Poll- Do you support "underground" midwives? - Page 10 - Mothering Forums

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#271 of 285 Old 03-30-2012, 07:04 AM
 
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slmommy, I think you have hit on the crux of our difference with your statement:

 

"...So, how is it possible to legalize cpms, change whatever regulations people want to change, change consumer protection measures... while still "protecting" hb"

 

The question I start with is not "how to protect homebirth", the question I start with is "how do we ensure the best outcomes for mothers and babies"

 

so I think we will just have to agree to disagree.

 

"Obviously, just due to high risk and high rates, hospitals lose more babies for a variety of reasons than homebirth midwives do."

 

Since homebirthers are something like 2% of the population, I would certain expect that hospitals would lose more babies (as a hard number) than CPMs.  I am not convinced that if you look at the rates that homebirth midwives lose fewer babies than hospitals (even given the higher risk population that hospitals are (or should be) serving) -- in fact, I think the preponderance of the evidence is otherwise.

 

Obviously, a provider may not necessarily be at fault for each incident of injury or death -- however, I think the rates of such injuries and death should be available on a provider and hospital basis, perhaps breaking out causation (for example, separating out death due to aspyxia from death to due congenital abnormalities from death due to infection).

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I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#272 of 285 Old 03-30-2012, 10:46 AM
 
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and how do we define best outcomes?  It seems that is the same thinking that makes the high c-section rate "okay" so long as most babies and moms survive and possible bad outcomes sometimes are prevented.  After all, if baby is healthy, the question of how violated your bodies were along the way, necessary or not, doesn't even matter, right?

 

seems like you are for the medical model

 

protecting homebirth is critical, making it operate like hospital birth destroys it and forces justifiably frightened women to UC instead of have attended homebirths, please choose hospital or hospitalesque birth center births if you want the medical package

 

Increasing information on provider outcomes in a database is not "regulation" and it seems to me that the difference is huge. Who is against better information?  I don't disagree with that, but I strongly disagree with requiring CNM/malpractice insurance, doctor "approval" or oversight of a midwife as a condition for providing backup support, etc.

 

I'd propose to exclude the practice of attending births from the definition of "practicing medicine" across the board.  If something like a medical emergency occurs, then the midwife would provide "medical" care and be exempt legally the same way as someone providing first aid.  She could transport, remain with transfers as a doula, provide information without fear.  If attending births as midwives was simply fully legal everywhere with the existing CPM licensing, but officially not considered medical practice, then midwives could all practice openly and databases could be openly available as well.  They could be self-regulating but no longer underground.  This would allow midwives to operate legally and openly alongside rather than inside the sick and twisted medical system.  The CPM community would just need to create the right protocol to fit this model, so that everyone had guidelines for when and how to transition to medical care. 

 

So birth is not an illness, attending is not medicine, and responding "medically" to unexpected events or helping a mother get needed medical care at a hospital would never get a midwife in trouble.  Training and licensing could include many things, all documented and open, and the body of practicing midwives would maintain their own regulations and licensing.  If that body was not constantly in a defensive posture, it would no longer need to "protect homebirth" nor would midwives feel the need to gather around and keep quiet about incidents that may or may not be misinterpreted to be used against homebirthers and midwives in general.  CPMs need to feel safe practicing all around, so they can feel safe also acting and speaking against a peer who has acted unethically or unprofessionally.  (Though I notice that doctors and nurses do the same thing--hide things to protect the reputation of peers.)  I am ALL FOR legalizing CPMs and seeing a world in which there is no such thing as an illegal birth attendant.  I am not at all for the mainstream medical establishment and/or insurance companies having a hand in it, though.  I am not for negating existing training and licensing models and structures of CPMs because not all practitioners have acted professionally.  And I certainly do not think CNMs should be the only recognized legal homebirth attendants.  No need to throw the baby out with the bathwater.  Illegality causes a lot of problems within the midwifery community, but that doesn't mean that CPMs are poorly trained or qualified, or that their certification should not be acknowledged, or that their own regulation cannot be adjusted and adapted to correct problems.  Identifying problems and fixing them is one thing but launching broad attacks on midwives who find ways to practice despite the frightening obstacles they face is really missing the point. 

 

I strongly respect law and order.  But if the laws violate me they lose my respect.  My values system is such that when a law is in the wrong and causes harm, we should feel it is right to practice civil disobedience.  And when we know a law is wrong, it's not only acceptable, but perhaps our duty as well to support those who are engaged in such civil disobedience even when we do not choose to take the same action alongside them.

 

Legalizing midwives would be wonderful, accessible background information about each practitioner would be wonderful, internal regulation can be maintained and improved, external regulation would be disastrous, and those who are currently practicing illegally deserve a lot more respect than they are getting from some folks here. 


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#273 of 285 Old 03-30-2012, 12:16 PM
 
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I'm in Texas- where midwives are licensed and not tightly regulated.  Licensed midwives can attend a variety of births and don't have to carry insurance or be backed by an OB.  It sounds like some who are arguing against "illegal" midwives may also be arguing against LEGAL midwives as they exist here.  

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#274 of 285 Old 03-30-2012, 04:45 PM
 
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Quote:

Originally Posted by Buzzbuzz View Post

slmommy, I think you have hit on the crux of our difference with your statement:

 

"...So, how is it possible to legalize cpms, change whatever regulations people want to change, change consumer protection measures... while still "protecting" hb"

 

The question I start with is not "how to protect homebirth", the question I start with is "how do we ensure the best outcomes for mothers and babies"

 

so I think we will just have to agree to disagree.

Yeah. I don't have much to add that pps haven't already said. We are in a "homebirth" forum. I think women should have many options in their birthing choices. I do not think subtracting choices will ensure better outcomes. Obviously I would prefer if all states allowed cpms to operate legally. 

 

I would agree with alegna that you have hinted around not supporting even legal cpms. I don't know what changes you would personally like to be made to that system, but I also don't see how many changes could/*would* be implemented without completely detracting the good things cpms have to offer or turning them into cnms. I also don't really have much interest in debating that.

 

I am sure, as in all of the maternal care systems really, there are bad cpms who have hurt women and babies. I wonder what exactly is your gold standard of birthing outcomes however, when US is ranked 39th for maternal mortality, and is the nation with the largest positive increase change between 1990-2008, until you get to the nation ranked 125th. I don't think those "outcomes" were solely created by cpms, and yes, I understand other health and lifestyle issues in the US probably play a part in that. I also agree with a pp that "outcomes" is pretty grey, are we just counting live mom and baby? There are lots of other outcomes that affect plenty of health/mortality issues down the road.

 

http://www.healthmetricsandevaluation.org/news-events/news-release/maternal-deaths-fall-worldwide-half-million-annually-less-350000

 

I'm sure it has been discussed here many times before, but I'll throw it out there anyway.  http://www.bmj.com/content/330/7505/1416.full

 

And I really hope I and other women continue to have some choice in where and who we will give birth with. In addition to birth being a very personal event, which every woman regards differently and has different feelings about, it seems that there is a huge discrepancy geographically in the US about types of maternity care available... you can have awesome hospitals and mws to terrible hospitals and no mws. So I really think birthing choices are best made by the person who is best aware of those factors - the mother.

 

ETA: Buzzbuzz, while I can kinda understand some of your issues with illegal mws, I am kinda baffled as to how you think even the mainstream hospital, ob/gyn route provides a lot of the things you are after - particularly consumer protection. As far as I understand, not only would it be incredibly difficult to prove/take legal action against a hcp in that situation, the system that has been created to prevent litigation is causing a lot of outcome problems, and maybe is the *main* reason women are looking towards mws.

Informed consent, bodily autonomy, choice, are very important to me. It seems that in some situations, depending on the hospital, individual hcps, etc. you can lose quite a few of those things. 

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#275 of 285 Old 03-30-2012, 06:30 PM
 
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To think that OB's are always held accountable for their roles in traumatic or tragic births is naive. All those waivers you sign, especially before c-sections are in place to protect the hospital staff. Plus, with their malpractice insurance, if you happened to be successful in suing (rare), they will likely still continue to practice without a hiccup. There isn't a whole lot more accountability amongst hospital HCP's. vs. CPM's or underground midwives w/o insurance.
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#276 of 285 Old 03-31-2012, 08:09 AM
 
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"To think that OB's are always held accountable for their roles in traumatic or tragic births is naive. All those waivers you sign, especially before c-sections are in place to protect the hospital staff. Plus, with their malpractice insurance, if you happened to be successful in suing (rare), they will likely still continue to practice without a hiccup. There isn't a whole lot more accountability amongst hospital HCP's. vs. CPM's or underground midwives w/o insurance."

 

I think you are confused about the purpose and nature of consent waivers if you think they protect a doctor against malpractice.  And certainly, in some situations, they do not protect the doctor against the occurrence of the listed risks (for example, I understand some VBAC mothers have successfully sued for uterine rupture resulting in infant death (without malpractice) claiming that they did not understand that that was a potential risk despite it being specifically covered by the consent).

 

I also think you are confused about the nature of malpractice insurance -- the insurance company does not HAVE to insure you.  Premiums can be raised to a point where they are unaffordable or one can become uninsurable.  So to pretend that a malpractice claim has no impact on the doctor's practice is, I believe, simply wrong.

 

Also -- you don't mention the M&M reviews which at held at every hospital after a significant adverse outcome.  In fact -- I think that is one of the major issues homebirth practice, particularly illegal homebirth practice as there is no way for the provider to learn from mistakes, put better practices in place, etc. with third party input or provide a valuable learning experience to others.

 

Also you don't even mention the role of the state medical and licensing boards which accept and review complaints and can revoke licenses to practice medicine.

 

Oh, and by the way, which is it?  Are all OBs out there performing unnecessary procedures in the name of defensive medicine or are successful suits rare? 


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#277 of 285 Old 03-31-2012, 08:40 AM
 
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I don't know much about litigation, medical malpractice, hospital waivers, malpractice insurance etc.

 

As far as I understand it... you could go for medical malpractice lawsuit for brain damage, significant bodily damage, death for baby or mom IF you can prove malpractice. I don't think you have any recourse if unnecessary procedures were being performed on you, or say an episitomy or c/sec was performed against your will, or if received drugs or other procedures done without informed consent. Or if you get an infection from the hospital (but you brought up the illegal cpm and mrsa). You also have no control over what actually finds its way into your chart. I find it interesting many hospitals have banned video cameras to hinder lawsuits. I wonder how often complaints are actually taken seriously. 

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#278 of 285 Old 03-31-2012, 09:33 AM
 
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I worked as an L&D nurse for 10 years (a long time ago--so things have changed) but "bad outcomes" are VERY well hidden in the hospital.  It's kind of like the military.  Criminal matters are dealt with in the military and are very well kept from the outside world.  The reason we don't hear about all the bad things that happen in hospitals is because they are very well hidden.  Peer review among physicians is mandated for various reasons, not the least of which is to determine how to lessen liability.  The only way we hear about the tragedies that happen in hospitals is when the patients or their lawyers talk to the media.  When it comes to home birth, there is no big hospital structure shielding us from the media, no big money covering us, like in the hospitals.  That's why every bad home birth story is out there for everyone to read.  Oh, and then, of course, there's those stories by word of mouth.  I always love the "My baby would be born dead if I wasn't in a hospital" stories.  One such story stated, "An hour before the baby was born, the placenta stopped working...." and, of course, that person believed that is what happened to her-- (of note: the baby was born alive!)  When people say, "my baby would've died" and then give no information after that, it tells us something about that case.  Maybe they don't truly understand what happened, or maybe the circumstances leading up to the catastrophe would only give fuel to the home birth side of the debate which says if you agree to all the interventions, you must accept the consequences.  

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#279 of 285 Old 03-31-2012, 11:56 AM
 
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Maybe the biggest problem with the "illegal " part of this whole story is , that it seems , in many instances , women don´t have a choice . 

It is not so much about good or bad home birth versus good or bad hospital birth , it is in many instances the problem , that the most important people in that equation , mothers and their babies , often don´t have a real choice .  

I am a vba3c mother myself and I was lucky to deliver my baby here in Scandinavia , where nobody ever even questioned my decision to try a natural birth .

They just supported me , in what I wanted , but in many other places , especially in the US , it´s like you have 2 options , a hospital birth with all the good and bad interventions , modern medicine has to offer ( if you even find a hospital , that will go along with you ) or a home birth , where you either don´t find a midwife , that will ( or is legally allowed to ) attend the birth and trying to find someone , who will do it " undercover " . 

Not even to mention where their qualifications , if they even have any , come from .

It shouldn´t have to be about the mother supporting an underground midwife , it should be about the insurance companies , the Government and the medical community supporting us as grown - up , knowledgeable individuals , then there would be no need for anyone to hide ! 

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#280 of 285 Old 04-04-2012, 06:37 AM
 
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"I am a vba3c mother myself and I was lucky to deliver my baby here in Scandinavia , where nobody ever even questioned my decision to try a natural birth."

They just supported me , in what I wanted"

 

From my understanding of Scandinavia generally, they supported you because what you wanted was what they wanted you to have.  If you had wanted a c-section at maternal request you might not have felt quite so happy!.

 

"The only way we hear about the tragedies that happen in hospitals is when the patients or their lawyers talk to the media."

 

Are complaints and proceedings by the state board of medicine not available for review in your state?  For example, I have been able to review the on-going board of medicine proceedings against Dr. Biter (navelgazing midwife's former "Dr. Wonderful") in California very easily.

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#281 of 285 Old 04-04-2012, 04:35 PM
 
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Quote:

Originally Posted by Jane93 View Post

"I am a vba3c mother myself and I was lucky to deliver my baby here in Scandinavia , where nobody ever even questioned my decision to try a natural birth."

They just supported me , in what I wanted"

 

From my understanding of Scandinavia generally, they supported you because what you wanted was what they wanted you to have.  If you had wanted a c-section at maternal request you might not have felt quite so happy!.

 

"The only way we hear about the tragedies that happen in hospitals is when the patients or their lawyers talk to the media."

 

Are complaints and proceedings by the state board of medicine not available for review in your state?  For example, I have been able to review the on-going board of medicine proceedings against Dr. Biter (navelgazing midwife's former "Dr. Wonderful") in California very easily.

 

maybe tonttu can speak to it herself, but if she had 3 c/s, I wonder if she wouldn't have been allowed a 4th at maternal request...

 

PPs here were stating that women are not knowledgable/capable enough to determine whether or not cpms are legal in their home states, and that there is not enough information available to properly choose a cpm...

 

Though I do not follow her blog too closely, as far as I know, navelgazing mw was extremely supportive of Dr. Wonderful for a looong time, so if she as a mw, was unaware of potential issues with an ob/gyn she frequently collaborated with, how are lay-people supposed to be able to correctly judge ob/gyn? Only after lawsuits and media come around, supposing they do? What about all the time before that? 

 

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#282 of 285 Old 04-05-2012, 04:58 AM
 
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Jane 93 , that is not quite true ! Here in Sweden , yes , because the doctors see no reason to cut somebody´s stomach open , if there is no need . 

And even 3 cs are not necessarily considered a reason ( depending on individual case , of course ) .

But if you insist , you will find a place , that will give you a cs , they really mostly follow patients lead and respect their wishes , so if a first - time Mother wants a cs , because she is e.g. scared , even w/o a medical reason , they will give her a cs ( they will talk to you about the risks and benefits either way , though ) and for me I had a long talk and a thorough exam by the doctor in charge and after weighing all the pros and cons together , we both decided , in my case it would be worth a try , since I am a good candidate ! 

When I lived in  Finland , however , they flat out told me , after 2 cs , they wouldn´t even bother trying anymore , even though I had two natural deliveries after those cs and it was a fight for me to get them to accept , that if I end up with another cs , I will NOT have an epidural .  

But I guess , the difference is , that Sweden is a liberal and democratic country and Finland is not 


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#283 of 285 Old 05-09-2012, 09:48 AM
 
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Yes, women should be able to use any midwife they want.

 

Thank goodness for underground midwives!  They allow women to have homebirths with experts in attendance in states which refuse to lisence CPMs.  If it weren't for underground midwives, both my children would have been born at home in unassisted births when I wanted assisted births.  Thank goodness for midwives who risk arrest in order to make sure that women have access to expert health professionals.

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#284 of 285 Old 05-27-2012, 06:36 AM
 
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Yes- I think women should be able to use the practitioner of their choice. I also think more midwifery creditiinals should be regulated so we don't have this issue and more birth options are safe and available for all women

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#285 of 285 Old 05-28-2012, 10:41 PM
 
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I wouldn't use one unless it was a birthing situation like a breech baby or twins(both no-no's in the state of Alaska outside of a hospital), and I would make sure they know what they are doing, not just someone playing midwife. I do prefer, for a normal birthing situation, a certified midwife. I'm hoping for any future children to be brought into this world with the help of the midwives who delivered DS!


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