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#181 of 285 Old 03-16-2012, 03:31 PM
 
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Buzz the map reflects what the article says here: 

 

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Practising as a direct-entry midwife is still (as of May 2006) illegal under certain circumstances in Washington, D.C. and the following states: AlabamaGeorgia,HawaiiIllinoisIndianaIowaKentuckyMarylandNorth CarolinaSouth Dakotaand Wyoming.[44] However, Certified Nurse Midwives can legally practise in these areas.

 

Which if you look at the Mana state chart those are the states : "Legal by Statute, but Licensure Unavailable." or "Prohibited by Statute, Judicial Interpretation, or Stricture of Practice"

 

The other states, (not clearly legal and not clearly illegal), are in that grey area Valerie and Plummeting are discussing. If you know you are in one of those weird states - and don't want an "illegal" mw, then DON'T get a cpm... (do one of the other options lovebeingamomma listed - uc, birthcenter, hospital, travel to another state.) If one is very concerned about the legality, why not go a very clearly "legal" route? The law in some areas is unclear about cpms, so go with a clear legal option. I really don't see how this is so complicated. 

 

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#182 of 285 Old 03-16-2012, 05:02 PM
 
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Originally Posted by Plummeting View Post



But what I'm saying is that the term is irrelevant. She's saying that if the law doesn't specifically allow midwifery, it's illegal. I'm saying that if the law doesn't mention it at all, that is going to be determined by a jury, IF it's ever prosecuted, and it might not be. So then where are we? You're saying it's illegal in places where women get prosecuted, but what about when they're found innocent? Was it not illegal? Do you believe the jury was just too stupid to understand the law? What are you saying?

 

For instance, since you're a lawyer, you know that in many states, the "practice of medicine" includes doing anything for the treatment of disease/illness/injury. Pregnancy isn't a disease, illness, or injury. If a midwife isn't giving medications she's not authorized to give, she's got a good case for herself, if she's attending a normal, low-risk birth, which is, by definition, none of those things described above. So if she's prosecuted for practicing medicine without a license, sure, they can DO that, but did she really practice medicine without a license, if all she did was catch a baby? Not by the state's own definitions she didn't. That would mean that what she's doing is not illegal. Something isn't illegal just because someone finds some way to contort the law around to make it so.


The term is not at all irrelevant. Many midwives continue to use it in the sincere belief that they really are "alegal" and safe from prosecution if they don't do anything that they consider to be "practicing medicine." I have had this debate many, many times with midwives who believe that "practicing medicine" is limited to giving drugs, suturing, and starting IVs. What I am saying is this (although I think I have said it before): In states where midwives are not licensed and regulated, nor specifically exempt from the medical/nurse practice acts, they are subject to prosecution for practicing medicine/nursing without a license. In other words, ILLEGAL. Or, to put it another way -- if a midwife does the same things a doctor or nurse does, but is not a licensed doctor or nurse (or working in a state where statute explicitly states that she doesn't have to be licensed to do these things), she is practicing illegally, and takes the risk of arrested, prosecuted, and convicted of practicing medicine or nursing without a license. Having said that, it should be noted that some states prosecute midwives and some do not. Some states simply don't have the money or the inclination to chase down midwives; some states may ignore midwives for years and then -- under a new administration or some other impetus -- decide to begin investigating them. As Buzzbuzz pointed out in a previous post, the reluctance of a state to prosecute midwives should not be interpreted as an endorsement of the legal status of those midwives!

I agree with you that the first place to look for the definition of medical practice is statute, but your pronouncement that "pregnancy isn't a disease, illness, or injury" doesn't help us much.  First of all, if the state is prosecuting a midwife for practicing medicine without a license, it is using *its own definitions* to do so.  You state that "by definition"  catching a baby is not the practice of medicine.  Perhaps by your definition, or the definition of midwives, but in prosecuting a criminal case, the state doesn't take a poll to see which definition is preferred by the defendant. 

 

Second, even if we accept that pregnancy is "not a disease, illness, or injury" but rather "normal" and "low risk," what sorts of things does a midwife do during the pregnancy to make sure that the pregnancy is normal?  Urine dipstick testing? Fundal height?  BP?  Let's say she does a fingerstick to check for hemoglobin.  Perhaps it is a little low, and because she is a good midwife, she suggests to the client ways in which she can increase iron levels to increase her blood count.  In this case, hasn't she just diagnosed and treated a medical condition?

 

Finally, in your post you refer only to practicing medicine without a license.  Please bear in mind that midwives in increasing numbers are being ordered to cease and desist the unlicensed practice of NURSING or NURSE-MIDWIFERY.  The overlap there is even greater.

 

Valerie RN,  JD

 

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#183 of 285 Old 03-16-2012, 05:04 PM
 
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Originally Posted by Buzzbuzz View Post

I'm also not sure I would be running to NARM for its opinion on this -- it certain has an interest in presenting things in the best light and is not a statement about what a prosecutor may or may not choose to prosecute in any particular state.


So it is ok to trust FDA but not MANA... (of course we all don't trust organizations we don't like). I don't know why MANA would lie about the state regulations of CPMs... the list was last updated May 2011, http://mana.org/statechart.html, don't you think there are any CPM's out there who need this info so that they can choose to NOT work in a state where the law prohibits or is murky about cpms? It is not an opinion, it is a list of the status of mw in various states. If someone wants more specific, go look at individual state legislation. Still not impossible to find and do not need to be a PI to do so. Or, you know, if one is so concerned about legality, go for an obviously legal option.

 

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#184 of 285 Old 03-16-2012, 05:13 PM
 
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Slmommy -- the paragraph directly before the one you quote says:

 

"In 27 states it is legal to hire a direct-entry midwife, or certified professional midwife (CPM).[43] It is legal in all 50 states to hire a certified nurse midwife, or CNM, who are trained nurses, though this practice is rare as most CNMs work in hospitals.[43] Some CPMs continue to attend mothers in the 23 states where it is illegal, and can be arrested and prosecuted, while efforts are underway to change the law."

 

So which is it -- 10 or 23?

 


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

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#185 of 285 Old 03-16-2012, 05:13 PM
 
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Originally Posted by Buzzbuzz View Post

Plummeting - I think you are explaining quite well for everyone else how easy it may be for a consumer to be confused about the legal status of her midwife.

 

 

Valerie -- is there a potential issue for doulas here as well, if they cross certain lines (in terms of advising, actions, etc.) even in states where only licensed midwifery is legal?

 

 


Another really good question, Buzzbuzz.  There certainly is a potential issue there, especially for doulas who work as monitrices.  Quite a few years ago, an Illinois doula received a cease and desist order (demanding that she stop practicing medicine without a license) after a mother planning a hospital delivered precipitously at home.  The family and doula quickly transferred to the hospital, but the hospital staff reported the doula to our state regulatory agency.  I think it is important that doulas become familiar with their state's medical and nurse practice acts, and how their state defines the practice of medicine and nursing. 

 

Valerie RN, JD
 

 

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#186 of 285 Old 03-16-2012, 05:18 PM
 
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You do realize that MANA is a midwife advocacy organization?  On its website it specifically lists as one of its goals:   "To promote public education and midwifery advocacy".

 

The FDA is a governmental entity supported by our tax dollars that is not an advocacy group.  Is the FDA perfect?  No, there are certainly improvements that can be made. 

 

However, when you are thinking of MANA you should be thinking about big Pharma advocacy/lobbyist groups as being parallel organizations rather than the FDA. 


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

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#187 of 285 Old 03-16-2012, 05:21 PM
 
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Originally Posted by slmommy View Post

http://en.wikipedia.org/wiki/Home_birth#United_States

 

takes about all 3 seconds and has a map. There are many other resources that explain state-state specifics.

 

ETA - http://mana.org/statechart.html very specific about legality/licensure/not regulated but not prohibited/prohibited for CPMs



For quite some time, some of us (a group of attorneys who deal with issues related to midwives and homebirth) have been nudging NARM to change that chart.  Some of it (especially those parts that refer to "legal by judicial interpretation" and such...) reflect a misunderstanding of the law and a misinterpretation of how it works.  Again referring to Ida Darragh's excellent essay in From Calling to Courtroom, she writes:

 

"Midwives in illegal states accept the necessity of practicing underground until they eventually retire, leave the state, get arrested, or change the laws. Midwives in the other states are living with the most uncertainty because of the fallacy of "alegal" status. They spend years in training, invest in setting up a practice, sometimes work for years establishing a reputation, and then one day when least expected comes "the knock on the door." Life changes at that moment. Her clients have to find someone else; all her time and money go toward her defense; her family tries to understand but nothing seems fair; and she questions her own sanity. "But wait," she cries, "I'm legal by judicial interpretation or statutory inference!"

 

Valerie RN, JD

 

 

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#188 of 285 Old 03-16-2012, 05:45 PM
 
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Originally Posted by Buzzbuzz View Post

Plummeting - I think you are explaining quite well for everyone else how easy it may be for a consumer to be confused about the legal status of her midwife.

 

 

And I think you are confusing the fact that I'm not a lawyer with an inability to determine whether or not my midwife can actually practice without the fear of prosecution. I've been quite aware of what the laws were in both states in which I have planned to use a home birth midwife. As I ALREADY explained, in this state, midwifery is technically legal, but midwives can't be licensed and they can't administer medications, HOWEVER my midwife is also an ND, and therefore she CAN do all sorts of things, including start IVs, carry certain drugs, prescribe certain drugs, etc. (because NDs have limited prescriptive power in my state). I'm pretty sure that means I understood exactly what the legal status of my midwife is in this state. If I lived in a state in which midwifery was completely unregulated, I'd be a little more clear on exactly how it worked in that state. The fact that I haven't needed to become highly versed in that particular situation in no way constitutes an inability to do so. To suggest that it does says more about your character than it does about my ability to learn something I need to know. 

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#189 of 285 Old 03-16-2012, 05:47 PM
 
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Originally Posted by Buzzbuzz View Post

Slmommy -- the paragraph directly before the one you quote says:

 

"In 27 states it is legal to hire a direct-entry midwife, or certified professional midwife (CPM).[43] It is legal in all 50 states to hire a certified nurse midwife, or CNM, who are trained nurses, though this practice is rare as most CNMs work in hospitals.[43] Some CPMs continue to attend mothers in the 23 states where it is illegal, and can be arrested and prosecuted, while efforts are underway to change the law."

 

So which is it -- 10 or 23?

 

 

The map is what the text states regarding those states where it is clearly illegal by legislation - as I thought I clearly stated above. This wikipedia article info is from 2006, and I would never use wikipedia as the end all be all of research, but as a quick starting point. If someone chooses to not do research, look at one source, or take the word of someone else, that's on them.

 

According to Valerie, it seems as though it is "illegal" in those other "murky" states, so while there is difference in legislation/clarity, she is saying it is illegal in all 23, (or current 2011 number if different). Which is what the above paragraph stated. What is unclear is that the map is showing the states with specific legislation making cpm illegal.

 

I still do not understand about how you can be unclear about whether or not your midwife is illegal or potentially illegal. Some women don't care. If it is very important to you that your mw is legal - and you know cpms are clearly illegal or are wondering about the shady legislation - then don't hire one. If a cpm is advertising herself as a cnm, that's a whole other legal issue, is it not?... and wouldn't you be able to ask to see a cnm's license/diploma if you were concerned? Wouldn't you find out if your mw is a cnm or cpm or neither? Why would you just take their word for how they understand their legality? If she is a cpm in a state cpms are illegal, even if she believes she is not illegal, why would you hire her if concerned about the legality? I have a feeling most women who hire cpms in the "shady" states are not that concerned about the legality, know their mw is a cpm, and take her word for her understanding of legality because they believe the legal reprecussions are on her side, or just don't care. That is not the same as someone like the OP who was VERY concerned about the legality and should go for a clear legal option if that is the main concern in her selecting a care provider.

 

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#190 of 285 Old 03-16-2012, 05:51 PM
 
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Originally Posted by Valerie View Post

For quite some time, some of us (a group of attorneys who deal with issues related to midwives and homebirth) have been nudging NARM to change that chart.  Some of it (especially those parts that refer to "legal by judicial interpretation" and such...) reflect a misunderstanding of the law and a misinterpretation of how it works.  Again referring to Ida Darragh's excellent essay in From Calling to Courtroom, she writes:

 

 

Valerie, is the chart in any way incorrect in specifying in which states cpm is "regulated?" As far as I understand it, it is fairly clear to see in which states it is clearly legal.

 

Anyone concerned more about the legality than anything else in hiring a mw, should probably err to the side to caution, if legality is their primary concern.

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And I think you are confusing the fact that I'm not a lawyer with an inability to determine whether or not my midwife can actually practice without the fear of prosecution. I've been quite aware of what the laws were in both states in which I have planned to use a home birth midwife. As I ALREADY explained, in this state, midwifery is technically legal, but midwives can't be licensed and they can't administer medications, HOWEVER my midwife is also an ND, and therefore she CAN do all sorts of things, including start IVs, carry certain drugs, prescribe certain drugs, etc. (because NDs have limited prescriptive power in my state). I'm pretty sure that means I understood exactly what the legal status of my midwife is in this state. If I lived in a state in which midwifery was completely unregulated, I'd be a little more clear on exactly how it worked in that state. The fact that I haven't needed to become highly versed in that particular situation in no way constitutes an inability to do so. To suggest that it does says more about your character than it does about my ability to learn something I need to know. 


What do you mean by "technically legal"?  If midwives in your state "can't be licensed," then how is it that they are authorized to practice midwifery?

 

Valerie RN, JD
 

 

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#192 of 285 Old 03-16-2012, 06:26 PM
 
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Originally Posted by slmommy View Post

 

Valerie, is the chart in any way incorrect in specifying in which states cpm is "regulated?" As far as I understand it, it is fairly clear to see in which states it is clearly legal.

 

Anyone concerned more about the legality than anything else in hiring a mw, should probably err to the side to caution, if legality is their primary concern.


I agree.  To the best of my knowledge, it is no problem to specify which states provide for the licensure of direct-entry midwives.  All you really have to do is look at statute.  It is when direct-entry midwifery is not addressed by statute that problems arise. 

 

Valerie RN, JD
 

 

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#193 of 285 Old 03-17-2012, 05:40 AM
 
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I still do not understand about how you can be unclear about whether or not your midwife is illegal or potentially illegal. Some women don't care. If it is very important to you that your mw is legal - and you know cpms are clearly illegal or are wondering about the shady legislation - then don't hire one. If a cpm is advertising herself as a cnm, that's a whole other legal issue, is it not?... and wouldn't you be able to ask to see a cnm's license/diploma if you were concerned? Wouldn't you find out if your mw is a cnm or cpm or neither? Why would you just take their word for how they understand their legality? If she is a cpm in a state cpms are illegal, even if she believes she is not illegal, why would you hire her if concerned about the legality? I have a feeling most women who hire cpms in the "shady" states are not that concerned about the legality, know their mw is a cpm, and take her word for her understanding of legality because they believe the legal reprecussions are on her side, or just don't care. That is not the same as someone like the OP who was VERY concerned about the legality and should go for a clear legal option if that is the main concern in her selecting a care provider.

 

I agree with this.  I still don't know how to just say I know my midwife isn't licensed by the state and therefore we both engaged in a practice that was illegal.  I still feel it was safe.  So, yes, I supported my "underground" midwife.  I would do it again.  

 

I assume others disagree. Fine.  What are we arguing about?
 

 


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#194 of 285 Old 03-17-2012, 02:00 PM
 
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[W]e both engaged in a practice that was illegal.

 


What did *you* do that was illegal?

 

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What did *you* do that was illegal?

 

Valerie
 

 


I knew that she'd be bringing pitocin, for example.  She didn't have to use it for me but it was a contributing factor to why I hired her.

 


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I knew that she'd be bringing pitocin, for example.  She didn't have to use it for me but it was a contributing factor to why I hired her.

 



Ok.  I understand the implications of an illegal midwife having and perhaps using Pitocin, but you said:

 

"I know my midwife isn't licensed by the state and therefore we both engaged in a practice that was illegal."  How is it that *you* "engaged in a practice that was illegal"?

 

Valerie RN, JD 

 

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Ok.  I understand the implications of an illegal midwife having and perhaps using Pitocin, but you said:

 

"I know my midwife isn't licensed by the state and therefore we both engaged in a practice that was illegal."  How is it that *you* "engaged in a practice that was illegal"?

 

Valerie RN, JD 

 


Well I suppose there's nothing I did that was illegal.  Maybe throwing the placenta in the trash!  I guess I'm stating that I knew "the score" when I hired her.

 

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#198 of 285 Old 03-18-2012, 08:11 AM
 
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It's easy for people who live in states where midwifery is legal to get down on illegal midwives.

 

I live in Alabama. It is illegal to have anyone help you at a homebirth -even a husband or partner. They can and have been known to prosecute in such instances. CNMs are legal, but they all work at hospitals and most aren't allowed to attend the actual delivery; that has to be done by an OB.

 

Natural birth is out of the question at most hospitals; VBACs are banned at most. If you try to refuse a repeat c/s, they'll do it without your consent. The c/s rate at some of our hospitals is over 50% -and climbing. Inductions and interventions are routine. Just try and get up and walk around during labor at most hospitals and see how quickly you get doped up -if you don't get taken to the OR.

 

In response to this craziness, there are a lot of underground midwives -almost all of whom are licensed and certified in any of the surrounding states that allow midwifery. Hundreds of women use them each year, and hundreds more travel outside the state to see other midwives. I intend to do the latter, but if I had no other choice in the matter, I would go with an underground midwife if I could. And I say this despite having one of the best OB/GYNs in the state.


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I support all midwives, particularly if they are practicing illegally. Mostly because they are willing to risk ALL they have for the rights of women to birth where they choose with whom they choose! Of course, I would check into their previous work and speak with others who have worked with them. I did request that info from our midwife. When you live in a state where homebirth midwives are illegal, you become a HUGE advocate for all those who are practicing under the radar! No one should have the right to tell me who I choose to employ to catch my baby. I can do it home alone with no skilled birth attendant and it be totally legal, and possibly un-safe, but to have a skilled birth attendant could cost her everything she has because she's practicing illegally? I don't think so! It's my body, my baby, my birth, my choice who takes part in the experience! There are a ton of Dr's out there who should not have licenses and likewise, a lot of midwives who shouldn't either. It should be consumer choice not dictated by an arbitrary government mandate who only cares because it's putting money in their own pockets! Licensing is just another for of tax and as far as I'm concerned, I love un-licensed midwives and support them 10000%!

Exactly!  Couldn't have said it better myself!
 

 


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#201 of 285 Old 03-19-2012, 06:05 PM
 
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Okay, this is my problem with the whole thing. I think there lots of women who are just sure that if they just ask questions of their midwives (and like the answers) that they are getting a competent provider. And I think that's a load of BS.

 

I don't think that most consumers of midwifery services (i) even know what questions to ask to ensure they are getting a competent providers and (ii) would be able to evaluate the "correctness" of their midwife's responses even if they did ask the right questions. Then there are all the important factors that questioning can't really tease out -- for example, how well does the midwife perform under pressure or in an emergency?  Does the midwife really know how to suture?  Could you evaluate how "good" her suturing was if she demonstrated it for you?

 

This isn't true just for midwives, its true for all medical professionals. For example, my MIL just recently had brain surgery. Do you think she or any of her family really knew, based on interviewing the doctor alone, whether he was competent to perform the surgery or not? Absolutely not.

 

What we relied upon for evaluating the doctor was:

 

(1) his educational history, including being a fellow in goodstanding of the appropriate boards of specialty

(2) his length of practice and frequency of performing the procedure in question

(3) his lack of malpractice claims

(4)  his licensing by the state board of medicine and lack of complaints filed with the board

(5)  his reputation amongst other doctors (NOT patients) to the best of our ability to determine

 

So, when you're only relying on a minimal number of criteria (some of which are irrelevant for CPMs -- for example #1 is almost completely irrelevant for most CPMs, since they largely obtain their skills through self-study and #3 is irrelevant for most CPMs -- since they are uninsured, they are uncollectible and thus they don't get sued)  those criteria become more and more important.  Since unlicensed midwives are insulated from civil lawsuit and there is no board keeping track of results or where complaints can be lodged it can be extremely difficult for a consumer to make an evaluation of their competency.    


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

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#202 of 285 Old 03-19-2012, 07:17 PM
 
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Okay, this is my problem with the whole thing. I think there lots of women who are just sure that if they just ask questions of their midwives (and like the answers) that they are getting a competent provider. And I think that's a load of BS.

 

I don't think that most consumers of midwifery services (i) even know what questions to ask to ensure they are getting a competent providers and (ii) would be able to evaluate the "correctness" of their midwife's responses even if they did ask the right questions. Then there are all the important factors that questioning can't really tease out -- for example, how well does the midwife perform under pressure or in an emergency?  Does the midwife really know how to suture?  Could you evaluate how "good" her suturing was if she demonstrated it for you?

 

This isn't true just for midwives, its true for all medical professionals. For example, my MIL just recently had brain surgery. Do you think she or any of her family really knew, based on interviewing the doctor alone, whether he was competent to perform the surgery or not? Absolutely not.

 

What we relied upon for evaluating the doctor was:

 

(1) his educational history, including being a fellow in goodstanding of the appropriate boards of specialty

(2) his length of practice and frequency of performing the procedure in question

(3) his lack of malpractice claims

(4)  his licensing by the state board of medicine and lack of complaints filed with the board

(5)  his reputation amongst other doctors (NOT patients) to the best of our ability to determine

 

So, when you're only relying on a minimal number of criteria (some of which are irrelevant for CPMs -- for example #1 is almost completely irrelevant for most CPMs, since they largely obtain their skills through self-study and #3 is irrelevant for most CPMs -- since they are uninsured, they are uncollectible and thus they don't get sued)  those criteria become more and more important.  Since unlicensed midwives are insulated from civil lawsuit and there is no board keeping track of results or where complaints can be lodged it can be extremely difficult for a consumer to make an evaluation of their competency.    


I think you highlighted your issues with women choosing cpm pretty well. I guess though, like you admit, we can never totally be sure of what exactly we are getting from any health care pro, on any given day.

 

I admit I am not very read-up on the process cpms go through for certification, since I'm not in the US and uc'ed. 

 

But, I would say, (1), there are some education programs for cpms, and apprentice-ship is a popular course, I don't think it is all self-study. Also, I would take an experienced midwife with years of experience and many births under her belt over an ob/gyn resident. I think in terms of birth, you can combine 1 and 2. (3) and (4), I think you can get around by word of mouth/some research. I know you stated before concern about mws name changes and moving, and difficulty for consumer to find that... but if your mw has been in the same area for many years, and attended many women in your community, you should be able to get a good idea. (5) is a good idea to overcome lack of 3 and 4, how well known/regarded by other mws, doulas, childbirth educators, other hcps, etc.

 

I don't know, I'm not well versed in NARM requirements like I said. You can push for better/different requirements/regulations. But then there will still exist lay midwives outside of cpms. You take away lay midwives, and women will still uc. Where is it going? At some point we have to let women make and be responsible for their choices and assume their own risks. 

 

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I believe percentage-wise there are more incompetent physicians attending births than CPMs and it's extremely difficult to tell which ones are incompetent.

 

But then my idea of incompetence and yours are probably different.

 

I would consider a lot of factors but here is an easy stat for the sake of argument:  Anyone know the stats on the number of docs in the neighborhood of 10% C-section rate for non-repeats?  How many even keep it under 20%?  Because that's my absolute ceiling and anything higher confirms incompetence and as far as I know that statistic alone would shrink the field pretty dramatically.

 

Other doctors don't give bad reviews of their peers for doing lots of sections, and as far as I know no one wins malpractice claims over unwarranted sections but in my reality they are tragedies of incompetence.  Fully authorized, ordained, legal, insured, and licensed but incompetent nevertheless.  There's always an excuse and a lot of them are flimsy and there's nothing we can really do against it.  It's a pretty risky gamble as far as I can tell. 

 

I guess a lot of us are completely screwed.  Look at the choices.  Now we have the illegality attacked when it was our only humane alternative in some places. 

 

 

 


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But then my idea of incompetence and yours are probably different.

 


I think this is really important.

 

For the moment, we are all "allowed" (most of the time) to make some alternative health choices - NDs, homeopaths, whatever non-traditional therapies. Someone interested in that type of medicine would have very different ideas and values about standards and course of treatment than mainstream. 

 

Personally, I feel that health freedoms are fundamental. 

 

ETA: I don't mean to necessarily compare natural, normal childbirth to alternative medicine. Natural, normal childbirth shouldn't really require any medicine in the majority of cases, just some help and support, and some assistance or help with plan B if things turn out not "normal" 

 

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You're right, we probably do priortize certain things differently. 

 

I hear about these extended labors and pushing phases (inevitably described as "gentle" -- which I will note is the mother's perception only) far off the curve of normality and what I think about is that little baby holding its breath during each contraction as the labor goes on and on and on.

 

 

 

 


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

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#206 of 285 Old 03-20-2012, 04:38 AM
 
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You're right, we probably do priortize certain things differently. 

 

I hear about these extended labors and pushing phases (inevitably described as "gentle" -- which I will note is the mother's perception only) far off the curve of normality and what I think about is that little baby holding its breath during each contraction as the labor goes on and on and on.


I have concerns about what is the curve of normality and who sets it. (placental delivery and time limits there I think are really absurd, ot, but, so what if it takes 41 minutes instead of 30, or 15?). Everyone seems to have very different labors... and interventions can cause your labor to go differently in unexpected ways.

 

What do you mean little baby is holding its breath? I was under the impression that in most cases of healthy mom, baby, and healthy placenta, the baby still receives some, but reduced oxygen during contractions, and/or even if the bloodflow is cut off during a strong contraction that the healthy fetus can tolerate this. (I've read that the guy who invented fetal heart monitor never intended, or saw it necessary for every mother/fetus to be monitored). I had extended pushing phase, and I would definitely not call it gentle, and I didn't try to prolong it to torture my baby. I guess we just see things differently, you are worried about the stress of normal labor on the baby, and I would be more concerned about stress of electrodes being pinned into scalp, pitocin contractions, vaccum or forceps, immediate cord cutting and treatment after birth, etc.

 

 

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I had an OB with which I was doing shadow care who recommend using Cytotec to induce my labor.  When I asked if there were any side effects (having researched it before), she responded "none".  I don't see how that's competent or professional.  I'm not going to argue about whether it should be used on pregnant women even though it's not FDA approved for that, but to say it has NO side effects is bad medicine to me.

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I had an OB with which I was doing shadow care who recommend using Cytotec to induce my labor.  When I asked if there were any side effects (having researched it before), she responded "none".  I don't see how that's competent or professional.  I'm not going to argue about whether it should be used on pregnant women even though it's not FDA approved for that, but to say it has NO side effects is bad medicine to me.


Those of us who haven't been to medical school or studied for years and years may not know enough to fully judge/choose a hcp, as Buzz pointed out... but when the little you *do* know is in apparent conflict with hcp... time to run!!

 

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#209 of 285 Old 03-20-2012, 10:45 AM
 
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On one hand, I've known for years that I wanted to have a homebirth. On the other, when I got pregnant, I started by seeing a great hospital-based CNM. It would have been covered by my insurance, legal and all. But no matter how much I was trying to like the experience, I wasn't.

I then went to find a homebirth midwives. And I have to say that I was surprised by the results of my search. I used to think that homebirth is a philosophy of sorts. And I was very surprised to actually see how different midwives were completely different from one another. What was normal to one, was a reason to transport for another. etc, etc.

Some of the midwives I interviewed were legal (CNMs), but in all honesty - I was not feeling them at all. Neither was my husband. I did not like what they had to say or how they answered my numerous questions (which included what will you do if ...). But then I did not like some of the underground midwives either. I did find one that I meshed with the most. I agreed on what she had to say. I talked to some of her previous clients, I asked hard questions, but in the end I was confident with my choice.

If I went down the legal route, I would have never had the kind of care I actually desired. The legal route for me would have been 9 months of painful misery and a lot of fights for what i wanted vs what they wanted with my care provides.I would have spent 9 months worrying that my birth will not be what I want.

 

Of course, I fully understand that different people desire different things. Different people look for different things in their midwife and an overall experience. What I may want - somebody else may not want at all. I get it. But for me personally - only one midwife actually fit what I wanted, and she was illegal.

 

While I would agree that being legal is definitely preferred to illegal, I do support the underground midwives. Had I not had the support of one of them, my pregnancy and birth would have been an experience very damaging to my mental health (and no, I am not exaggerating because I have a past history that affects how I deal with issues of intimate nature in my life).

 

eta: while it may appear from the above that I was putting myself above the baby;s safety, that is not the case. I did meet one underground midwife who I believed was unsafe. I also met a legal midwife who was so medical, both my husband and I wondered why she chose to do homebirths at all. Inductions and transports seemed abundant and "no big deal" kind of thing.
I genuinely do not know what would have happened if I did not find the midwife I chose, but I can honestly say that she practiced in a way that I believe was safe and science-based while also fitting my requirements for emotional comfort.


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#210 of 285 Old 03-20-2012, 11:34 AM
 
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Quote:


I think this is really important.

 

For the moment, we are all "allowed" (most of the time) to make some alternative health choices - NDs, homeopaths, whatever non-traditional therapies. Someone interested in that type of medicine would have very different ideas and values about standards and course of treatment than mainstream. 

 


This is an excellent point! While there are some NDs and homeopaths around taht practice where I live, they are not exactly legal either. Insurance does not cover my ND. And it doesn't matter that he has an official education and his license is perfectly legal in another state.

Yet, I cannot tell you how many times I have been helped by these kinds of practitioners. If they were to be hunted down as much as midwives are here in IL, it would be beyond devastating.

 

While the legal argument is that technically homebirth is legal anywhere, it's only the practitioners that are forbidden, this argument is driving me up the wall.

Why is it that it is legal for a practitioner in, say, WI) to do a VBAC at home while it is not legal in, say, IL?

What are they implying? That those practitioners in WI are better trained? And if that is not the case, are women in IL and WI different? Can the WI women's bodies birth by VBAC inheretently safer than the IL women? I mean, that really is absurd, isn't it? it almost feels discriminatory in a way. WHy is WI any better than IL???

We have those freedoms, but no legal ways to achieve them. What is the point? And if somebody is making a law that affects these freedoms (like a law where a legal practitioner cannot do a VBAC at home) how is that not taking it away?


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