Poll- Do you support "underground" midwives? - Page 3 - Mothering Forums

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#61 of 285 Old 08-22-2011, 04:17 PM - Thread Starter
 
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A question for everyone who hasn't had hospital VBAC options, if you could choose between homebirth or truly supportive doctors/midwives of VBAC, VBA2C or more in a hospital (theoretically), would you still choose homebirth?


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#62 of 285 Old 08-22-2011, 04:49 PM
 
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Quote:
Originally Posted by lovebeingamomma View Post

A question for everyone who hasn't had hospital VBAC options, if you could choose between homebirth or truly supportive doctors/midwives of VBAC, VBA2C or more in a hospital (theoretically), would you still choose homebirth?



I don't know. I have no idea what a truly supportive hospital birth - of any kind - would even look like. Maybe I'd choose the hospital in that situation, but it's kind of like asking me if I'd still shop for Christmas presents for my kids, if Santa Claus were really going to bring them whatever they want. It's completely outside my reality. My last c-section was better than any of the others, but there were still a few things that tripped it up...and I know for a fact that I lucked out on nursing staff, because one of the ones who made my post-op stay such a mess with ds2 was coming on duty as we left with dd2.


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#63 of 285 Old 08-22-2011, 05:30 PM
 
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Originally Posted by lovebeingamomma View Post

thank you for sharing.
 


 

 

I'm not sure who you're responding to mindfulmomma...
 



 


Sorry I hit quote and it did not go through I will repost...

 

 


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#64 of 285 Old 08-22-2011, 05:34 PM
 
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How is is okay that women choose other women who are not qualified/licensed to attend them? That's placing not just the mother in jeopardy but the baby, too.The "birth freedom" movement is dangerous.
 

 

Why do you feel the need to attack my thoughts and opinion...I could have certainly voiced my disagreement with the blatant fear I hear coming from women, many of who I suspect are licensed MW's. It is not my choice to decide what is too risky for someone. It is not my choice to tell a woman how to give birth. It is not my choice to tell women that the only choice they have in using the person they feel will best support them and their needs has to be Licensed by the state or some abitrary organization that thinks they know that woman's body better than she does.
 

 


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#65 of 285 Old 08-22-2011, 06:29 PM
 
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Quote:
Originally Posted by lovebeingamomma View Post

A question for everyone who hasn't had hospital VBAC options, if you could choose between homebirth or truly supportive doctors/midwives of VBAC, VBA2C or more in a hospital (theoretically), would you still choose homebirth?


I DO have the option of a hospital VBAC with supportive CNMs. I also have the option of homebirth with a CNM. I still decided to use an unlicensed (in my state, licensed in another state) CPM. I don't see birth as a medical event that requires a medical provider to facilitate it.


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#66 of 285 Old 08-22-2011, 06:32 PM
 
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Originally Posted by Storm Bride View Post

Wow - I missed this before:

 

Actually no, 10% is a HUGE and unacceptable number, if it means that of 10 women, one will end up with a dead or disabled baby or will suffer from complications herself. E.g. an acceptable neonatal mortality at the hospital is less than 1 per 1000 (under 0,1 %)!

 

Are you suggesting that women don't suffer all kinds of complications under the care of OBs? You say 10% is a huge number if it means dead or disabled baby or maternal complications. Then, you compare that 10% solely to neonatal mortality rates.

 

I've suffered complications. Not one of them shows up in my records. Not one. My nerve damage just isn't relevant to anyone except me and dh. The incisions that didn't close, due to infection, for almost six weeks didn't require rehospitalization, so it went "poof" into "not written down, so it didn't officially happen" land. They don't reach some kind of arcane standard, so they don't count as complications. (IMO, anything that affects a woman's daily life, six years after the fact, is a complication.)



and 10% is not morbidity and mortality rates, 10% is any complication. And FWIW stormbride, I agree with you :( Im sorry about the issues you've had.

 


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#67 of 285 Old 08-22-2011, 09:43 PM
 
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Originally Posted by Storm Bride View Post

Wow - I missed this before:

 

Actually no, 10% is a HUGE and unacceptable number, if it means that of 10 women, one will end up with a dead or disabled baby or will suffer from complications herself. E.g. an acceptable neonatal mortality at the hospital is less than 1 per 1000 (under 0,1 %)!

 

Are you suggesting that women don't suffer all kinds of complications under the care of OBs? You say 10% is a huge number if it means dead or disabled baby or maternal complications. Then, you compare that 10% solely to neonatal mortality rates.

 

I've suffered complications. Not one of them shows up in my records. Not one. My nerve damage just isn't relevant to anyone except me and dh. The incisions that didn't close, due to infection, for almost six weeks didn't require rehospitalization, so it went "poof" into "not written down, so it didn't officially happen" land. They don't reach some kind of arcane standard, so they don't count as complications. (IMO, anything that affects a woman's daily life, six years after the fact, is a complication.)


Starllamia didn't specify complications in her original post, and to me, it sounded as if she was referring to serious complications along the lines of dead, disabled babies and mothers and if that was the case, then 10% WOULD be an unacceptable number.

 

Comparing the percentage of all the complications (along the lines of dead, disabled babies and mothers) to just one of the complications was an imperfect comparison and I knew that, which was why I explicitly stated that I WAS referencing to just one statistic: neonatal mortality rate.

 

Still, the difference between 10 % complications (a large part of which seemed to be neonatal mortality) and a 0,1 % neonatal mortality rate at the hospital was huge, that I thought it worth looking at, even considering the imperfection.

 

And yes, there are complications at the hospital too. But even considering that not all of them get written down (especially the not life-threatening ones):  complications like someone dying do NOT go unnoticed as a rule and those are the kind of complications that most DEFINITELY should never ever be even remotely near 10 %.

 

 

P.S.: Yes, also non-lifethreatening complications need to be charted and addressed. Not doing so is bad practice, regardless of provider.

 


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#68 of 285 Old 08-22-2011, 10:39 PM
 
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Quote:
Originally Posted by Kanna View Post


 

P.S.: Yes, also non-lifethreatening complications need to be charted and addressed. Not doing so is bad practice, regardless of provider.

 



It's fairly standard, ime. My records from my first don't mention that I refused consent (obviously - that would be inviting a lawsuit). They don't mention that I wasn't informed about, nor did I consent to, any of the drugs I was given by IV (including at least one sedative).

 

The records from my second don't mention that dd1 kept skipping breaths, all through her two day hospital stay. (Of course, a nurse informed us that wasn't uncommon with c-section babies - maybe they just didn't think it was worth writing down.) They don't mention that I still had nothing to feed her with (no supply) when I left the hospital.

 

The records from my third mention that he had jaundice, which he didn't. They don't mention that I left the hospital with an incision that hadn't closed (twisted staple...and now that I've had both staples and sutures for my external closure, I'm tempted to call the widespread use of staples minor malpractice, in and of itself - theyr'e SO much more painful and have a much more profound effect on mobility - but I didn't know that until I got sutures witih my last). They don't mention that breastfeeding was proceeding beautifully until a nurse messed up ds2's latch, interfering with us. They don't mention that I was given duramorph (I presume) with my anesthesia, without my knowledge or consent. 

 

The records from when I transferred with my stillborn son are...interesting. They include an assertion that a particular Vancouver midwife was in my room visiting with me until late at night. I know the midwife in question - but she wasn't there. A doula friend was. Other than that, the records aren't exactly inaccurate, but the bias in them is disturbing, and some of the assumptions made about me, based on...well, nothing, really...are vile. There were other aspects of my care that I feel were completely unacceptable...and the fact that I had a police escort the one time I got to see my son, because someone was on a midwife hunt (based on the mistaken identification of the woman in my room) makes me sick to my stomach even now.

 

I don't have my records from dd2. I'll get them eventually. I fully expect them to have significant errors and omissions. If they don't, they'll be the only set of my records that are actually accurate. It was also the only visit where I wasn't bullied in any way - it's amazing how well they treat you, when you do what you're told like a brainless child, and have a real dead baby in your chart.

 

I expect "bad" practice from the medical profession. It's all I've ever received.


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#69 of 285 Old 08-23-2011, 07:56 AM
 
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If there are any underground midwives in Halifax who would like to deliver my baby, please let me know (you can send a private message). I would love a home birth but that isn't an option here unless I go unassisted and though I am 90% confident in my ability to birth unassisted, having someone qualified or experienced would make it possible for me. 


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#70 of 285 Old 08-23-2011, 08:33 AM
 
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Sorry Kanna I just assumed that you knew that 90% or more of pregnancy and labour go perfectly normaly with no complications. That 10% of complications isnt largeley made up of neonatal mortality, less then 1%, statistically speaking is not a significant part of 10%. I think you need to forget that 10% because you may be confused. Mortality rates make up under 1%, not anywhere near 10%! Unfortunately maternal mortality in the USA is vastly underreported, there is no regulations on reporting maternal deaths, and this is a hospital issue not a midwifery issue, they are not even required to properly note the cause of death.
 

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Starllamia didn't specify complications in her original post, and to me, it sounded as if she was referring to serious complications along the lines of dead, disabled babies and mothers and if that was the case, then 10% WOULD be an unacceptable number.

 

Comparing the percentage of all the complications (along the lines of dead, disabled babies and mothers) to just one of the complications was an imperfect comparison and I knew that, which was why I explicitly stated that I WAS referencing to just one statistic: neonatal mortality rate.

 

Still, the difference between 10 % complications (a large part of which seemed to be neonatal mortality) and a 0,1 % neonatal mortality rate at the hospital was huge, that I thought it worth looking at, even considering the imperfection.

 

And yes, there are complications at the hospital too. But even considering that not all of them get written down (especially the not life-threatening ones):  complications like someone dying do NOT go unnoticed as a rule and those are the kind of complications that most DEFINITELY should never ever be even remotely near 10 %.

 

 

P.S.: Yes, also non-lifethreatening complications need to be charted and addressed. Not doing so is bad practice, regardless of provider.

 



 


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#71 of 285 Old 08-23-2011, 09:13 AM - Thread Starter
 
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I found this thread I haven't read thru all of it but it might be helpful to you: http://www.mothering.com/community/t/1231558/home-birth-in-halifax
 

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Originally Posted by ali171 View Post

If there are any underground midwives in Halifax who would like to deliver my baby, please let me know (you can send a private message). I would love a home birth but that isn't an option here unless I go unassisted and though I am 90% confident in my ability to birth unassisted, having someone qualified or experienced would make it possible for me. 



 


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#72 of 285 Old 08-23-2011, 11:47 AM
 
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Thank you, I read through the thread but it is unfortunately a little old and we have since lost all our midwives in Halifax. There were three here when we started trying to have a baby. The whole program shut down the month before I found out I was pregnant. 


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#73 of 285 Old 08-23-2011, 01:44 PM - Thread Starter
 
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wow that's too bad!  Was it for legal reasons they stopped practicing?
 

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Thank you, I read through the thread but it is unfortunately a little old and we have since lost all our midwives in Halifax. There were three here when we started trying to have a baby. The whole program shut down the month before I found out I was pregnant. 



 


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#74 of 285 Old 08-24-2011, 11:01 AM
 
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I've worked in several fields that required an exam and/or practical experience to be licensed, and I've met some SCARY people who are licensed but not qualified.  You can train yourself to take a test well, you can b.s. your way through practical requirements... I've seen it done more than I care to think about.

I think licensing in general is b.s. (driver's licenses included, even if it IS a horrible comparison).

 

Do I want someone who knows what they're doing? SURE DO!  

Does having a license prove that they know what they're doing? SURE DOESN'T! 

 

 

I hired "illegal" midwives - they were both CPMs, which are not recognized in my state, but less than a mile away (over state lines), they're licensed. They'd delivered more babies than most of the CNMs that I interviewed, and cared MUCH more about my general well-being beyond my uterus and breasts than the CNM I initially hired.

I transferred to the hospital and my baby died - the OBs said it would not have been preventable, even if I'd been in the hospital during labor.

I still stand by my decision to hire who I hired.

 

To go along with the pilot comparison - the CNMs I've met are the type to obsess over the landing gear light while not noticing the plane is losing altitude (resulting in a fatal crash).  The CPMs I've met could manage to safely land the plane when it runs out of fuel and loses electricity in both engines.

 

Oh, and sorry, I can't get behind an article/blog that doesn't seem to know what the acronym CPM stands for.

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Originally Posted by Kanna View Post

 

If a MW is licensed in one state, and not in the next, does that make her "not qualified"? Who gets to decide what being "qualified" really means?

 

Well, there are the NARM examps that CPM's need to pass to get licensed. But some consider even these woefully inadequate:

http://midwifeology.blogspot.com/2011/08/educational-standards-of-american.html

 

 

 

 

 

 

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#75 of 285 Old 08-24-2011, 09:23 PM
 
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This is hard to answer, because the laws differ so much from state to state. I'm in an alegal" state. I can practice openly, because I do not carry/use restricted items, which one  has to be licensed to use. Other midwives here practice covertly, and lead people to think  midwifery is illegal, just because they carry/use pitocin and other things they are not supposed to be doing unless licensed. I Trust Birth is a natural  occurrence, not a medical event, and when it becomes so, it then belongs in a hospital, where they do have and can relatively safely use medical equipment! Those Restricted items are restricted for a reason, even O2 can have deleterious side effects and have no place at a homebirth, IMHO. However, if I was in an illegal state, I would be very uncomfortable being a midwife. I would probably revert back to being a UC birth educator. If in a legal state, I have seen plenty of restrictions placed on the midwives I wouldn't like to comply with, so I'd probably comply with the laws, most of the time, but encourage UC education if they desired something I couldn't legally do, like VBAC, twins, or breech. I do believe in respect for authority, but I believe in the spirit of the law over the letter of the law. KWIM?

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#76 of 285 Old 08-24-2011, 09:56 PM
 
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This is hard to answer, because the laws differ so much from state to state. I'm in an alegal" state. I can practice openly, because I do not carry/use restricted items, which one  has to be licensed to use. Other midwives here practice covertly, and lead people to think  midwifery is illegal, just because they carry/use pitocin and other things they are not supposed to be doing unless licensed. I Trust Birth is a natural  occurrence, not a medical event, and when it becomes so, it then belongs in a hospital, where they do have and can relatively safely use medical equipment! Those Restricted items are restricted for a reason, even O2 can have deleterious side effects and have no place at a homebirth, IMHO. However, if I was in an illegal state, I would be very uncomfortable being a midwife. I would probably revert back to being a UC birth educator. If in a legal state, I have seen plenty of restrictions placed on the midwives I wouldn't like to comply with, so I'd probably comply with the laws, most of the time, but encourage UC education if they desired something I couldn't legally do, like VBAC, twins, or breech. I do believe in respect for authority, but I believe in the spirit of the law over the letter of the law. KWIM?

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#77 of 285 Old 08-24-2011, 10:24 PM
 
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I do because without my underground midwife I would not have been able to have my first birth (twins) at home the way I wanted and I'm very glad she took the risk to attend me as a first time mom.

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#78 of 285 Old 08-25-2011, 08:58 AM
 
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I do because without my underground midwife I would not have been able to have my first birth (twins) at home the way I wanted and I'm very glad she took the risk to attend me as a first time mom.



Me too exactly!


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#79 of 285 Old 08-25-2011, 06:19 PM
 
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I just read an article about illegal midwives in Quebec, might be interesting to some of you http://www.montrealgazette.com/health/Illegal+midwives+call/5281552/story.html


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#80 of 285 Old 08-25-2011, 06:29 PM
 
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What an interesting thread!

Personally, I have mixed feelings. I think, for me, my "support" of illegal midwives depends on why they are choosing to practice illegally. I'm a lot more ok with midwives practicing underground in places that won't license them (so that women have options) than with midwives who, for whatever reason, choose not to pursue a license that is legally available to them. Ideally, though, midwifery wouldn't be illegal anywhere. Until that's the case, I'm thankful that there are midwives who are willing to work under the law to provide a "third option" to women (like myself) who live in a place where they can only legally choose a hospital birth or UC.

That said, while I've certainly considered using an underground midwife, it's just not something I personally am comfortable with. I need to know that whoever attends my birth is not only trained and experienced, but willing (and able!) to work with the medical community, should the need arise.

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#81 of 285 Old 08-25-2011, 07:23 PM
 
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What an interesting thread!
I need to know that whoever attends my birth is not only trained and experienced, but willing (and able!) to work with the medical community, should the need arise.

Yep. Not just drop you at the hospital if things go wrong but able to walk into the door with you without fear.
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#82 of 285 Old 08-26-2011, 12:19 AM
 
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What an interesting thread!

Personally, I have mixed feelings. I think, for me, my "support" of illegal midwives depends on why they are choosing to practice illegally. I'm a lot more ok with midwives practicing underground in places that won't license them (so that women have options) than with midwives who, for whatever reason, choose not to pursue a license that is legally available to them. Ideally, though, midwifery wouldn't be illegal anywhere. Until that's the case, I'm thankful that there are midwives who are willing to work under the law to provide a "third option" to women (like myself) who live in a place where they can only legally choose a hospital birth or UC.
 


 

This.  Our state only licenses on type of midwife (CPM?) and not the other.  There is a group trying to get all midwives licensed, but they're not there yet.  Until then I am perfectly ok with choosing the "illegal" midwife especially after talking to people who have birthed with her.  If you end up transferring with one here they take you, say they were your doula and you say you were doing a UC.  Even my doctor supported my home birth (and told me to call her if I transferred)  so I had zero issues.


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#83 of 285 Old 08-27-2011, 08:30 AM - Thread Starter
 
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Am I hearing this right, the illegal midwife would say she's just a doula?  How then would she update the doctors on the care she's been giving you throughout your labor?  Wouldn't those details be rather important to your continued care at the hospital seeing as it's turned into an emergency situation?  I don't understand why woman would consider this a safe/acceptable situation...am I reading this wrong...


 

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This.  Our state only licenses on type of midwife (CPM?) and not the other.  There is a group trying to get all midwives licensed, but they're not there yet.  Until then I am perfectly ok with choosing the "illegal" midwife especially after talking to people who have birthed with her.  If you end up transferring with one here they take you, say they were your doula and you say you were doing a UC.  Even my doctor supported my home birth (and told me to call her if I transferred)  so I had zero issues.



 


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#84 of 285 Old 08-27-2011, 10:59 AM
 
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Am I hearing this right, the illegal midwife would say she's just a doula?  How then would she update the doctors on the care she's been giving you throughout your labor?  Wouldn't those details be rather important to your continued care at the hospital seeing as it's turned into an emergency situation?  I don't understand why woman would consider this a safe/acceptable situation...am I reading this wrong...


 



 



You read it right.  And they give you your files.  I completely understand how that wouldn't work for some people, but I was completely ok with it.


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#85 of 285 Old 08-28-2011, 05:21 PM
 
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This is the sort of thing I'm talking about when I say the interests of the illegal midwife and patient are not aligned...see the following text from the book "From Calling to Courtroom"...

 

"For those midwives who do carry Pitocin, I would advise them to never admit it to anyone who has the ability to testify (that is, anyone except your husband). If a midwife ever feels the need to inject Pitocin or administer any kind of drug, such as Methergine, she should refer to such substances as "minerals.""

 

So basically, the advice is to deny the mother information about what is being injected into her body and make it so she cannot accurately report to the hospital (in case of transfer) what medicines she has had during labor (an extremely important point for her new medical team to know). 
 



I have pondered this post for quite a while before I decided to respond.  While your quote is correct, it might be more accurate if presented in context.  If you have read the book, you no doubt recall that this quote was one among many that were collected to present the viewpoints of many midwives.  It in no way represents "advice" or any kind of editorial stance.  In fact, I vehemently disagree with this midwife -- I believe that withholding information or outright lying is always wrong.

 

From Calling to Courtroom was written in order to provide a ready source of information for midwives having legal issues due to practicing midwifery.  It was designed to educate midwives and midwifery clients about the law, about what to do during an investigation, and how to support prosecuted midwives.  The book is unapolgetically in favor of midwifery licensure.  When we decided to write the book, we committed ourselves to two ideals:  1)  no one would be paid for contributing to the book; and 2) it would be available for free online.  We met both of those and -- while some of the book is becoming dated -- From Calling to Courtroom continues to remain a valuable resource.

 

Valerie Runes, Esq., RN

Editor and one of the authors of From Calling to Courtroom

 

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#86 of 285 Old 08-28-2011, 05:31 PM
 
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I live in a state where it's illegal. If I were to have a hospital birth, I'd again be subject to interference, personal violations, and routines that decrease safety of birth. I was blessed to have women around trained and experienced to help at a home birth. I wish I didn't have to have someone break the law for me, but moving isn't an option and really hospital wasn't a viable option either.

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#87 of 285 Old 08-28-2011, 10:30 PM
 
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Yes, women should be able to use any midwife they want.

 

I used an "illegal" midwife when I had my fourth baby at home. I am grateful for her willingness to attend my birth.


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14yo ds   11yo dd  9yo ds and 7yo ds and 2yo ds  
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#88 of 285 Old 09-04-2011, 09:57 PM
 
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Valerie -- I don't believe my quote is inaccurate or even out of context.  This is the advice of a particular midwife that is particularly effective in illustrating the ethical quandry of the illegal provider.   Though I am pleased that someone on the thread was willing to acknowledge that the sort of behavior described was unethical.

 

As with any provider of an illegal service or substance there is no protection for the consumer in any way, shape or form.  The consumer has more protection with regard to her massage therapist or hairdresser than she has with an illegal midwife.

 

 

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#89 of 285 Old 09-04-2011, 10:00 PM
 
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As a further note, as I understand it, a mother may legally have anyone she wishes in attendance during her birth in all 50 states.  What is illegal is the payment being made to the illegal midwife for her services. 

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#90 of 285 Old 09-05-2011, 08:44 AM
 
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Pretty sure it's not the payment, it's the "practicing medicine without a license", if they decide midwifery is practicing medicine, and they don't give midwives licenses, then it's illegal for that reason. I think there's a lot of protection, the midwife puts everything on the line when she practices illegally, she messes up she doesn't just loose her livelihood or money, she can go to jail. Unfortunately there are some still practicing unprofessionally and putting moms and babies at risk that's why it's up to the consumer to check references and training, and yes go ahead and alert authorities if she's done things very wrong.

 

Also I don't agree that midwives should be attending births without the equipment and training to give immediate emergency medical help, like newborn resucitation and treating severe pph, things that might not wait for transfer or always respond to herbs and techniques. Maybe it's allowed in some states but as far as what I know at the moment, it seems irresponsible to me.

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