbirth while attended by a CPM.  Yet as both you and the Amnesty International report have pointed out, maternal mortality rates in the U.S. have been staggering!

 

For these reasons and with all due respect, I wonder why you're focusing so intensely on those 0.67% of homebirthed babies when there is clearly a much greater problem in the U.S. with mainstream maternity care?

 


In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
Turquesa is offline  
#96 of 107 Old 08-22-2011, 05:33 PM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by Turquesa View Post

Kanna, I wanted to juxtapose and address two points that you made.

 

First:

 

 

The second quote comes in the context of responding to why you care so much about this issue:

 

 

 

 

Did you know that 0.67% of babies in the U.S. are born in homebirths?  Yet the stats you cite show that neonatal mortality is DOUBLE in the U.S. what it is in Germany!  I understand your concern about that fact. I'm concerned, too, as is anybody with a conscience. 

 

I already explained in Post #107 of our previous thread that our system is set up so that those scary homebirth anecdotes that you saw make the newspaper....and preventable neonatal deaths in hospitals never will. 

 

So consider this: If every homebirthed baby in the U.S.--100% of that 0.67%--died as a result of a CPM-attended homebirth, it wouldn't come CLOSE to explaining that inexcusable 4/100,000 statistic.  (Doctors will often get defensive and explain this away by blaming the victims; we childbearing women are all old and fat and poor and high-risk.  eyesroll.gif  But it still doesn't explain why as such a highly industrialized nation alleged to have the "world's best health care," we have ranked alongside Malta and Slovakia.)

 

Now consider this.  In that Johnson and Daviss study that has been tortured within an inch of its life.....NO woman in 2000 died in childbirth while attended by a CPM.  Yet as both you and the Amnesty International report have pointed out, maternal mortality rates in the U.S. have been staggering!

 

For these reasons and with all due respect, I wonder why you're focusing so intensely on those 0.67% of homebirthed babies when there is clearly a much greater problem in the U.S. with mainstream maternity care?


*chuckles* 

 

This is a bit unrelated and I'd do something similar in a heartbeat, but it did amuse me that you linked to an article which stated that "A review paper published in 2010, for example, found the risk of newborn death was two to three times higher for babies born during planned home births compared to planned hospital births." while arguing for homebirth.

 

To your question on why you're wondering why I'm "focusing so intensely on those 0.67% of homebirthed babies when there is clearly a much greater problem in the U.S. with mainstream maternity care?":

 

From what I've gathered, there's a huge problem in the U.S. with mainstream maternity care...because of insurance. Which a lot of people don't have. So they, including moms-to-be have big holes in their health-care. Not because it isn't available. But because they're not able to pay for it.

 

Germany and vast majorities of Europe DO have health insurance for all.

 

This study is a bit older, but does point in the direction of health insurance being a big factor in maternity and neonatal care:

 

http://www.nejm.org/doi/full/10.1056/NEJM198908243210805

 

Threads here on MDC seem to confirm that impression:

 

http://www.mothering.com/community/t/1170695/well-uc-is-pretty-much-our-only-option-now-update-post-20

 

http://www.mothering.com/community/t/1103379/those-with-no-insurance-and-paying-out-of-pocket

 

 

Tackling the American Health Care System? Totally out of my league.

 

Making some posts and discussing things here on MDC? That I CAN do.  ^_^

 

 

 

 

 


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

Kanna is offline  
#97 of 107 Old 08-22-2011, 05:52 PM
 
starrlamia's Avatar
 
Join Date: Dec 2010
Location: Ontario Canada
Posts: 536
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Good post, but i dont think ive ever heard that the USA has the best healthcare lol just the opposite.

 

TBH- Kanna, I think you have decided based on media that you dont agree with homebirths, for whatever reason, and there is no changing your mind or opening your eyes to the fact that homebirths barely make up enough of a percentage of births in the USA to make a dent in either mortality rates. Take Canada for example, our homebirth rate is anywhere from 1.1%-2.4% depending on what you read, and yet our mortality rate is lower then the usa, and in studies homebirth morbidity and mortality were virtually the same (statistically insignificant difference but homebirth scored a tiny bit better). This is on par with pretty much every country who has done studies on homebirth rates, so obviously there is something more going on in the USA and the mortality rates there.

 

Quote:
Originally Posted by Turquesa View Post

Kanna, I wanted to juxtapose and address two points that you made.

 

First:

 

 

The second quote comes in the context of responding to why you care so much about this issue:

 

 

 

 

Did you know that 0.67% of babies in the U.S. are born in homebirths?  Yet the stats you cite show that neonatal mortality is DOUBLE in the U.S. what it is in Germany!  I understand your concern about that fact. I'm concerned, too, as is anybody with a conscience. 

 

I already explained in Post #107 of our previous thread that our system is set up so that those scary homebirth anecdotes that you saw make the newspaper....and preventable neonatal deaths in hospitals never will. 

 

So consider this: If every homebirthed baby in the U.S.--100% of that 0.67%--died as a result of a CPM-attended homebirth, it wouldn't come CLOSE to explaining that inexcusable 4/100,000 statistic.  (Doctors will often get defensive and explain this away by blaming the victims; we childbearing women are all old and fat and poor and high-risk.  eyesroll.gif  But it still doesn't explain why as such a highly industrialized nation alleged to have the "world's best health care," we have ranked alongside Malta and Slovakia.)

 

Now consider this.  In that Johnson and Daviss study that has been tortured within an inch of its life.....NO woman in 2000 died in childbirth while attended by a CPM.  Yet as both you and the Amnesty International report have pointed out, maternal mortality rates in the U.S. have been staggering!

 

For these reasons and with all due respect, I wonder why you're focusing so intensely on those 0.67% of homebirthed babies when there is clearly a much greater problem in the U.S. with mainstream maternity care?

 



 


Aspiring Midwife applying to University for fall 2011!
starrlamia is offline  
#98 of 107 Old 08-22-2011, 06:11 PM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by starrlamia View Post

Good post, but i dont think ive ever heard that the USA has the best healthcare lol just the opposite.

 

TBH- Kanna, I think you have decided based on media that you dont agree with homebirths,

 

Actually, I DO agree with homebirth...with a competent, skilled provider.

Yes, women SHOULD have the option of a homebirth....but they shouldn't have to worry about their saftey and that of their unborn kid while doing so.

 

I know I get really mad at other doctors when I hear about one of them acting negligently and if I came across one at my workplace, I'd lobby my ass off to get that doctor shut down.

 

I can't fathom why the midwife community DOESN'T seem to be up in arms at the reports of some of their own acting so negligently that it has led, amongst other things, to babies dying.

 

Instead, e.g. when Midwife Karen Carr was up on charges for manslaughter, other midwives rallied to help and support....NOT the grieving parents....but the negligent midwife. headscratch.gif

 

http://www.washingtonpost.com/local/midwife-faces-involuntary-manslaughter-charges/2011/04/18/AFTsqs1D_story.html

http://marylandmidwives.webs.com/karencarr.htm

http://marylandmidwives.webs.com/sponsors.htm

 

Granted, I don't have all the details....but somehow, something seems fundamentally wrong with this picture.

 

for whatever reason, and there is no changing your mind or opening your eyes to the fact that homebirths barely make up enough of a percentage of births in the USA to make a dent in either mortality rates. Take Canada for example, our homebirth rate is anywhere from 1.1%-2.4% depending on what you read, and yet our mortality rate is lower then the usa, and in studies homebirth morbidity and mortality were virtually the same (statistically insignificant difference but homebirth scored a tiny bit better). This is on par with pretty much every country who has done studies on homebirth rates, so obviously there is something more going on in the USA and the mortality rates there.

 

It's not the overall mortality rate I'm concerned about. It's the neonatal mortality rate of hospital births versus homebirths in the US that I'm trying to get to the bottom of. Because still, by looking at the data and the studies available, homebirths in the US seem to have WORSE outcomes......and that SHOULDN'T be the case. They should be equally safe.

 

Right now, US moms seem to be caught between a stone and a hard place: Have a mother and child friendly, low-on-interventions homebirth....which carries a higher risk of complication....or have a (possibly quite unpleasant) stay at the hospital, with a higher risk of interventions happening....but a lower risk of serious complications. (Complications as in "neonatal mortality rate")

 

Doesn't seem fair to the moms, does it?



 


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

Kanna is offline  
#99 of 107 Old 08-22-2011, 07:00 PM
 
starrlamia's Avatar
 
Join Date: Dec 2010
Location: Ontario Canada
Posts: 536
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

it definately doesnt seem fair at all. TBH though, with the recent study ACOG came out with, I really cannot take it seriously, that organization is not exactly honest or in it for the moms and babies.

I dont think any midwives should support careless midwives, but all the info for the Carr case is media presented, so it will be inherently biased, plus without seeing case notes I really cannot make a judgement call. And to be fair, this family had a breech baby and decided to go ahead with a homebirth despite the risks, that is not neccessarily the midwife's fault IMO, because breech can be safely done.


Aspiring Midwife applying to University for fall 2011!
starrlamia is offline  
#100 of 107 Old 08-22-2011, 07:41 PM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

 

Quote:
Originally Posted by starrlamia View Post

it definately doesnt seem fair at all.

 

*g* Another point we can agree on.

 

TBH though, with the recent study ACOG came out with, I really cannot take it seriously, that organization is not exactly honest or in it for the moms and babies.

 

Which study are you referring to exactly?

 

I dont think any midwives should support careless midwives, but all the info for the Carr case is media presented, so it will be inherently biased, plus without seeing case notes I really cannot make a judgement call.

 

I can't make a judgement call either (and said as much), but this kind of behaviour (one midwife being negligent, midwife community does nothing about it) seems to occur quite frequently.

 

Mom loses baby to negligent midwife....nothing happens.

Quote: What can you do when your child dies due to a midwife's negligence?....
The midwife review board did nothing but give us shit. Funny enough, they also have sat idly by while multiple babies die under her care."

 

http://momofmanyfeet.blogspot.com/2010/08/calling-out-negligent-midwife.html

 

And to be fair, this family had a breech baby and decided to go ahead with a homebirth despite the risks, that is not neccessarily the midwife's fault IMO, because breech can be safely done.

 

O.k. serious lack of information about the details on my part, so this more of a what-if scenario then anything else...I feel that IF the midwife had failed to inform the family of the risks and / or misinformed them about her abilities to deal with a breech...in that case it WOULD have been negligence.



 


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

Kanna is offline  
#101 of 107 Old 08-23-2011, 06:31 AM
 
Turquesa's Avatar
 
Join Date: May 2007
Posts: 4,058
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 30 Post(s)


 

Quote:
Originally Posted by Kanna View Post


*chuckles* 

 

This is a bit unrelated and I'd do something similar in a heartbeat, but it did amuse me that you linked to an article which stated that "A review paper published in 2010, for example, found the risk of newborn death was two to three times higher for babies born during planned home births compared to planned hospital births." while arguing for homebirth.

 

Yea, yea.  I get it.  winky.gif  That was the first of thousands of hits that I got on the topic when I did a search.  All of those hits confirmed the accuracy of the the CDC's 0.67% statistic.  And I'm sure you know by now that these anti-homebirth medical groups are citing a meta-analysis that has been debunked ad nauseum.   

 

To your question on why you're wondering why I'm "focusing so intensely on those 0.67% of homebirthed babies when there is clearly a much greater problem in the U.S. with mainstream maternity care?":

 

From what I've gathered, there's a huge problem in the U.S. with mainstream maternity care...because of insurance. Which a lot of people don't have. So they, including moms-to-be have big holes in their health-care. Not because it isn't available. But because they're not able to pay for it.

 

Fair enough.  I, too, think that insurance status may play a significant role in the high neonatal and maternal mortality rates.  (In fact, we only have anecdotal evidence thus far, but numerous homebirth CPMs can tell you about all of the uninsured clients that they have because out-of-hospital midwifery offers uninsured women a MUCH more affordable option). 

 

So why aren't you focusing your concerns on THAT issue (among other factors contributing to the mortality rates) of women lacking health care coverage?   

 

Let me put it this way: Do you, from the bottom of your heart, wish to stop women and babies from dying in childbirth?  Because believe me, Kanna, a LOT more lives will be saved by shifting the discussion to U.S. health care injustices and underinsurance than they ever will be by nitpicking Midwife Erika's (and other midwives') credentialing process.  Unfortunately, while blinded by its zeal to stop American women from choosing homebirth, the American Medical Association completely has its priorities in the wrong place.

 

Perhaps by scapegoating midwives and women who choose homebirth and refusing to address problems of underinsurance and anti-evidence practices, they feel that they can blame-shift the problem of high maternal and neonatal mortality rates into somebody else's lap.  irked.gif 



 


In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
Turquesa is offline  
#102 of 107 Old 08-23-2011, 06:33 AM
 
Turquesa's Avatar
 
Join Date: May 2007
Posts: 4,058
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 30 Post(s)


blowkiss.gif

Quote:
Originally Posted by starrlamia View Post

Good post, but i dont think ive ever heard that the USA has the best healthcare lol just the opposite.

 


In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
Turquesa is offline  
#103 of 107 Old 08-23-2011, 06:52 AM
 
Kim L Mosny CPM's Avatar
 
Join Date: May 2011
Posts: 12
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by Kanna View Post




Thanks for the input!

 

To give us a little bit more insight, is there a pdf of the 41 pages skills criteria somewhere? I browsed the NARM website and couldn't find it.

 

And what does the written exam look like? Especially concerning emergencies and safety? Could you maybe post a few example questions?

 

Thanks again!


Here are the 41 pages of skills verification... every skill listed must include a date of acquisition of proficiency and the preceptor's signature

Please keep in mind that this (verification of skills) is only PART of the entire NARM application

 

Test (Written Exam) Specifications begin on page 35 of the Candidate Information Bulletin

 

Here is a breakdown of the written exam by category.

 

 

CPM Written Examination Matrix
Content Area Total % of Exam / # of Items
I. Midwifery Counseling, Education and Communication .  .  .  . 5% / 17
II. General Healthcare Skills .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5% / 17
III. Maternal Health Assessment .  .  .  .  .  .  .  .  .  .  .  .  .  . . 10% / 35
IV. Prenatal .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  25% / 88
V. Labor, Birth and Immediate Postpartum .  .  .  .  .  .  .  .  .  35% / 123
VI. Postpartum .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .15% / 54
VII. Well-Baby Care .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5% / 16

 

Kim L Mosny CPM is offline  
#104 of 107 Old 08-23-2011, 07:46 PM
 
starrlamia's Avatar
 
Join Date: Dec 2010
Location: Ontario Canada
Posts: 536
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

The mom was already denied a homebirth with her original midwives due to the baby being breech, im sure they educated her or at least she would have had an inclination.

 

Quote:
Originally Posted by Kanna View Post

 



 



 


Aspiring Midwife applying to University for fall 2011!
starrlamia is offline  
#105 of 107 Old 09-14-2011, 11:16 AM
 
RealMidwife's Avatar
 
Join Date: Sep 2011
Posts: 1
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi Kanna,
You do seem like you're genuinely looking for answers, and I appreciate that you haven't resorted to the playground antics you mention. 
I did still feel a bit odd about your post and after thinking about it, realized it was because saying you want to make homebirth safer carries with it the implication that there are flaws that need to be improved. Now, if I'm wrong, and your standpoint is more about how to continue to improve what I think is a good system, then I misunderstood and apologize. If there was a specific hole in the system, I would definitely want to fix it immediately. To me, the data hasn't shown that there is a safety issue with out-of-hospital birth. 
I am curious to see the MANA data released, but as I've worked extensively with the researchers in how to ensure we are fully compliant and that our clients are 100% represented in their data set, I don't have any conspiracy theories about why it isn't out yet. Up until 6/2011, entering births in that database has been voluntary for midwives. In 6/2011, it became mandatory for all clients of licensed Oregon midwives to be entered into the database at the start of care. So, I think it will be a while before we get a full picture of what's going on. 

Now, about the data already being discussed: I've heard criticism regarding using the CDC wonder data for out of hospital births, for reasons already mentioned on this thread and the one before it. Even if the numbers were 100% accurate, I don't think it gives a complete picture of midwifery care, and from the outside it's hard to understand. How can we know what the story of those infant losses were? Did the clients know ahead of time, and still choose to welcome their baby at home? Most hospitals, when confirming a fetal demise during pregnancy, will encourage the parents to go home and tale their time, and come back when they're ready to birth the baby. They may choose to continue with a homebirth plan in that case. Or, a baby with anomalies incompatible with life, known in advance by ultrasound. Or, a baby with unknown anomalies when the parents declined ultrasound in pregnancy. I just can't help but think that those are in the numbers too. 
As for evidence of negligent/incompetent midwives, I don't think the anecdotal evidence of these birth stories being posted is enough. I'm not AT ALL blaming or pointing fingers at the grieving parents. I feel devastated by their losses, and the possibility of losing a baby affects EVERY DECISION I make as a midwife. But. We don't have both sides of the story. We don't have these women's charts (not that we should, I just bring that up as a way to see the other side of the story). With only the grieving, understandably heartbroken, parents' side of the story, it's difficult for me to judge whether there was negligence involved. Not to say I'm not judgmental! smile.gif But I try, when thinking of my fellow care-providers, to believe they thought they were acting in the best interest of the family, or supporting the family's wishes. (Not just midwives. I also believe that about OBs, pediatricians, etc). So, I don't believe there is enough evidence to support the idea that midwives are poorly-trained and acting negligently, and that we need to do something about it. 
As a licensed midwife in my state of Oregon, we are required to peer review any birth that meets our non-absolute or absolute risk criteria. Also, absolutely anyone (even from within our board) can file an anonymous complaint about a midwife, where our board then reviews the chart involved, contacts the parents, etc. We are creating a much more extensive review process as well, where we can request a peer review of a challenging case, with detailed chart review etc. Some of us even get to attend the hospital review when a loss happens (and is transported to the hospital). So, from my perspective, there is a system of checks and balances going on. 
In terms of licensed or unlicenced: I do think, especially in this climate that it makes sense to require licensure. In my opinion, many midwives who are unlicensed cannot afford the fees involved. To compare, the CNM yearly license fee is under $200 (maybe even under $100? Feel free to correct me on this) and the midwifery licensure fee is now $1800 a year. For most midwives, that is prohibitively expensive. Why? A busy midwife working in a birth center (not a great example, bc part of working in a birth center is that these fees are covered for you) makes around $4000 a month before taxes. That yearly license fee represents almost a month of take-home pay. There isn't any other license that can be compared cost-wise. So, if we did come to a place of thinking safety would be better maintained if midwives were licensed, we'd need to get somewhere on that fee.
Speaking of CNMs, you had mentioned "upgrading" the CPM to a CNM. Unfortunately, the CNM degree has it's flaws, which is why I chose not to get it. I wasn't interested in a bachelor's in nursing, and didn't find it relevant for my midwifery studies. I was much more drawn to the program I attended, a Bachelor's in midwifery, with (at least) three years of school dedicated to midwifery alone. I don't agree that you have to be a nurse first to be a midwife, and wanted to spend as much time as possible on midwifery studies. 
The other thing being brought up a lot is malpractice insurance. Again, prohibitively expensive. I definitely hear what people are saying about having babies with life-long care needs. But again, I don't see this as a safety issue: our clients know completely from the first visit when they sign the hiring agreement exactly what our education is, level of experience, and that we don't carry malpractice insurance. Because I know people don't always read what they sign, I go over it verbally too. So, if the client is made aware that we don't carry it, and still makes a choice to hire that midwife, what's the problem there? Again, not seeing anything that needs changing because these are things we already do. From what I've read by the people vocally hurt and angry about their midwifery care, a lot of it seems related to lawsuits: upset that they felt they had no recourse against their midwife. Again, because we don't know both sides of the story, we don't know whether the clients knew any of that going in. I do know both sides for one of the stories circulating here, and like all stories, the two sides are very different.  Knowing that information makes me have a (healthy, I think) dose of skepticism about the other stories. I know it's an unpopular position to question grieving families, so let me be absolutely clear: I'm devastated for your loss. I can't even begin to know what you've been through. I just can't judge the midwife from your stories without knowing both sides, seeing the chart, etc, things that aren't going to happen.
What I said about malpractice also brings up something else I've seen lately: a lack of belief/understanding about informed choice. There seems to be a belief that if women were given true information, they wouldn't choose what they've been choosing. That seems so insulting to those women! Not everyone is going to make the same choices, and women have a right to choose their care provider. We go to great lengths to make sure a woman has all the information at hand, and I can safely say we give a lot more time to this than hospital-based providers do. On every test/screen that comes up, we give clients a pamphlet about it with pros and cons, risks and benefits, possible outcomes. We also discuss the test and make sure they know what the hospital protocol and standard of care is. We have time for this in our hour-long appointments. If something has an especially increased risk (but is still legal!) we have the client write out themselves what we've discussed, and what the risks are. That way, we know they really get it and they're not just signing their names to a piece of paper.
Sorry for the lengthy post! In summation, I think we have to agree there's a lack of safety before trying to make it more safe. Mainly because if we don't know what is unsafe, how can we correct it?
RealMidwife is offline  
#106 of 107 Old 09-14-2011, 04:06 PM - Thread Starter
 
Kanna's Avatar
 
Join Date: May 2011
Location: Germany
Posts: 215
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

*waves hi*

 

Currently lots to do at home....it'll take me a while to respond. But I guess MDC and this thread will be around for a while yet  ^_~


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

Kanna is offline  
#107 of 107 Old 10-13-2011, 06:48 AM
 
jenrose's Avatar
 
Join Date: Apr 2004
Posts: 331
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

There aren't good studies on the safety of home vs. hospital because in many ways the data just doesn't exist at a meaningful level. To truly compare CPM care to OB care, you can't just look at "Where the birth happened", but where the parents planned for the birth to happen, who they were seeing  in pregnancy, etc. We saw from one look at the data that comparisons of birth at term showed better results for OBs...but given current OB practice, how much less likely is an OB patient to make it to term in the first place? How many are likely to be "risked out" for specious reasons, and therefore managed by a high risk practitioner? 

 

I'm not going to go to the studies right now, but to personal experience. 

 

I had an embolism when I was 19, due to a then-undiagnosed heritable thrombophilia and birth control pills (prescribed by a CNM working for a student health clinic, ironically, after I told her, "You know my mother had a clot while pregnant, are birth control pills safe for me to take?") It was misdiagnosed by several practitioners until I finally took my sorry ass to the ER where they figured out I'd lost 3/4 of my lung capacity to a massive embolism over the course of three weeks. Clot busting drugs gave me my lungs back, but from then on out, I was labeled "High risk".

 

I got pregnant about 18 months later (see: birth control pills nearly killed me), assumed because of the high risk label that I'd have to seen an OB, went to an OB and was told, "No you're too high risk for us, you have to go see the perinatologist."

 

So don't get me started on the whole "OBs see higher risk patients anyway". Confronted with anything remotely out of the "usual" set of problems, they seem to pass the buck way faster than a midwife will. 

 

The perinatology clinic said, "You're fat and you had a clot, you're high risk, here, take heparin."

 

My mother nearly died during her last pregnancy taking heparin. First she clotted, then went on heparin, they never got her stable, the placenta abrupted, clotted, and then she nearly bled to death while losing the baby.

 

I said no.

 

They sort of blinked and shrugged their shoulders and I had zero problems with clotting, due the the serendipity that WIC's only palatable frozen juice was 100% welch's pure grape juice. Which is an anticoagulant, but no one knew that at the time. I saw a naturopath, who had me take garlic and ginger to reduce my clotting risk, as well.

 

My blood sugars were on the low end of normal. My blood pressure was ridiculously normal. Despite being fat, I had nice ankles even up to term.

 

Sometime in the third trimester, I started fantasizing about locking myself in the bathroom at the hospital and not coming out until the baby was born. Good instinct. I hired a midwife to act as my labor support. 

 

Had I not, the contractions I started having at 35 and 36 weeks would have sent me in to the hospital, where they would have seen me dilate from 1 to 2 and then things peter out, and they would have jumped on the high risk bandwagon and scared me into "augmenting" what was really just annoying prodromal labor. My midwife instead came out to my house and checked me, listened to baby, had her oxygen with her in case things actually did take off faster than we could get to the hospital, and when things petered out, she said, "Good. Have a half glass of wine and a bath and call me if they pick up again."

 

She came out and sat with me through contractions at least 3 times before I hit term. She wasn't a CPM yet, she was an apprentice-trained midwife without a high school diploma, with more common sense in her little pinky than the entire hospital had, combined. Because she was there with me, checked baby, paid attention, and had as her priority to help me keep things normal, I didn't end up going into the hospital until I was in labor for real, at 40 weeks 3 days.

 

I told the hospital "No" at every turn. No, they couldn't use the belts to keep the monitors on, if they wanted to monitor, they could stand there and hold the damn things in place. Nurses bore easily. This resulted in textbook intermittent monitoring. No, with a clotting disorder, I do not consent to have heplocks or IVs placed unless I actively need IV meds. EVER. No, I didn't want to talk to the anesthesiologist. No, I don't want to sit down, I want to walk.

 

That hospital had a 90% epidural rate. They had no freakin' CLUE how to manage a labor like mine. Not one thing they did made the process safer, and the rapid cord clamping made my daughter anemic. Forcing me into a semi-sit to push created a nasty tear. A clueless doctor who thought that my desire for "natural" meant she should take fewer stitches in my bottom meant that my bottom will never, ever be the same without surgery. Nurses came to "check my incision" and "Ask how the drugs were helping" even though I had not had a cesarean and didn't even know the drugs had been prescribed (and was not taking them). Because of faint, faint staining of the waters, they stuffed a suction tube down my daughter's throat to her vocal cords, despite the fact that she was screaming her fool head off and clearly fine.

 

I spent the next 11 years reading about birth. I was so done with the whole medical establishment that I knew that with my risk factors (by then I'd added asthma and apnea and another 30 pounds) I might not find a midwife, but there was no way in hell I was going back to OB care. I planned for a UC, but miscarried. Ironically, a day after talking to a perinatologist about being able to consult with him on some of the risk factors, and having him tell me, "90% safety isn't good enough". I'd written back to him saying, "You can't guarantee 100% safety. You can't guarantee I won't miscarry next week."

 

After losing the baby, I got pregnant again, and interviewed midwives, because I wanted some access to the system if I needed it. Of the four I interviewed, only one truly demonstrated commitment to informed consent and my right to refuse treatments I did not feel necessary. I ended up hiring her, and because she trusted me and I trusted her and she LISTENED, I did have her at my birth, and she helped keep me from panicking when things weren't "textbook" but were still safe enough for home. In the hospital, I would have been sectioned. In the hospital, my baby would have been in the NICU. Neither option would have improved our outcomes over what we did at home. In fact, most of the kids with her syndrome born in the hospital end up having MORE problems than my little girl does. 

 

This pregnancy, I have a different midwife for a variety of reasons, and it's really the ideal. No one can come up with research to demonstrate the safety of this approach, but I'm being seen by a midwife who consults regularly with a perinatologist. I will birth at home, 7 minutes from a high-risk facility. Our door-to incision time may be as short as 15 minutes if it comes to that. My midwife is okay with me getting ultrasounds as needed, and taking prescribed medications. We have a plan for coping with my risk factors. They are all, currently, decently controlled.

 

And while I may be 300+ pounds with a host of chronic medical issues, I also have a history of very normal births, fast, no gestational diabetes, no high blood pressure, adn even now, at 7 1/2 months pregnant, my bp is running 102/58, my glucose has never managed to get higher than 112 (1 hour after eating) and  no one has given me any convincing data that hospital birth would likely improve out outcome, and there's plenty of evidence it could hurt us if we did it unnecessarily. 

 

All that said, I NEVER hand my care over to anyone. Ever. That way lies malpractice and I've regretted it every time I've tried. 


Jenrose, Mama to DD1, born 1993, DD2, born 2005, and DS1, Jan. 2012. Babywearing, cosleeping, homebirthing mom with fibromyalgia and hashimotos.  DD2 has a rare chromosome disorder. 

jenrose is offline  
Reply

Tags
Homebirth Safety

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