Thoughts on "planned home births are associated with double to triple the risk of infant death than are planned hospital births." - Page 3 - Mothering Forums

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#61 of 394 Old 03-11-2013, 11:28 AM
 
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I really don't think that high school education is necessary for training, nor is university necessarily the correct approach. But I do believe that regulation and ensuring a high level of education is important, in the sense that midwives who train are taught the appropriate information and ensured to have the required competency to practice. There are some great programs in the USA for becoming a midwife, that are not at a university but are incredibly indepth and comprehensive. And there are some really basic programs as well that I really hope people use as their sole education (though I know some do). You also have to remember that here in Canada, while midwifery is a university education, 2.5 years of that 4 year education is focused on clinical learning. Students still do a few courses per semester but the focus is on clinical experience.

 

Great discussion guys, it is really refreshing seeing a debate that does not dissolve into arguments and insults!


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#62 of 394 Old 03-11-2013, 11:58 AM
 
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I didn't mean to sound defensive; also, was responding to two separate posts in one and probably should have clarified. :)

I think midwives here (in the US) tend to be adversarial out of reaction to an adversarial attitude toward them (and homebirth).  In many places, if you transfer into the hospital, or if you go into the hospital for something else during your pregnancy, and they find out you're planning a homebirth, you're treated like a third-class citizen. 

 

I hate that there is not a "stepped" set of options.  I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor.  Essentially, that's the traditional way of doing things.  Women didn't all used to call doctors to deliver their babies.  They just - had babies - generally with other women around them, but not necessarily "qualified midwives." If they needed more help, they called in the local "wise woman," who *did* have more knowledge/experience.  And as a last resort, if necessary, they called on a doctor.  But liability keeps this from being an option anymore.  You pretty much have to choose your highest level of intervention from the start.  (That's not an absolute.  But generally speaking.)

 

And I totally agree about so much being pharma-company-driven that it's hard to find studies, papers, etc. that are unbiased.  Even the "other side" then tends to be biased because of a strong felt need to prove their point.

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#63 of 394 Old 03-11-2013, 02:00 PM
 
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And why is there a hostile attitude towards midwives? Or, is it just some midwives.

I am a midwife with a birth center/home birth practice. I have no problem sending my clients to the hospital during the pregnancy or during labor. For the AP trips to the hospital I will sometimes get a call from the ER doc letting me know what's going on and if there is anything else I would like done. Sometimes there are dumb questions or comments from nurses, and occasionally doctors, that the clients tell me about, but nothing hostile.
 

It may be because I tell the clients that if we need to transfer in , it will be because the hospital can do something I can't, or because the baby and mom need a bit closer watch than is appropriate OOH. If we go in being respectful and truthful, we may get a doc who starts out hostile, but realizes we aren't being adversarial and defensive. Then they relax and it can be a really good experience. The docs learn that all OOH birth midwives and families all want what is best for the mom and baby and the families learn that hospitals are not evil places forcing unwarranted interventions. I always introduce myself, take full responsibility for the care provided and truthfully answer all the questions needed so the staff has the history they need to help the family make the best decisions they can.

 

Been an OOH midwife for more than 10 years and I see things getting better in terms of hospital acceptance for the parent's wishes when we do have to transfer in.


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#64 of 394 Old 03-11-2013, 02:13 PM
 
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Great discussion guys, it is really refreshing seeing a debate that does not dissolve into arguments and insults!

 I think that has to do with the quality of the people participating ;)


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#65 of 394 Old 03-11-2013, 02:33 PM
 
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I have a long time frIend who emagrated to Ontario. She was a self- study apprentice trained midwife who was licensed here and had lived in several other states and became licensed in those states as well. She called and talked directly to the people managing the bridge system and she was accepted into that pathyway of being licensed so basically she had to learn the hospital side of things and is now a LM in Ontario. It is still adversarial and they artifically keep the number of midwives down because doctors are so unhappy with having to support midwifery care. The way they keep the numbers down is very subitle-the hours of work/on call number counter is a limited set so if you actually do more hours there is no way to report it, and all the midwives that serve home or hospital do more hours than the counter allows- if they would remedy that there would be more midwives. And there are things like if you s transfer a mom in for pain meds the midwife administers them and then stays to be the labor nurse - doctors have labor nurses they dont have to labor sit... Midwives are on their own- these are the subitle ways that they fight against midwifery care... There are some obvious ways too but it is like here case by case. And they can have similar EMS fiascios...

It is to say that you may not have to have a degree if you have enough experience- and you take some college accredited classes then do their bridge program-
Here we already have CNMs established as hospital midwives and they are moving toward a doctorate education base-if CPMs were to bridge like the gals in Canada did it would undercut their educational base and the power behind it... I just think of CPM and some LM educational pathways as being the vocational tech school of midwifery- a CNM when in nursing school gets an hour or 2 of didatic education on pregnancy and birth so no wonder that they need more schooling to become a midwife- many many more hours of education directed toward maternal and child health- unfortunately because they are " degreed" programs you are writing English papers too and so then again stretches out the number of hours it will take to actually study the core subjects . There is a reason that RN programs dont move away from jr colleges and that is because the level of training is just as good if not better with those quick programs as far as learning the basics- i am saying that 2-3 years would probably suffice if we were to support a vocational education in Midwifery instead of a higher degreed program. My friend that is in Canada she didnt ahve to learn anything new about midwifery what she had to learn was medicine- like how to monitor an epidural... And she wants to stay as far from that as possible-
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#66 of 394 Old 03-11-2013, 03:03 PM
 
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mwherbs,   When you mention the OB portion of a nursing program, what is your reference for the didactic of 1-2 hours regarding pregnancy and birth?
 


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#67 of 394 Old 03-11-2013, 06:11 PM
 
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I think midwives here (in the US) tend to be adversarial out of reaction to an adversarial attitude toward them (and homebirth). In many places, if you transfer into the hospital, or if you go into the hospital for something else during your pregnancy, and they find out you're planning a homebirth, you're treated like a third-class citizen.

That post makes me sad. In my community home birth transfers are treated very well. I live in a state where midwives don't have to throw their clients out at the er bc they are afraid of punishment. I have dreams about women having the ability to feel safe about wherever they give birth. I am afraid though that this will remain a dream for a lot of women in our country (the US). The truth is we don't need studies to tell us that hospitals need to stop using unnecessary intervention and that hb mw need better practice standards. Women need to do the best research they can in their area. If my only option was a hospital with a 40% cesarean rate, bet your butt I would be looking for a midwife. If my only option was a backroom mw, w/o good credentials my choice would be to find the best hospital possible. We can't categorize hb in the US at all, there are too many variables.
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#68 of 394 Old 03-12-2013, 11:11 AM
 
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"I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor."

 

I believe that this is the way that things are supposed to ideally work in the UK -- they have their homebirth option, midwife led units and consultant led units. 

 

However, it is not a perfect world over there as there have been some reports of "turf issues" with midwives unwilling to transfer patients to consultant led units as the patient's risk profile changes.  Additionally, while I am not in the UK myself, I have been on enough "mommy boards" that I have seen women located in the UK complaining about the difficulty of getting an epidural on request.  I believe that an epidural would, in the UK, require transfer of the patient from a midwife lead unit to a consultant lead unit -- so I have some suspicions that there may be midwives attempting to delay/interfere with epidural requests in order to retain the patient in the midwife unit.

 

I'll see if I can dig up some of the reporting on this...


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

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#69 of 394 Old 03-12-2013, 11:21 AM
 
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Well, my husband has also pointed out, in the hospital personnel's defense, that for most of them, the only "homebirths" they've ever seen are the ones that resulted in transfers!  So their experience with homebirth is typically that it's "bad," dangerous, or "doesn't work."

 

We are actually hoping that we helped with this perception at our local hospital, when we came in with preterm labor at 29 weeks.  We'd had 2 homebirths already - with perfectly healthy babies - and were planning a homebirth with this third, but went in to the hospital when the preterm labor began.  This not only allowed them to see that our older girls were safe and healthy, but that we were obviously not opposed to medical care when we felt it warranted.  I don't think they get to see that much.  (And they were able to stop my labor, I carried to term, and we delivered at home - and took baby back in to visit "her" nurses. :) )
 

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#70 of 394 Old 03-12-2013, 11:44 AM
 
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I have a long time frIend who emagrated to Ontario. She was a self- study apprentice trained midwife who was licensed here and had lived in several other states and became licensed in those states as well. She called and talked directly to the people managing the bridge system and she was accepted into that pathyway of being licensed so basically she had to learn the hospital side of things and is now a LM in Ontario. It is still adversarial and they artifically keep the number of midwives down because doctors are so unhappy with having to support midwifery care. The way they keep the numbers down is very subitle-the hours of work/on call number counter is a limited set so if you actually do more hours there is no way to report it, and all the midwives that serve home or hospital do more hours than the counter allows- if they would remedy that there would be more midwives. And there are things like if you s transfer a mom in for pain meds the midwife administers them and then stays to be the labor nurse - doctors have labor nurses they dont have to labor sit... Midwives are on their own- these are the subitle ways that they fight against midwifery care... There are some obvious ways too but it is like here case by case. And they can have similar EMS fiascios...

It is to say that you may not have to have a degree if you have enough experience- and you take some college accredited classes then do their bridge program-
Here we already have CNMs established as hospital midwives and they are moving toward a doctorate education base-if CPMs were to bridge like the gals in Canada did it would undercut their educational base and the power behind it... I just think of CPM and some LM educational pathways as being the vocational tech school of midwifery- a CNM when in nursing school gets an hour or 2 of didatic education on pregnancy and birth so no wonder that they need more schooling to become a midwife- many many more hours of education directed toward maternal and child health- unfortunately because they are " degreed" programs you are writing English papers too and so then again stretches out the number of hours it will take to actually study the core subjects . There is a reason that RN programs dont move away from jr colleges and that is because the level of training is just as good if not better with those quick programs as far as learning the basics- i am saying that 2-3 years would probably suffice if we were to support a vocational education in Midwifery instead of a higher degreed program. My friend that is in Canada she didnt ahve to learn anything new about midwifery what she had to learn was medicine- like how to monitor an epidural... And she wants to stay as far from that as possible-

actually that depends completely on the hospital, each hospital sets their own policies when it comes to midwives. Also not every doctor is upset with supporting midwifery care. Midwives have a "counter" to help with burnout and for allowing safe practices. For instance if you are up 24 hours you are to have a mandatory 8 hours off (I think its 8) because they recognize that after so much time working you may not be making as sound choices due to sleep deprevation. Most of what you stated entirely depends on the hospital, in some areas midwives have full scope of practice in regards to induction and epidurals.


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#71 of 394 Old 03-12-2013, 11:46 AM
 
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"I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor."

 

I believe that this is the way that things are supposed to ideally work in the UK -- they have their homebirth option, midwife led units and consultant led units. 

 

However, it is not a perfect world over there as there have been some reports of "turf issues" with midwives unwilling to transfer patients to consultant led units as the patient's risk profile changes.  Additionally, while I am not in the UK myself, I have been on enough "mommy boards" that I have seen women located in the UK complaining about the difficulty of getting an epidural on request.  I believe that an epidural would, in the UK, require transfer of the patient from a midwife lead unit to a consultant lead unit -- so I have some suspicions that there may be midwives attempting to delay/interfere with epidural requests in order to retain the patient in the midwife unit.

 

I'll see if I can dig up some of the reporting on this...

it would require a consultant but midwives would still lead the woman's care. Transfer of care in the UK almost always means that doctors are consulted and not that midwives are no longer involved.


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#72 of 394 Old 03-12-2013, 02:00 PM
 
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How many newborns would the average midwife deliver a year if they weren't limited or regulated?

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#73 of 394 Old 03-12-2013, 02:08 PM
 
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Most transfers are non emergic. They are for pain medication, failure to progress and poor presentation. True emergency transfers are not what docs commonly see. The most recent ACOG statement on homebirth chastised doctors for being unprofessional with transfers.
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#74 of 394 Old 03-12-2013, 07:02 PM
 
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For example,

 

"Gas and air, water and morphine are all available on the MLU. Epidural is not, but can be obtained if necessary downstairs in the CLU. If we had any concerns about you or your baby during your labour, you would be transferred downstairs to the CLU."

 

http://www.enherts-tr.nhs.uk/patients-visitors/our-services/maternity/midwife-led-unit/

 

In a "midwife led unit" as the name indicates, primary professional responsibility lies with the midwifes.  Upon transfer to a consultant led unit, the OB assumes primary professional responsibility (while others remain involved in care).  What I am concerned about is the battle for "control".

 

This is one example of the sort of turf war I mentioned earlier (please note, story involves a number of baby deaths and includes pictures):

 

http://www.dailymail.co.uk/news/article-2038746/Midwives-ignored-doctors-instructions-scandal-hit-Cumbria-maternity-unit.html


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

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#75 of 394 Old 03-12-2013, 07:57 PM
 
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This is one example of the sort of turf war I mentioned earlier (please note, story involves a number of baby deaths and includes pictures):

 

http://www.dailymail.co.uk/news/article-2038746/Midwives-ignored-doctors-instructions-scandal-hit-Cumbria-maternity-unit.html

Here is a better link for this story, which deals with hospital birth doctors and midwives. I don't see how this is relevant to a discussion about homebirth, unless we are talking about some of the advantages of HB over hospital birth. 


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#76 of 394 Old 03-13-2013, 07:32 AM
 
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I'll be honest, I couldn't bring myself to read the article, not because I choose to close my eyes to information, but because the daily mail is just a tabloid.... one of today's other headlines: 'Drunk man punched girlfriend's father and bit a boat captain after getting caught having sex in the bathroom on a cruise' lol

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#77 of 394 Old 03-13-2013, 04:10 PM
 
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I had a great "easy" pregnancy.  I was well taken care of seeing a midwife and an OB that I started with before I decided I really wanted a home birth.  Everything was normal the whole time.  Labor was great and fairly quick from what I am hearing.  During the home birth me and the baby were checked and monitored  (fever, BP, fetal heart tones...) and again all was great.  However, my little angel did not breath after delivery.  I was not that scared right away.  I was very prepared and saw lots of videos and knew that if could take a few seconds. Seconds turned to minutes and she never took a breath.  Ambulance was called and they arrived in minutes. It was all too long for my daughter and she lasted a week at the hospital on every type of machine to keep her different, delicate systems functioning.  It was a horrible experience and as much as I would love to experience giving birth in the comfort of my home and to be able to snuggle with my child and husband in our own bed in our home after delivery.  I could never chance it again and I could never recommend it to someone else.  Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

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#78 of 394 Old 03-13-2013, 04:36 PM
 
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I could never chance it again and I could never recommend it to someone else.  Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

Totally understandable, mama, and I'm so sorry for your loss, especially as a fellow Baltimore area mother. PM me if you need/want any local support. heartbeat.gif


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#79 of 394 Old 03-13-2013, 11:39 PM
 
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How many newborns would the average midwife deliver a year if they weren't limited or regulated?

I don't know but midwives can do up to 60 births a year, plus the ones they do secondary for and any backup they provide. As a future midwife I cant imagine attending more than 8-9 births a month on top of prenatal and postpartum care. Our midwives already experience a high level of burnout being on call as they are.


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#80 of 394 Old 03-14-2013, 06:44 AM
 
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I don't know but midwives can do up to 60 births a year, plus the ones they do secondary for and any backup they provide. As a future midwife I cant imagine attending more than 8-9 births a month on top of prenatal and postpartum care. Our midwives already experience a high level of burnout being on call as they are.

That's what I had heard too, I just wasn't sure if it was correct. Also, as with any profession, I'm sure you're expected to devote a certain amount of time for professional development. 

 

At 60 babies and $2,500 per baby, it doesn't really seem to me that the government would be squeezing midwives out of the system. There aren't many professions in Canada which take 4 years of university where you're almost guaranteed a job and paid that kind of money. If it's something you enjoy doing (you couldn't pay me a zillion dollars a year to deliver babies! lol) it seems like a pretty good deal to me. 

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#81 of 394 Old 03-14-2013, 07:03 AM
 
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Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

 

I am so sorry, Knoel. How heartbreaking. My heart goes out to you. This is so, so sad. I can't imagine not having an answer for my child's death, either. How incredibly hard.

 

Thank you bringing us all back to the reality that when we discuss safety statistics we are talking about real people and real lives - not just numbers.

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#82 of 394 Old 03-14-2013, 07:20 AM
 
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At 60 babies and $2,500 per baby, it doesn't really seem to me that the government would be squeezing midwives out of the system. There aren't many professions in Canada which take 4 years of university where you're almost guaranteed a job and paid that kind of money. If it's something you enjoy doing (you couldn't pay me a zillion dollars a year to deliver babies! lol) it seems like a pretty good deal to me. 

There seem to be a strong disagreement within (some of) those who support homebirth midwifery and many who oppose it about whether midwives make a lot of money. My impression is that homebirth midwifery is a fairly low-paying job for comparable stress and work-load. 

 

Let's keep in mind that even if a midwife takes her allowable 60 births/year, she has expenses even in areas where midwives either do not or cannot afford malpractice (another hot issue).  All of the midwives I'v seen have and office, an office manager, supplies and equipment galore, stock herbs and medicine, a full library, must have an extremely reliable car, and in the States they must pay for things like private medical insurance and pay taxes out of that salary. 

 

Multiplying midwifery fees times the number of births does not give a remotely accurate view of a midwife's salary, I am quite sure (as someone who worked closely with a small business owner).  

 

Maybe some of our midwives can comment more on this subject...


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#83 of 394 Old 03-14-2013, 07:50 AM
 
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Yeah, midwifery is not exactly lucrative around here. My last homebirth, 4 years ago, was $3000 but I'll assume it has gone up by now. That covers everything except the birth kit and nbs. She has to pay her assistance, bloodwork, licensing fees, office expenses, urine tests, repair and replace equipment, additional birthing supplies, fuel for her vehicle, vehicle upkeep, phone and pager, educational upkeep, professional memberships, advertising,  etc... and be on call so she can't exactly schedule a bunch of women all together. And yes, Idenity is right, she must pay her own self-employment taxes in addition to federal and state income taxes and her own health insurance and liability insurance if she can afford it. Not to mention that so many midwives believe their work is a service to the community amd women they serve so they often will reduce fees or allow women to make payments over many months. 

 

My husband charges a comparable hourly rate for his work. On the surface you would think we were doing well, but after expenses and the number of hours he has to put in vs. the hours he charges for it doesn't amount to much, not enough to be considered a living wage for our area.

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#84 of 394 Old 03-14-2013, 08:14 AM
 
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FYI, in a CU, midwives are still handling the vaginal deliveries--they just don't run the unit. It's slightly confusing in that you can technically be under midwife care for antenatal and deliver in a CU. Most women deliver in CUs--the distinction is more analogous to a birthing center (MLU) vs labor & delivery (CU). The issue with getting an epi in a CU is separate; until a few years ago, not all units maintained 24/7 anesthesia availability or restricted it to surgery only. Most units now maintain it but staffing is not always adequate to ensure all women who want one get it, plus there is politicization of epidural when it comes to the RCM and some midwives do not behave well when one is requested. As a practical matter, especially out of hours, coverage in consultant units is not always adequate. There have been changes since my first delivery, but back then, consultants worked office hours. Nights and weekends, registrars (residents) were doing all the work. 

 

If you developed pre-eclampsia (FYI, I delivered my first in the UK, chronic hypertension with superimposed PE) you would be transferred from MLC to CLC antenatally and would automatically deliver in a CU. I was transferred to consultant led care early in pregnancy when my hypertension was discovered--it is considered risk out for midwifery. The official criteria for MLC in my trust were extremely stringent (no VBACs for example) and there is some "turf war" over cases. In addition you can be nominally under consultant care (as for VBAC) but yet have the vast majority of your care done by the midwives as the consultants have their hands full with women who actually need specialist obstetric care. (I had all my regular antenatal visits with an OB, but when I needed to come in just for urine and BP, I could see a midwife.) 

 

As for education: it's hard to compare UK based education to American. First of all, a number of health related fields that are considered graduate entry in the US are considered undergraduate in the UK, so our insistence on graduate level preparation for midwives has to be considered in light of the fact that we also require it for physical/occupational therapists, which they do not. (In fact, medicine is a first degree in the UK--a 5-6 year program with no previous bachelors required.) In addition, the UK BSc in Midwifery prepares you for all aspects of care--home, hospital, and community. The American CPM only prepares you for home, which is part of the reason it would not be considered adequate in Europe. 


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#85 of 394 Old 03-14-2013, 08:34 AM
 
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There seem to be a strong disagreement within (some of) those who support homebirth midwifery and many who oppose it about whether midwives make a lot of money. My impression is that homebirth midwifery is a fairly low-paying job for comparable stress and work-load. 

 

Let's keep in mind that even if a midwife takes her allowable 60 births/year, she has expenses even in areas where midwives either do not or cannot afford malpractice (another hot issue).  All of the midwives I'v seen have and office, an office manager, supplies and equipment galore, stock herbs and medicine, a full library, must have an extremely reliable car, and in the States they must pay for things like private medical insurance and pay taxes out of that salary. 

 

Multiplying midwifery fees times the number of births does not give a remotely accurate view of a midwife's salary, I am quite sure (as someone who worked closely with a small business owner).  

 

Maybe some of our midwives can comment more on this subject...

I was just speaking about the Canadian system... Their average salary is $80,000-$100,000 after overhead and expenses. If they're not making that much they're either not working as much or not managing their practice properly. Almost everything is written off and the corporate tax rate keeps getting lower and lower. Insurance is mandatory but written off as well as professional memberships. Any medications on the "Drugs in Midwives’ Authority" list are dirt cheap in Canada anyway (that's why we get busloads of Americans filling their prescriptions here and going back with suitcases full of pills). I'm not saying that it's easy work or that I could even do it, but if it's something someone loves to do, it's pretty decent compensation compared to other government funded professions in this province, and the chances of finding work are almost guaranteed.... whereas if you study to become a teacher, you require more education, make about half as much and there are currently 3x more teachers graduating than there are teaching positions.... so it seems to me that our government under compensates equally and without prejudice.   

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Total on call hours would show that there needs to be more midwives because the hours are over and above what is thought to be reasonable...so if all the hours were truly tallied then there would be more employed midwives- the demand in Canada is high and the home births get booked way out ahead and there are waiting lists, but most of the births midwives are handling are hospital births in Canada. Of course not every doctor is against midwives, not my point, intergration into the hospital is still not just simple perfect and seamless. There are some basic policies in general that are different than the majority of US hospitals- like continous electronic fetal monitoring- does every laboring mom have this in Canadian hospitals?
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#87 of 394 Old 03-14-2013, 12:18 PM
 
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40% of women in Ontario who request a midwife don't get one, so that alone should indicate we need more midwives but there doesn't seem to be any interest for many to become one. The university programs are undersubscribed, I heard there are only something like 30-40 new midwives registering each year.

 

Not ever laboring mom has fetal monitoring here, I've never heard about it used with anyone I know. 

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mwherbs

 

I left a reply to one of your post farther up this thread. You stated that nurses only get 1-2 hours didactic for pregnancy and birth. Do you have a source for that statement?

 

Thanks
 


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I was just speaking about the Canadian system... Their average salary is $80,000-$100,000 after overhead and expenses. If they're not making that much they're either not working as much or not managing their practice properly. Almost everything is written off and the corporate tax rate keeps getting lower and lower. Insurance is mandatory but written off as well as professional memberships. Any medications on the "Drugs in Midwives’ Authority" list are dirt cheap in Canada anyway (that's why we get busloads of Americans filling their prescriptions here and going back with suitcases full of pills). I'm not saying that it's easy work or that I could even do it, but if it's something someone loves to do, it's pretty decent compensation compared to other government funded professions in this province, and the chances of finding work are almost guaranteed.... whereas if you study to become a teacher, you require more education, make about half as much and there are currently 3x more teachers graduating than there are teaching positions.... so it seems to me that our government under compensates equally and without prejudice.   

 

There isn't really a "Canadian system", it varies widely from province to province, and even from region to region in some provinces.  I'm also pretty sure it's even higher stress than teaching, and there are more hoops to jump through in order to become fully trained.

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40% of women in Ontario who request a midwife don't get one, so that alone should indicate we need more midwives but there doesn't seem to be any interest for many to become one. The university programs are undersubscribed, I heard there are only something like 30-40 new midwives registering each year.

 

Not ever laboring mom has fetal monitoring here, I've never heard about it used with anyone I know. 

you need to do more research :) The university programs get hundreds of applicants, it is incredibly hard to get in, in Ontario only 90 places between the three schools and over 900 apply, the same goes for MRU and UBC, they get probably 6-10 times more applicants than there are seats. This is my third year applying. We have more than enough interest the problem stems from not being able to have enough preceptors for our students and as such we cant raise the seats higher than we can support. Midwives have to pay professional fees every year as well as other business expenses, out of pocket, this is deducted off their paycheque. You are on call 24/7 and depending on where you work you either have 6-8 days off a month or 2 weeks off call, while still doing clinic work. Midwives do make decent money but they still have disparages in their pay and it's a job of passion not money or prestige.

 

electronic fetal monitoring is generally used when there is an indication


Aspiring Midwife applying to University for fall 2011!
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