midwife under fire in MO - Mothering Forums
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#1 of 31 Old 10-15-2010, 10:32 AM - Thread Starter
 
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Whether you are a supporter of homebirth in our tribal area, or simply support families' right to choose their birth care, you may be interested in helping:

First, a link that will take you to the fundraising campaign for legal defense:

http://pledgie.com/campaigns/13728

This is the first news story to emerge about this case:

http://www.news-leader.com/apps/pbcs...D=201010090336

This is the 'probable cause statement' from the police dept as they prepared to levy charges against the mw:

http://www.news-leader.com/assets/pd...25egI0nWKn4%3D

Please remember in reading these things, that 1. The media knows nothing about birth but a LOT about sensationalizing things. 2. The probable cause statement contains the plain facts *as the officer understands them* (which may well leave out other pertinent facts)...including comments he heard made by a doctor involved. Most dr.s know nothing of natural birth, let alone homebirth and apparently, the dr quoted is pretty anti-homebirth.

Some other things--these comments are long, but I hope if you're a supporter of hb or just choice, you will read it anyway It could help...you, your friends, and midwifery:

Whether or not you would support a non-CPM mw for your own births, remember that this sort of case can and no doubt will be used against MO midwifery in any way possible by those who are already trying to knock down our CPM-legal status. That is just the nature of politics--money and power tend to be strong motivators. We don't know why this mw was not a CPM, because it seems she had a lot of experience--possibly, enough to apply for the CPM exam. But sometimes it is only $$ that prevents a qualified mw from taking the exam, since the whole NARM process costs at least $1400.00. That can be prohibitive for some (or at least delay their CPM application while they save $$). So we should NOT assume that the mw was 'less experienced' than she needed to be to apply for the NARM exam/CPM.

In fact, it is POSSIBLE that she was far more experienced than many mws who are able to afford taking the NARM exam. Remember that achieving CPM status is based on 'minimum numbers of prenatal/birth/newborn/pp experiences'--a number of those elements of birth care that are considered to be enough for 1. Being able to competently work with normal birth and 2. Being able to spot difficulties that are beyond the mw's skills--so she knows when to get help.

So--many a newly-certified CPM has little or even NO experience dealing with complications that can occur with pregnancy/birth/newborns. She may be quite competent when it comes to helping with normal birth--which MOST births are! But it is also likely, especially if a student mw 'fast tracks' her way to a CPM (only gaining the min clinical experiences needed to apply for the NARM, as is becoming more common), that she has not seen much 'deviation from the norm'. But NARM standards do include measuring any mw's ability to spot difficulties best handled by more experienced providers than she may be when first certified. This is very important to know--along with knowing that some difficulities CAN be managed well by a more-experienced mw, and in far fewer cases, only by an OB with hospital/med technology.

Also, it has come to my attention that in MO, anyway, some mws are criticized for having 'too many transfers of care'. It seems to be a belief that ANY transfer from home can too easily be used against mws generally--if she goes to the hospital, then she is open to legal attack, especially if she is not a CPM yet. And this belief makes no sense to me, given my long years watching homebirth, midwifery, prosecutions (nationally), etc. First, some really do need medical care, even if they started pregnancy in the 'lowest-risk category'. 2nd, sometimes it is hard to determine EARLY ENOUGH TO GET HELP, just who truly will need med care. Thus, it may be most prudent to transfer care for some who end up with normal births in the hospital....because of 10 ppl transferred, maybe only 1 really needed it...but it could not be determined EARLY ENOUGH TO GET HELP just which of those moms/babies would truly need med help. Many issues resolve with a mw's help, or just on their own during labor--some get worse. No matter how experienced a mw is, though experience can make a difference, there are scenarios at birth that are impossible to predict.

Know too, that some of a mw's transfers may occur from CLIENT CHOICE--even if the mw believes things are still plenty safe. It is your right to go to the hospital if YOU feel it's best--even if your mw disagrees. While it's a good thing for a mw to give the reasons she feels staying home is still safe (or maybe that she can help you w/pain management well enough, if you're thinking 'epidural'), a mw who is operating with respect for informed consent will support families' wishes about transfer and not argue about it; she will not insist on having her way. Remember that a mw, apart from safety concerns, has a concern for her reputation and 'transfer stat', and possibly will fear for her legal safety--these things should NOT get in the way of your wish to transfer. She will respect your wishes AND YOUR INTUITION, and accompany transfer and help you in every way possible to have the best birth possible.

I would never want a mw or family to think that having the baby at home is THE most important thing. A mw with knowledge of medical protocols, and good communication skills is well-able to help make a hospital transfer a positive experience for families, even if they do need medical help. And if transfer turns out to be 'unneeded', then it is still possible to have a natural birth with little interference in the hospital. A mw's comm skills, and a family's preparedness for this possibility makes all the difference.

So, when you're interviewing a mw, it is important to speak with her about transfer of care. During pregnancy, considering transfer of care is very important for all, even if only few families really need it. You might even ask prospective mws for references from clients with whom she has transferred care, so you can get an idea of how she handles transfer. Know too, that the national 'norm' for hospital transfer is 10%, among licensed or certified mws. THIS IS PRUDENCE IN ACTION, not fear or incompetence. A good mw may well have a lower transfer rate (and many mws say that they transfer more 1st time moms, for exhaustion or pain relief, more than other moms--their stat for FTM's may be over 10%, but for other moms, lower--and the total average is 10%). I myself would be somewhat suspicious of any mw who claims a transfer rate below about 7%....because most likely, she is staying home with some moms in situations where the availability of med care (if not it's actual use) is safest for moms/babies.

Think of it this way: let's say there are 10 transfers of care, but only 1 of those moms/babies really needed (or just wanted) medical care or at least medical oversight/availability. The other 9 can still potentially have ecstatic births in the hospital, at least if they are prepared, and if their mw has good comm/advocacy skills (both factors make ALL the difference in how a transfer goes). While those 9 may be disappointed they lost their hb, they have first, had a safe birth. 2nd, they have made a highly valuable contribution to homebirth and to midwifery on the whole: by being one of the 'needless transfers', they have helped guarantee the safety of the 10th family who really needed med help. They have helped to show a very positive face of homebirth families--that we are sensible, sane and safety minded.

And the mw who transfers these 10 families has MOST LIKELY helped to avert tragedy/difficulty for the 1 family, if that makes sense. Transfer of care, when undertaken prudently, does NOT make midwifery look bad--it makes midwifery look good. Besides, and this is so important to understand: those who hate homebirth are looking for BIG NEWS to use against hb and mws. A 'needless transfer' (which is usually not determined until after the fact, btw) that results in a safe happy birth, is NOT what the anti hb med ppl are going to try to use against hb and mws. There is no 'ammo' in a safe normal birth! The media will not report the dull news of another happy birth. And especially if the mw does have good comm skills, she will not ruffle anyone's feathers at the hospital and create situations where med ppl are mad at her and seek to punish her. Plus, if a birth does lead to a poor outcome (that 1 of 10 'needed transfers'), that outcome is unlikely to be tagged to the mw if the birth occurs in the hospital...at least if transfer occurs before signs get really poor.

Yes, there are occasionally--rarely--surprising emergencies that arise at birth. But for the healthy family with a competent, prudent mw, this is just so extremely rare. Most often, difficulties can be spotted coming during pregnancy, or during labor while there is still plenty of time to transfer care. While this sort of emergency can more often lead to loss or impairment, it is unlikely to lead to charges relating to 'manslaughter'. For the non-CPM, it could lead to prosecution for being uncertified--but that is not nearly so damaging to her or to midwifery, as is a manslaughter or reckless endangerment charge.

Finally--it is the family's job to be their own best advocate. Don't surrender your power to your mw, any more than you would surrender your power to a doctor (except in a true emergency). Your mw SHOULD be listening to you--YOUR INTUITION is every bit as important as your mw's skills and intuition! The mw might feel signs are 'good enough', she may feel she has everything in hand. If YOU don't feel right about staying home, then her assessments are not as important as your intuition.

We can't prevent every difficult birth or loss. That is never going to be possible, no matter where we give birth or with whom. But we can prevent many of them. Prudence is so important! We can't prevent every loss or difficulty--but we can do much to prevent the worst of scenarios from occurring when it comes to the law, and media involvement--factors that burden and complicate matters for families and mws alike so greatly--by considering the things I've said. I didn't invent these points...I've just learned over time how important they can be for families, and for homebirth and mws in general.

Whatever you may think about this case against a mw in Springfield, it can still be used to further homebirth, midwifery, and choice in general. As a famous mw once said long ago to those who did not want to support her (in a case eerily like this one): 'go ahead and use me as a good example of a bad example, if you like--but do use my case to help the cause however you can!' With some savvy, this can be done--and that famous midwife did so. We can't bring back a baby who is gone...we can help homebirth midwifery be safer and more available to families who choose it.
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#2 of 31 Old 10-28-2010, 12:41 PM
 
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Let's try this again... We need to be very careful of what we support in the midwifery and home birth community. Licensure and certification lends to the credibility of midwives and is a very important step. EVERY medical professional has to go through the lengthy and yes, expensive schooling, testing, state certification and licensure process in order to practice in their chosen field. Midwives are no different in needing to complete that process, a process which was only been made legal in the past couple of years. CPM's have a very fragile standing right now and these cases do nothing to support, promote, or improve their relationships with the public and medical community. In fact, it is these exact stories of not-state-licensed people that will be used to try to overturn recent legislation. We all need to stand together saying unlicensed midwifery won't be tolerated by anyone in MO. Unlicensed midwives, while maybe being very competent, don't help the cause.

You have also mentioned how "most dr.s know nothing of natural birth, let alone homebirth and apparently, the dr quoted is pretty anti-homebirth." One of the doctors listed in the probable cause statement is Dr. Redfern. Dr. Redfern, while being very opposed to home birth, is a very well known, respected doctor in this community. He was part of a group of doctors who sued the hospital because of "the business practices of the hospital". His group of doctors HIGHLY recommended all of their patients to have a doula to further the success of natural childbirth in a hospital setting. In addition, he is certified to perform the rape exam of children. How do I know all of this about Dr. Redfern? I was a patient of his, until I switched to another doctor in his practice for fertility reasons (who btw, supported my decision to have a home birth and wonderfully assumed I would be breastfeeding, never even mentioned or assumed formula!). Yes, I would love for him to change his mind about home births and stories like this aren't going to be the stories that do.

Instead of being divided on this issue, we need to come together to ensure that only competent, state licensed, state certified, legal midwives are practicing. There are many, many wonderful stories about home births which happened legally in the state. These are the stories that need to be promoted to further solidify the standing of midwives in MO.

Crunchy mama to Boo and #2
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#3 of 31 Old 10-28-2010, 01:03 PM
 
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Originally Posted by sdcarter View Post

Instead of being divided on this issue, we need to come together to ensure that only competent, state licensed, state certified, legal midwives are practicing. There are many, many wonderful stories about home births which happened legally in the state. These are the stories that need to be promoted to further solidify the standing of midwives in MO.

Wrong. I respectfuly disagree and want to point out the other side.

I want you to take a good look at what you're saying. Only "state licensed, certified, legal midwives" and only "legal" births should be promoted. All this does is give the state or governing authority ALL of the expectant mothers power. Its wrong.

I am lucky enough to live in a state where there is no licensure no regulation, and every choice is the mothers. The mother gets to decide who is qualified to attend her. The mother. Not some governing authority. When you take birth from the mother and hand it to anyone, you are not practicing midwifery. Midwife means WITH woman. It is up to the woman to choose who is qualified to stand WITH HER. Period. The end.

Midwives are NOT medical professionals! Birth is normal! not a medical event! You are missing the point completely! What licensure is trying to accomplish is nothing more than hospital birth in the home. If that's what you want, then hire a Certified Nurse Midwife who is a Medical professional, trained in MEDICINE, trained in Nursing, and bring her to YOUR own birth.

Keep your judgments, opinions and your choices to yourself, and allow other women to choose what is best for themselves. Licensing midwives turs midwives from servants of women to servants of their licensing board. Vbac? sorry cant help ya, my license wont allow it. go to the hospital or go uc. Breech? sorry, license wont allow it. go to the hospital or go uc. Multiples? sorry, license. Do you follow?

The list of limitations will only get bigger and # of "successful" homebirths smaller. Licensing tells women "you are not competent enough to decide who should serve you while you birth. You're not qualified. You must follow our protocols." Let's not be naive. Mandatory licensure is where anyone who is not certified and licensed by the state will be seen as an underground midwife, who is unskilled and incapable of serving and will be in jeopardy of a felony conviction if caught continuing to serve. This says to the parents--ONLY certified midwives are qualified and capable of serving you. ONLY licensed midwives have the ability to meet your needs. Sounds like something else doesn't it--"only OB's are capable--only hospital birth is safe". And what will happen, (because it has happened in every other state who has fought for licensurre)--is that those licensed midwives WILL GIVE UP certain rights that ARE NOT THEIRS TO GIVE. They will toss certain mothers under the bus so to speak to get their coveted licenses--VBAC's and multiples as well as breeches are almost always the first mother's told that they are not worth fighting the hard fight for--and now women of size are quickly being added to this list! Why aren't we fighting for the rights of the woman who actually conceived the baby, will carry it, go through the pain of birth for it and nurture and care for it for its lifetime? LET THESE WOMEN CHOOSE who is and who is not capable of serving them. Some will want a licensed provider--there are lots of OB's and CNM's that will be more than willing to serve them! Some will be perfectly happy--as they are and have been for many, many, many years with the unlicensed midwives whether certified through NARM or not. Some will choose no one at all--but it should be THEIR CHOICE, not the provider.

When the provider makes the choice--or fights for the choice--they are fighting for themselves--serving themselves, serving their pocketbooks, their fears, their issues! Until we begin to put mama's and baby's first, we will loose this battle time and time again and it will be the mama's and baby's that suffer-- eventually the majority of the women who will be seeking home births will not be able to find someone to help them because their states will have decided they are not candidates for home birth because of this or that!

It is vital we stand behind unlicensed midwives, who are committed to their women, babies and families and their choices over any governing authority. It is critical. The whole licensure thing is identical to what happened to the Granny midwives of old--they were trashed, discredited, run off the scene and this is exactly what is going to happen to the very skilled, wonderful, highly capable "direct entry" or "lay midwives" who choose to serve mama's and babies, not the Big Push, or any certifying or licensing agency!

Yes, every mom should have a choice--but the choices are already out there! Leave things alone OR if you must fight--fight for the right people--mothers/baby's NOT midwives.

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#4 of 31 Old 10-28-2010, 01:17 PM
 
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I am supportive of the Missouri Midwife Association and all of the hard work they have put in to ensure legal home births in the state of Missouri, which includes their work in putting a state licensing and certification process in place, a standard which is in place for many states. Even hairdressers have to go through the school/licensing process so it was very reasonable to expect a standard for midwives (a standard supported by midwives!) We now have home births being attended by CPM's not being raided by police and CPM's charged with crimes! This legislation, which was supported by midwives was finally passed. It was their persistence and strength to go against the AMA that made home births by a CPM legal! It opened a door that could very easily be shut again!

Crunchy mama to Boo and #2
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#5 of 31 Old 10-29-2010, 09:33 AM - Thread Starter
 
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Sdcarter--

thanks very much for elaborating on your thoughts, and in doing so in more easily-received words I appreciate that.

I also disagree with you, in the same terms as SG784 (thanks, SG!).

And I have to add that in a case like this, I extremely doubt that CPM status would have prevented legal and media involvement in this case. The anti-homebirth crowd, led and greatly fueled (financially and energetically) by the AMA, ACOG and their state chapters, has been using everything they can to stop homebirth, for a very long time. The loss of a baby is strong ammo indeed; it is the kind of thing that prompts strong emotional responses such as your own initial post--and this is well-known to those who still fight homebirth. Leaning into people's gut reactions to such sad events, using heightened emotional rhetoric to blur rationality....a very typical way to sway public *and* court opinion.

Licensed midwives ARE prosecuted--go ask California, among the states with the highest incidence of licensed-midwife prosecutions. Licensing of midwives, so far, has not stopped the anti-homebirth people from continuing to persecute midwives on any number of flimsy foundations--it doesn't take a loss, though of course a loss is 'better' for the persecutors and prosecutors. The fact that these prosecutions are not often won does NOT stop the publicity about them, and it does NOT spare midwives from the financial burden of legal action nor the harm to herself, family and reputation that can ensue.

As for MMA and the consumer homebirth support through FoMM, yes, they have worked hard and deserve respect and praise for what they have accomplished. Very much so! Yet when it comes to protecting the families and midwives henceforward..shall we say....I don't see that they are the ones for the job. Or at least, shouldn't be the Main Ones for this job.

To me, it's people like sg784, all women and families who really think about what they need for safe birth, and speak of birth that way to midwives, courts, legislators and neighbors--it's these people who will now grow homebirth and midwifery most wisely and safely. Not the professional guilds or legal figures, not the politics of boardrooms and laws--but the people making birth choices and choosing birth services, whose input is most needed for growing homebirth and midwifery into this Post-CPM era.

To me, also, it's just a technicality that the midwife under prosecution is not a CPM--just a technicality to the prosecutor and to the rest of us as well. It's a case against a midwife and against homebirth too--and in our adversarial legal system, it will be used 'for' or 'against' the mw, and homebirth. How anyone chooses to engage with this case is a matter of personal choice, of course--I just hope we are careful, in the hurry to distance ourselves from the 'possibly bad and certainly illegal midwife' (and appear to be on the side of Right and Law), that we don't accidentally make it seem that we are 'against' midwifery, homebirth, and the right to informed consent in our health care. Especially, as sg784 points out, with a normal health condition--not a disease needing 'medical care'.

No one has to like the mw, or the way this all fell out. Seems to me we just have to know that it's a case that can and will be used 'for' or 'against' midwifery and homebirth in general. Those generally 'for' these things might be mindful of how you can support those causes through your engagement with this case (or choosing not to engage)--with thought and prayer, words and actions.
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#6 of 31 Old 10-29-2010, 12:30 PM - Thread Starter
 
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by the way--

sdcarter, you said: "Instead of being divided on this issue, we need to come together to ensure that only competent, state licensed, state certified, legal midwives are practicing. There are many, many wonderful stories about home births which happened legally in the state. These are the stories that need to be promoted to further solidify the standing of midwives in MO. "

For me, the first mistake anyone can make is to assume that 'competent' and 'legal' necessarily belong in the same sentence. Licensing does not guarantee competence. Competence, to be real, does not require legal status. With sg784, I hope we can see competence wherever it exists ('legal' or not). And I hope we see too, beyond any legal status to the real midwives and their real practices.

sg784, you said: "... OR if you must fight--fight for the right people--mothers/baby's NOT midwives. "

Just want to really emphasize that! MMA, just like the AMA and any other professional guild, exists to promote and protect a profession and it's member/practioners. Midwives, like any other professionals, only naturally will cooperate with each other to increase their legitimacy and prosperity. Professional guilds are formed expressly to serve those goals with joint advertising, lobbying, etc. In some ways, the business and political goals of midwives just naturally dovetail well with the needs and safety of mother/babies...but in some ways, they really don't. So it's up to families to keep *enough* attention on mothers and babies, on their safety and what THEY need--not just on what legislators, prosecutors, midwives or doctors need.

With sg784, I believe we all should be 'fighting for the right people'. We just shouldn't be assuming that midwives, any more than doctors or any other professionals, are going to be fighting for mothers/babies as hard as they are fighting for their professional goals.
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#7 of 31 Old 10-29-2010, 02:38 PM
 
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I extremely doubt that CPM status would have prevented legal and media involvement in this case.

The CPM status would help ensure that someone has had the training to help prevent this from happening in the first place. It won't prevent all, but it will help to ensure a safer environment than someone without training.

This will have to be something we agree to disagree on. I understand why many don't want any standards of care for fear of big government. I fear, as well as everyone who worked so hard to get legislation passed, more stories like this will happen without a standard of care, once again, not furthering the cause of legal home birth, as stipulated by current laws only recently passed. Prior to this, midwives were being charged as criminals, surely none of us want to go back to that! We will just have to disagree on how to make sure that doesn't happen.

Just curious, have you met anyone involved with this case? Strangely enough, I have, Elaine, Cloudpillar and Dr. Redfern, which is another reason I am in completed support of current laws in place requiring licensure.

Crunchy mama to Boo and #2
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#8 of 31 Old 10-29-2010, 02:48 PM
 
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Originally Posted by MsBlack View Post

This is the first news story to emerge about this case:

http://www.news-leader.com/apps/pbcs...D=201010090336

This is the 'probable cause statement' from the police dept as they prepared to levy charges against the mw:

http://www.news-leader.com/assets/pd...25egI0nWKn4%3D

Please remember in reading these things, that 1. The media knows nothing about birth but a LOT about sensationalizing things. 2. The probable cause statement contains the plain facts *as the officer understands them* (which may well leave out other pertinent facts)...including comments he heard made by a doctor involved. Most dr.s know nothing of natural birth, let alone homebirth and apparently, the dr quoted is pretty anti-homebirth.
So the mother was in labor for three days? The dr, whom others have described as friendly towards natural birth said
Quote:
Police asked Redfern why he thought Diamond couldn't deliver the baby.

"Dr. Redfern stated he thought it was the inexperience and panic of the midwife," the report said. "He said this because after talking to Dr. Mullins, the ER doctor that delivered (the baby) in the parking lot, that Dr. Mullins stated he was able to deliver the baby very easily with gentle downward traction."
I wonder how stating the following is 'sensationalizing'?
Quote:
Court documents show that Diamond has had previous complaints about her midwife practices.

Prosecutors allege another incident earlier this year also endangered a mother and child. Details about that incident weren't available Friday.

Diamond is barred from practicing midwifery in Colorado after an incident where a woman almost bled to death.
I wish I would have known more about the midwife who almost killed me and my firstborn. Luckily I got out of it with a csection and a baby.

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#9 of 31 Old 10-29-2010, 02:51 PM
 
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Yes, there are occasionally--rarely--surprising emergencies that arise at birth. But for the healthy family with a competent, prudent mw, this is just so extremely rare. Most often, difficulties can be spotted coming during pregnancy, or during labor while there is still plenty of time to transfer care.
and the above is the problem with the midwife in question, correct? She's been banned from practicing in one state, had a recent mishap in MO, and now this.

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#10 of 31 Old 10-29-2010, 03:40 PM
 
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I also have to wonder, how are we going to ensure competent midwives are assisting in home births? I understand state licensure doesn't guarentee competency, but it sure does help. What do you propose the recourse for someone who feels a midwife is incompetent or worse, has a baby die due to incompetence? Will all legal cases result in the "they're out to get midwives witch hunt" mentality, even in cases of gross negligence? Are we supposed to support incompetent midwives as well? Shouldn't we be discerning with our support? How are incompetent midwives going to be prevented from practicing? At some point, especially when a baby dies, there needs to some process to determine what went wrong, if anything and a midwife needs to step up to being held accountable for what happens during labor and delivery. There's a process for doctors, and yes, many times licenses aren't pulled when they very well should and no, midwives don't have big money, insurance companies, or hospitals backing them, covering for them. But even in that, how do you propose to keep incompetent midwives from delivering babies?

Thank you Multimomma! I'm sorry for your experience and I'm glad you had a healthy baby. I wonder how many people who have met her, or had her as a midwife, share the same experience/opinion as you?

Crunchy mama to Boo and #2
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#11 of 31 Old 10-30-2010, 07:26 AM - Thread Starter
 
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[QUOTE=sdcarter;15997607]I extremely doubt that CPM status would have prevented legal and media involvement in this case.

The CPM status would help ensure that someone has had the training to help prevent this from happening in the first place. It won't prevent all, but it will help to ensure a safer environment than someone without training.

QUOTE]

We tend to believe that certifications help, a lot more than they actually do. Do you have any idea how many complaints are brought against licensed medical professionals every year? 'Training and standards' are only one piece of things--what matters more when it comes to delivering health care of any sort is the personal integrity of the practitioner. I'm all for education! I'm all for making things as safe as possible through education--and I have seen both: how much competence, accompanied by humility and integrity, can come without 'certification', and how much incompetence can exist with people who got their due certifications but do not have enough humility or integrity.

Besides, MO has a flock of new CPMs who are not very experienced yet. Like I said, CPM standards are designed to help mws to know 'what to do for normal birth'--including 'what to do about poor signs'. Just as with any new doctor, dentist, etc, we have to count on the humility and integrity of these newbies to keep them from getting in over their heads.

Well--we actually shouldn't have to count on the mws (or docs, etc)--people receiving care should not be giving so much power and trust to providers in the first place. Think about it--how many sad/infuriating birth stories have you heard (home or hospital) where it was pretty clear that the client/patient did hand over all trust and power, and ended up with anything from great disappointment to trauma to a loss? One story that comes to mind is a case from San Diego a couple years back: an OB killed a baby with the vacuum extractor, making pulling efforts so strong that he was bracing a foot against the end of the delivery table to help him pull harder. Broke baby's neck. NOw that is NOT something I'm personally going to allow--at my own birth or anyone else's. But the parents did what they were 'supposed to do'--they handed their trust and power to that doc. Even the nurses present were afraid to say anything, even though they knew from experience that that doc was way outside bounds. While this is an extreme example, similar stories take place in hospital births every day--similar in that bad/traumatic things happen to moms and babies because the medical ppl assume the power, and families hand it over.

I've heard similar stories from sad homebirths (whether mw was licensed or not, mind you--not just stories of the ones who avoided certification). The mama/family has some feeling about the birth--a pain, a sign, just a 'bad feeling', and wants to transfer care. They get talked out of it because the mw doesn't see or properly interpret that sign to her 'professional standards'--to their eventual dismay when something bad does occur.

I'm NOT blaming anyone here. We are taught so deeply to respect authorities, and when it comes to medical (including mws) authority, even the most assertive of us can find ourselves nigh on tongue-tied. To me, it is just as wrong (maybe more so) that providers assume so much authority over us, and ply the psychological tricks heavily, to promote our absolute trust. They get a ton of legal and social support for this--and I don't see that we have benefitted from it, at all.

Of course, some trust is needed! But that should be a two-way street, families should never give up their trust in their own knowing, nor any part of their authority in their care. They should not be asked to. Providers should WANT any/all input from clients, to help guide their actions; providers should be working to inform clients, and open lines of communication, and have enough humility and integrity to know that their 'certification' is only a piece of what makes health care go right.

Fronting the flag of 'certification', to me, is only another way to push people toward greater trust in providers and less in themselves. Not that I think 'certification'/licensing/standards is wrong--not by any means. I'm saying that waving that flag leaves out a very important piece, which is clients' trust in themselves, and the importance of both being well informed and well in charge of their power in their health care.
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#12 of 31 Old 10-30-2010, 08:05 AM - Thread Starter
 
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Multimomma--you said:

"I wonder how stating the following is 'sensationalizing'?

Quote:
Court documents show that Diamond has had previous complaints about her midwife practices."

What complaints??? Were they valid complaints about her care, or made by people who were disappointed somehow, even though the care provided was fine? This statement 'sensationalizes' by adding weight to the idea that Diamond was already suspected of incompetence. But for instance: once a mw had a client where she stopped being able to determine baby's position. Asked family twice to get an u/s--they refused even after much discussion about why it could be important. Baby was breech--not discovered til advanced labor. Since the family was not prepared for breech birth, and were so very upset to discover the breech, mw and family agreed to transport. Best OB was on call--offered vag delivery, mama refused and insisted on csec. Mw accompanied transfer of care, helped the family get the best possible birth experience, remained available over the coming days. But the family complained against the mw to the state, and to any who would listen in her community, about that mw's 'incompetence'. But really--was the mw incompetent in that case? Foolish, maybe, to let the family choose whether or not to get a u/s to determine baby's position....but how is it incompetent to acknowledge an 'unknown quantity' and seek info? HOw is it incompetent to transfer care out of both family's wishes and prudence both?

"Prosecutors allege another incident earlier this year also endangered a mother and child. Details about that incident weren't available Friday."

Yeah, in the above case, the state and the family also alleged 'endangerment'. Only because they COULD--not because the mw failed to be competent, prudent, safe for that family. The words here do not sound so 'sensational'--but they lead the reader to think the worst, even though no facts are given.

"Diamond is barred from practicing midwifery in Colorado after an incident where a woman almost bled to death."

ALMOST BLED TO DEATH--now that IS sensationalizing. Again, we don't know what happened! Postpartum hemorrhage sometimes happens--and happens quite often in hospitals compared to homebirth. So this mw saw a hemorrhage, tried to stop it, and transferred care when the bleed wouldn't stop. THIS IS STANDARD OF CARE for CPMs and all licensed practitioners.

Remember that in fact, more women die as a result of medical birth care, than die due to problems with a homebirth. The US maternal mortality rate is disgraceful! And many of those deaths are greatly preventable, because so many of them are directly related to care given--different topic for another thread though.

Diamond was barred from practicing in CO, ONLY because she was unlicensed. I don't know her--I do know many mws who are highly competent but choose not to get licensed. Again, with these seemingly quiet, 'factual' words, the media paints the worst possible picture...and readers don't even realize it.

Again, the main point here is to know that law and media, greatly urged by the heavily vested interests of our Medical Institution, are making this case about homebirth and midwifery in general. Because I know so very little about this birth, I am not making a judgement of that mw's care in the case now ongoing. Maybe she could have done something differently to save a life--but maybe not. Sometimes, prenatal events determine a loss--even though on initial exam it appears that care was at-fault; this is extremely hard to determine with certainty and more than 1/2 of all stillbirths show no solid 'reason' for occurring. I don't know the facts of this case; I DO know that it's possible that the baby failed only during 2nd stage because of events occurring prior to labor's onset (2nd stage presents the greatest challenge to baby's resources--so no poor signs might be noticed til the last minute).

As for Dr Redfern's comments about the mw's 'panic and inexperience', that is a pure load of imagination, spoken off the cuff by a doc who is anti-homebirth. Some of us know mamas who pushed a longer time than that mama....and to all appearances, baby is making no or only little progress for a long time, even hours. Then suddenly, baby 'clears the tight spot' and comes out fast. I don't know, I wasn't there--and neither was Dr Redfern. But he knows better than me that this can be the case. Transfer of care was accomplished NOT because the mw couldn't aid delivery of baby--but because she saw signs that warranted med help. She may have stood back to allow ER doc to complete delivery, and doc assumed she 'couldn't' manage the birth.

Anyway--yeah, it's been sensationalized. Both law and media have poor reasons for doing this, in terms of 'justice' and 'competence'. Media wants to sell itself. Lawyers want to win cases. So it goes. I just hate to see the public duped about this case, and we ARE being duped. Even if you know Diamond and agree she is not qualified, I still think it is so important that we realize that this case is an opportunity to support homebirth and midwives; it is also an opportunity to harm those things by those people who want to stop midwives from assisting homebirths. Again, I just ask that we all recognize the potential for our words and actions to help or harm homebirth and midwifery. You don't have to support a particular mw to be mindful of your power to help or hinder homebirth and midwifery on the whole.
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#13 of 31 Old 10-30-2010, 08:42 AM - Thread Starter
 
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I also have to wonder, how are we going to ensure competent midwives are assisting in home births? I understand state licensure doesn't guarentee competency, but it sure does help. What do you propose the recourse for someone who feels a midwife is incompetent or worse, has a baby die due to incompetence? Will all legal cases result in the "they're out to get midwives witch hunt" mentality, even in cases of gross negligence? Are we supposed to support incompetent midwives as well? Shouldn't we be discerning with our support? How are incompetent midwives going to be prevented from practicing? At some point, especially when a baby dies, there needs to some process to determine what went wrong, if anything and a midwife needs to step up to being held accountable for what happens during labor and delivery. There's a process for doctors, and yes, many times licenses aren't pulled when they very well should and no, midwives don't have big money, insurance companies, or hospitals backing them, covering for them. But even in that, how do you propose to keep incompetent midwives from delivering babies?

Thank you Multimomma! I'm sorry for your experience and I'm glad you had a healthy baby. I wonder how many people who have met her, or had her as a midwife, share the same experience/opinion as you?
I much appreciate your thoughtful words here, sdcarter. You ask questions I like to ask, too, make the comparisons I think we need to make.

I think a condition of life is that we cannot stop the occurrence of 'human error' and 'human pride'...it's as much a 'risk factor' in every area of our lives as all other risks. With birth, our 'risk assessment' has to include those conditions along with 'medical risks' or 'lifestyle risks' to safe birth. We create these systems and structures to try to gain some control over the occurrence of human error or pride--but it turns out we are only so successful and no more. It turns out that we are able to reduce the occurrence and impact of those human foibles in some ways, but we enhance them in other ways through that system of standards and certifications....we humans are so capable of turning things to our own uses, after all--finding the loopholes, the ways to conceal things under carpets or in plain sight, etc.

Yes, we should absolutely be discerning! That is the main thing I hope to promote--our discernment of the issues, as we respond to this case. I just hope we can take *a lot* more into account than MMA's (and FoMM's) party lines, the prosecutor's and med ppl's party lines, and the sketchy 'news' we are granted about the case.

Sure, hear all of that respectfully, and take it into account--but as sg784 suggests, we should think outside the box those agency's have created, think for ourselves about what we, as mamas having babies (and grandbabies ) most need for OUR safety and satisfaction. Hey if not for birthing families, none of these pesky mws, OBs or med-law experts would even be needed at all!
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#14 of 31 Old 10-30-2010, 01:18 PM
 
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Remember that in fact, more women die as a result of medical birth care, than die due to problems with a homebirth. The US maternal mortality rate is disgraceful! And many of those deaths are greatly preventable, because so many of them are directly related to care given--different topic for another thread though.
Isn't the bolded due to the sheer numbers of women birthing in hospitals compared to homebirthing? What are percentages like? I honestly don't know, even though I've chosen homebirthing.

Quote:
Diamond was barred from practicing in CO, ONLY because she was unlicensed.
Was she? I thought it said she was barred after someone 'almost bled to death'.

Quote:
Because I know so very little about this birth, I am not making a judgement of that mw's care in the case now ongoing.
But haven't you? You have made a judgment, that we must support this midwife legally, without complete information, and the assumption that she did nothing wrong. Perhaps you know her personally? You are passing judgment on the parents, by saying they shouldn't have trusted her so much, 'passed over so much power'.

Quote:
As for Dr Redfern's comments about the mw's 'panic and inexperience', that is a pure load of imagination, spoken off the cuff by a doc who is anti-homebirth.
It's my understanding that someone on the list has already stated they know this dr personally, and he is not anti-homebirth. Do you have information that states otherwise, outside of his not supporting this particular midwife?

Quote:
Even if you know Diamond and agree she is not qualified, I still think it is so important that we realize that this case is an opportunity to support homebirth and midwives;
I cannot back this at all, in the slightest. I cannot support a midwife who is not qualified to help birth. I don't know if this is the truth in this particular case, but to just jump on and defend her is unconscionable to me. People hire midwives to help birth because our society is not one that readily provides a natural understanding of how birth works.

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It's my understanding that someone on the list has already stated they know this dr personally, and he is not anti-homebirth. Do you have information that states otherwise, outside of his not supporting this particular midwife?
I just want to clarify that Dr. Redfern is VERY ANTI-HOME BIRTH. He is, however, very pro natural childbirth in a hospital setting. He has written newspaper articles and it very outspoken in his position against home births, it isn't just against this one person. Even in all of that, he is a great doctor and I wish he would change his position on home births. This story isn't going to do that.

There are several components to this entire situation.

First, there IS a set of laws requiring midwives to become certified an licensed as either a CNM or CPM, whether or not you agree with them. This woman broke those laws. If there is a group of people who don't agree with these laws, then get together and get legislation passed, just as MMA and FoMM did.

The second issue is that a baby died, which right there warrants some kind of investigation to determine whether or not there was negligence on her part. A story of a baby dieing while under the care of an unlicensed midwife will NOT further the cause for supporting unlicensed midwives, in fact it supports the need for a standard of care.

Finally, there is a system in place for people to make claims against ANY LICENSED PROFESSIONAL. These claims are investigated and action is taken, anything from dismissing the claim to revoking a license. Any person can search any professional to see what claims have been made. This is one step someone can take when determining care. If someone is unlicensed, what system is in place for accountability? Where would a person look in their due diligence to look out for their interests? Just as Mulitmomma has said, she would have LOVED to have known about complaints against this person and her history, both in this state and other states.

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#16 of 31 Old 10-30-2010, 05:19 PM
 
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Thanks for verifying that. I must have mixed natural childbirth with homebirth

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[I], which is another reason I am in completed support of current laws in place requiring licensure.
Current MO law states that midwives are required to have cpm certification, which is not a license.
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I went to the professional licensing govt. website for MO, and you're right, there isn't any licensing in place for CPM!!! When all of the legislation went through, there was a lot of talk about requiring certification and licensing, and now I see they only have the certification in place. Even with that, it still is the law to be certified. If someone doesn't have the licensing board to follow up with to find out about a person practicing, how can they find out about their practice, especially if there has been complaints? Besides just word of mouth?

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#19 of 31 Old 10-31-2010, 05:24 PM - Thread Starter
 
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[QUOTE=sdcarter;16002170]I went to the professional licensing govt. website for MO, and you're right, there isn't any licensing in place for CPM!!! When all of the legislation went through, there was a lot of talk about requiring certification and licensing, and now I see they only have the certification in place. Even with that, it still is the law to be certified. If someone doesn't have the licensing board to follow up with to find out about a person practicing, how can they find out about their practice, especially if there has been complaints? Besides just word of mouth?[/QUOTE]


MMA has taken a role to address this--or at least, last time I read their written mission statement, they had a grievance procedure, code of ethics, etc. They are set up to accept and review complaints about midwives in MO, though of course they have no legal authority to compel anyone. Hard to say if MMA's process is effective...families have to come forward (maybe risking ugly confrontation), midwives have to be willing to hear complaints and address them pro-actively. The whole process has to be applied appropriately by everyone--and seems to be a difficulty.

Some say the present law (CPMs legal w/out state license & board) is flawed in this respect. I don't necessarily believe that--but it's true that midwives should be held accountable, and families should have support for complaints/concerns. Everyone has to participate somehow, honestly and willingly enough to make it work.

Earlier someone said I was 'blaming the parents', but I am talking about responsibility, not blame. "Taking responsibility", for me, is about being able to respond--being committed to responding on your own behalf to life's conditions. Yes, we should be able to trust care providers, and safely empower them to do things with/for us that help us get the safe happy birth we want. Just as much as we trust ourselves, our own knowledge and intuition about our life situations. Just as much as we empower ourselves to act toward health and safety.
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#20 of 31 Old 11-01-2010, 10:13 AM - Thread Starter
 
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Wanted to clarify a couple things about my last post, written in haste yesterday...

The issue of having some oversight of midwives' practices, a place for parents or involved professionals to complain and a system for disciplining and guiding mws--it is complicated!

First thing is that it can be really really hard for parents to bring complaints forward. Some reasons for this can be seen in this thread about complaints in the Healing Birth Trauma forum:

http://www.mothering.com/discussions....php?t=1256948

Above, I mentioned that families might fear 'ugly confrontation'. I want to be clear that this is a fear, but does not necessarily reflect reality. Most people fear confrontation, after all, and will avoid it at all costs. Some people may believe that instead, they will be ignored--and some have had the experience of their voiced concerns essentially ignored, by their provider at least. Sometimes also by statewide agencies such as MO's MMA and FoMM, for whatever reasons--or at least, a family may feel their concern was ignored....if not entirely through decisions made by the leadership, but in their general reception from general membership. Complaining about midwives is somewhat taboo for many, and no one wants to be ostracized for seeking support and justice.

Also, people who hear complaints (whether a midwifery guild, or a mw or other health professional) usually want to be VERY cautious about what to do with a complaint. That caution can at times be over-protective of mws who may well need help/guidance; it's not intended that way but it happens. It's a good thing for agencies to see beyond one situation to the impact on all of us, on homebirth generally, before deciding what to do. Not so great for families who believe they have been harmed, and seek justice--or just want solid info on mw-stats and reviews for decisionmaking--if agencies place the interests of homebirth and midwifery too far above safety for homebirth families...if they tend to be more suppressive of complaints, and mw-stats, rather than helpful to families seeking informed consent or possibly-due attention to a mw's problem areas of practice.

Too, it can be very hard to believe a family's complaint if one's own experience of a mw has been positive; very hard to believe that a mw so skilled in ways so many mother/babies need, could possibly be so unskilled in other ways, to the harm of some other mother/babies. We tend to forget that an easy 85 births of every 100, will go just fine all by itself--and that another 10% of mother/babies needs only minimal assistance for safe birth. We meet the 85 moms who are happy with their mw, whom they never strictly needed in the first place (even if she played a role the families value); we meet another 10 moms who are amazed at their mw's skill in assisting the minor-to-moderate flucuations in normal birth; sure sounds like these happy families show the mw's merit. When we hear a complaint from someone in that last 5-10% of families--whose needs were possibly outside that mw's skills-- it just doesn't make sense to us, given that mw's 'known stats'. It is hard to accept such a harsh thing--and this tends to complicate matters of discipline and guidance, KWIM?

Not saying that anyone intends to be a jerk--only that personal, professional and political matters are all engaged. And in small communities, the personal, professional and political elements can tend to get a bit too merged, maybe...it becomes very difficult for agencies to behave strictly like agencies in these matters.

But to me that's just the conditions we have and it's the reason I keep saying that taking responsibility, each of us, is the way to improve things. No agency (be in licensing board or 'self-monitoring') can be any better than the people who participate in it. Families need to speak up, and also to know their rights/responsibilities better. The people wanting homebirth, desiring mws, have to speak about what they want and what is wrong--and can't take 'no' too easily for an answer. If you are uncomfortable at any moment with any element of the situation during your work with a mw, listen to that and speak or act on it, trusting your instinct to help you make the best decisions. If you have a complaint your mw brushes off, then complain to MMA or FoMM--write a letter, go to a meeting; if that fails, you could seek support from individuals who may hear your concern and offer support in some way toward justice. Or if you don't have a complaint, but only want to see safe midwifery thrive, then you can also get involved actively--there are many ways to do so.

I think 'self-monitoring' can work--and prefer it to state medical board involvement. But I also think it only works if everyone supports it with time and active input--whether through organizations like MMA and FoMM, or other networking and communication to add to their efforts. Willing accountability--and everyone taking responsibility in our chosen ways--is how self-monitoring of midwifery in MO can be safest and most successful for all.

As usual, JMO
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#21 of 31 Old 11-03-2010, 07:17 AM - Thread Starter
 
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Multimomma--

you asked about maternal mortality rates: YES, childbearing women are more likely to die in hospitals than at home--the actual % of maternal deaths in hospital birth is greater than for homebirth. This is primarily because of our nationwide cesarean rate (30% plus, depending on region/hospital/OB); and women are 2-3 times more likely to die as a result of cesarian complications than from natural birth (postpartum hem, wound infection, other). Repeat cesareans raise the maternal mortality rate even more, because the risks of cesarean surgery elevate greatly with each successive surgery. If you go to ICAN's website, you can see the stats and studies.

ican-online.org (probably looking for the 'white papers' link on homepage will be best way to find quick answers).
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#22 of 31 Old 11-03-2010, 08:45 AM
 
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Earlier someone said I was 'blaming the parents', but I am talking about responsibility, not blame. "Taking responsibility", for me, is about being able to respond--being committed to responding on your own behalf to life's conditions. Yes, we should be able to trust care providers, and safely empower them to do things with/for us that help us get the safe happy birth we want. Just as much as we trust ourselves, our own knowledge and intuition about our life situations. Just as much as we empower ourselves to act toward health and safety.
MsBlack, I don't know if you understand what a terrible advocate you are being for midwifery here.

How is a laboring woman supposed to "take responsibility" and "respond to life's conditions"? Practically speaking? Am I, in labor, supposed to be able to recognize the signs of shoulder dystocia and coach the people around me concerning what to do about if Gaskin maneuvers have no effect (or if I'm already on hands and knees and Gaskin maneuvers will, therefore, do nothing)? Am I supposed to be able to identify exactly how large a splotch of blood indicates dangerous bleeding? To massage my own uterus to stop the hemorrhage while running an IV line for a transfusion?

And then let's throw in the fact that medical conditions - like shock, blood loss, and intense labor - are KNOWN, and UNDERSTOOD to affect cognitive processes.

I think that laboring mothers have every reason to choose to hand power and responsibility to professionals in these circumstances. When things go wrong and mothers aren't able to identify and respond to the problems, my first thought isn't "the mom should have done something," it's "the mom was in labor." The midwife doesn't have that excuse.

If the midwife cannot be relied upon for anything, if whenever something goes wrong with a midwife, it will be explained that the patient should have been more on the ball - well, what's the point of hiring a midwife? If I go to a hospital and my baby dies, at least I can be assured that there will be a thorough investigation into what happened and how it can be prevented from happening again.

You mention the case of an OB in San Diego who killed a baby during a botched vaccuum extraction. I remember that case. In that case, advocates of hospital birth didn't line up to defend that guy - they acknowledged that he had acted badly, that he had caused a baby's death, and that he shouldn't be practicing.
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#23 of 31 Old 11-03-2010, 11:09 AM - Thread Starter
 
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Yes, Meepycat--as Hermione Granger once said: "well spotted!" I am not trying to be a good advocate for midwifery--not exclusively-- nor even as much as my desire to advocate for safe birth and happy families.

Anyway, to me, this active self-empowerment and self-advocacy has to start WA-A-A-Y-Y-Y before an 'emergency point' is ever reached at birth, when a woman (as you astutely point out) is simply not able to think straight. When people do empower and inform themselves, they are just much less likely to need to 'think straight' in an emergency birth situation. This is because EITHER they will already have reached well-placed trust in their provider (instead of 'blind trust'), OR, they will have avoided an emergency in the first place--through self-care as well as self-advocacy.

I am trying to advocate for happy families and safe birth anywhere and with anyone, by trying to help de-construct our standing mythos concerning health care and personal power. That mythos is that the most important parts of knowledge belong to providers, and that therefore the power should rest with them. Generally in our health care, we are grossly under-informed and give way too much power to our health care providers. But no one needs a medical or midwifery degree to know 'enough' for making good decisions; and giving up all of our power is always a mistake.

Boiling it down to a couple of basic points, IMO:

1. of first importance to a safe birth is sufficiently informed and fully self-responsible self-care--ONLY a woman can grow and a birth a baby.

2. 2nd, know your midwife or doctor very well: ask the hard questions before you hire someone, don't take flimsy reassurances for an answer to important questions. Don't go on your friends' happy experiences--find out the down side because every practitioner has one. Risk is part of life, and birth; we can't eliminate it but we sure shouldn't dismiss it from our minds because we 'like' a mw or OB, or know happy former clients.

3. Insist on fully informed consent, all the way through care. Make real decisions based on evidence along with your own values, rather than taking anyone's word for it. MDC is full of stories of moms/fams who do this!

4. Insist on exercising your own intuition and being respected in that. Your care provider should be trying to elicit your intuitive knowing, and should find your hunches as important or even more so than their knowledge or intuition.

Meepycat, I'm pretty sure that a lot of midwives would agree with you--that I am not being a good advocate for midwives Unfortunately, some mws are just as happy as any OB is, to be the Hero to families and don't want pesky questions or any interference with their decisionmaking. Luckily, advocating for midwifery is not my intent even if it wins me no friends in the professional sphere. Safety is my biggest concern.

Pulling this world out of the mess it's in, by encouraging greater self-empowerment by individuals in all realms of life, is my larger goal.

Yes, all mws and health providers SHOULD be competent; we should be able to trust them a lot--with our lives, in a real sense. And no matter how skilled a provider is, giving them all the power has turned out to do us all a lot more harm than good. Hey, great if there is someone to sue or prosecute if things go badly, right? But as for 'responsibility' goes--well, only the family will have to 'be able to respond' to events in their own lives. Giving up our power to midwives, OBs, or anyone isn't just a mistake--it's the grandest delusion of all, given that only a family will live now and forever with their choices, giving up all power turns out to be far more destructive than helpful.

Who do you want to be, if tragedy occurs at your birth? Someone grieving, who feels entirely ok about all choices made, and trust placed...or someone grieving who has someone to blame/prosecute--and who may 'win' the case but STILL has to live with possibly poor choices made and trust misplaced?
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#24 of 31 Old 11-03-2010, 12:20 PM
 
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Anyway, to me, this active self-empowerment and self-advocacy has to start WA-A-A-Y-Y-Y before an 'emergency point' is ever reached at birth, when a woman (as you astutely point out) is simply not able to think straight. When people do empower and inform themselves, they are just much less likely to need to 'think straight' in an emergency birth situation. This is because EITHER they will already have reached well-placed trust in their provider (instead of 'blind trust'), OR, they will have avoided an emergency in the first place--through self-care as well as self-advocacy.
Without licensure and reporting, how is anyone supposed to be able to accurately evaluate a care provider? Without these things, it's possible for any professional to hugely misrepresent their record (this has been done in a number of professions, including midwifery, and the self-reporting you advocate doesn't solve the problem - it just removes professional consequence for negligent practitioners). Without licensure and reporting, parents would have to basically run a personal background check including a private investigator to be sure that there are no really alarming skeletons in the midwife's closet, and that they aren't blindly trusting someone who shouldn't be trusted.

Your suggestion that self-care and self-advocacy in advance can prevent childbirth emergencies is laughable. So many of the problems that arise in childbirth are temporary crises, which we cannot effectively act to prevent.

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I am trying to advocate for happy families and safe birth anywhere and with anyone, by trying to help de-construct our standing mythos concerning health care and personal power. That mythos is that the most important parts of knowledge belong to providers, and that therefore the power should rest with them. Generally in our health care, we are grossly under-informed and give way too much power to our health care providers. But no one needs a medical or midwifery degree to know 'enough' for making good decisions; and giving up all of our power is always a mistake.
The only births I have ever been present for have been the births in which I was involved. That's fine for me - I haven't chosen to make birth my profession. There's a limited number of things that any person can be an expert in, we choose, we specialize, and then we find ways to share our expertise. No, I don't need a medical or midwifery degree to attempt to make good decisions for my family, but without the expertise represented by those degrees, I might well not know when choices need to be made, or what the risks and benefits of those choices are. I certainly don't have any guarantee that I will know what it looks like when those choices arise.

No one can become an expert on childbirth - normal or otherwise - in nine months to a year of even very highly motivated personal study. Expertise in this field involves a great deal of experience. Midwives should, as professionals, be willing and able to demonstrate that they do actually have expertise and experience to offer, so that they can be of meaningful assistance.
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#25 of 31 Old 11-03-2010, 01:49 PM - Thread Starter
 
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Without licensure and reporting, how is anyone supposed to be able to accurately evaluate a care provider? Without these things, it's possible for any professional to hugely misrepresent their record (this has been done in a number of professions, including midwifery, and the self-reporting you advocate doesn't solve the problem - it just removes professional consequence for negligent practitioners). Without licensure and reporting, parents would have to basically run a personal background check including a private investigator to be sure that there are no really alarming skeletons in the midwife's closet, and that they aren't blindly trusting someone who shouldn't be trusted.

Your suggestion that self-care and self-advocacy in advance can prevent childbirth emergencies is laughable. So many of the problems that arise in childbirth are temporary crises, which we cannot effectively act to prevent.



The only births I have ever been present for have been the births in which I was involved. That's fine for me - I haven't chosen to make birth my profession. There's a limited number of things that any person can be an expert in, we choose, we specialize, and then we find ways to share our expertise. No, I don't need a medical or midwifery degree to attempt to make good decisions for my family, but without the expertise represented by those degrees, I might well not know when choices need to be made, or what the risks and benefits of those choices are. I certainly don't have any guarantee that I will know what it looks like when those choices arise.

No one can become an expert on childbirth - normal or otherwise - in nine months to a year of even very highly motivated personal study. Expertise in this field involves a great deal of experience. Midwives should, as professionals, be willing and able to demonstrate that they do actually have expertise and experience to offer, so that they can be of meaningful assistance.
Seems to me the mistake we make is assuming that a licensed professional can be blindly trusted. Anyone can have skeletons in their closet--of many sorts, including practice violations--that might be found with some searching. Most people don't do that search with their licensed professionals, OR the unlicensed ones...but IMO, should be doing some kind of searching on both kinds. Our licensing system is no sort of guarantee of safe, respectful, competent practice.

You are right--there are birth emergencies that cannot be prevented by advance choices. There are also birth emergencies that no one can 'manage safely'--they are fatal in and of themselves, no matter where or with whom you give birth. These both are in the smallest categories of problems arising at birth; there are many many more problems that CAN be prevented through self-care and self-advocacy--that is, the healthier the mom/baby going into birth, the more informed and prepared the family, the lower their risk for any kind of birth problems. It seems that this is something you don't understand very well--perhaps you haven't looked into it very deeply yet. But it doesn't make your point any stronger, by calling my point 'laughable'. This IS something that I have looked into deeply, over many years now. And again, it's not only about prevention (which isn't always possible) but also about how we feel about what happens, whether or not we feel that we made the best possible choices along the way.

As for expertise--yes, there is a reason for it in health care, and no, no one is going to have the same level of understanding of all the issues around some problem or another in pregnancy/birth. But let's take the example of prolonged rupture of membranes: the average person can understand the basic facts about it, and make sound decisions regarding it. This is something that a birth provider can explain to families, including risks, benefits, precautions, possible courses of care. I've seen it go both ways at home: families who choose to tranfer care to hospital w/prolonged rupture, solely based on risk factors and not on observable poor signs; those who choose to stay home with prolonged rupture, taking precautions and closely monitoring signs. This is info that I think needs to be shared with families, who are encouraged to be actively engaged in decisionmaking. On the other hand, you have OBs with ridiculous protocols such as having all moms with ruptured membranes IN the hospital immediately, and IN bed constantly, induced/augmented ASAP, w/csec in an arbitrary # of hours; this is not evidence based practice and families are not given good info or allowed to make decisions.

there are many such examples that exist in pregnancy/birth--most often, there is plenty of time to provide info and make decisions. This is where most care providers fall way too short--whether licensed or not. It is also where families sell themselves short; how many needless csecs and other interventions, so many of them causing all kinds of harm even if mom/baby make it through ok, because famiilies just go with our cultural mythos that Dr (or mw) knows best?

When it comes to the true (and rare) emergencies at birth, obviously there is going to be no committee meeting about what to do! Then, of course we have to trust our care providers to take timely appropriate action that we cannot decide or do for ourselves. I still submit that one's trust can best be placed when placed in a provider who has already proven various things about him/herself: knowledge, integrity, humility, a sincere desire to share the knowledge and power (instead of dominating the relationship), and a committment to fully informed choice by families.

Life, birth and licensing provide no guarantees. IME, the best we can do is remain awake, as involved and responsible as possible, and ready for what life brings us. I want for all midwives to be as knowledgeable and skilled as possible, with high integrity and sufficient humility about their limitations. And that will still never replace families doing their whole part; yes, we must at times trust our care providers with our lives, but we must still own our decision to do so. We have to be realistic about the conditions we face, and face them more mindful of our own well-being than we expect anyone else to be.
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#26 of 31 Old 11-03-2010, 09:56 PM
 
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Seems to me the mistake we make is assuming that a licensed professional can be blindly trusted. Anyone can have skeletons in their closet--of many sorts, including practice violations--that might be found with some searching. Most people don't do that search with their licensed professionals, OR the unlicensed ones...but IMO, should be doing some kind of searching on both kinds. Our licensing system is no sort of guarantee of safe, respectful, competent practice.

You are right--there are birth emergencies that cannot be prevented by advance choices. There are also birth emergencies that no one can 'manage safely'--they are fatal in and of themselves, no matter where or with whom you give birth. These both are in the smallest categories of problems arising at birth; there are many many more problems that CAN be prevented through self-care and self-advocacy--that is, the healthier the mom/baby going into birth, the more informed and prepared the family, the lower their risk for any kind of birth problems. It seems that this is something you don't understand very well--perhaps you haven't looked into it very deeply yet. But it doesn't make your point any stronger, by calling my point 'laughable'. This IS something that I have looked into deeply, over many years now. And again, it's not only about prevention (which isn't always possible) but also about how we feel about what happens, whether or not we feel that we made the best possible choices along the way.

As for expertise--yes, there is a reason for it in health care, and no, no one is going to have the same level of understanding of all the issues around some problem or another in pregnancy/birth. But let's take the example of prolonged rupture of membranes: the average person can understand the basic facts about it, and make sound decisions regarding it. This is something that a birth provider can explain to families, including risks, benefits, precautions, possible courses of care. I've seen it go both ways at home: families who choose to tranfer care to hospital w/prolonged rupture, solely based on risk factors and not on observable poor signs; those who choose to stay home with prolonged rupture, taking precautions and closely monitoring signs. This is info that I think needs to be shared with families, who are encouraged to be actively engaged in decisionmaking. On the other hand, you have OBs with ridiculous protocols such as having all moms with ruptured membranes IN the hospital immediately, and IN bed constantly, induced/augmented ASAP, w/csec in an arbitrary # of hours; this is not evidence based practice and families are not given good info or allowed to make decisions.

there are many such examples that exist in pregnancy/birth--most often, there is plenty of time to provide info and make decisions. This is where most care providers fall way too short--whether licensed or not. It is also where families sell themselves short; how many needless csecs and other interventions, so many of them causing all kinds of harm even if mom/baby make it through ok, because famiilies just go with our cultural mythos that Dr (or mw) knows best?

When it comes to the true (and rare) emergencies at birth, obviously there is going to be no committee meeting about what to do! Then, of course we have to trust our care providers to take timely appropriate action that we cannot decide or do for ourselves. I still submit that one's trust can best be placed when placed in a provider who has already proven various things about him/herself: knowledge, integrity, humility, a sincere desire to share the knowledge and power (instead of dominating the relationship), and a committment to fully informed choice by families.

Life, birth and licensing provide no guarantees. IME, the best we can do is remain awake, as involved and responsible as possible, and ready for what life brings us. I want for all midwives to be as knowledgeable and skilled as possible, with high integrity and sufficient humility about their limitations. And that will still never replace families doing their whole part; yes, we must at times trust our care providers with our lives, but we must still own our decision to do so. We have to be realistic about the conditions we face, and face them more mindful of our own well-being than we expect anyone else to be.


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I cannot back this at all, in the slightest. I cannot support a midwife who is not qualified to help birth. I don't know if this is the truth in this particular case, but to just jump on and defend her is unconscionable to me. People hire midwives to help birth because our society is not one that readily provides a natural understanding of how birth works.
Multimomma, its not up to you or anyone else to decide how qualified this woman is or isnt to help anyone give birth. It was up to the woman who chose her. Its about responsibility. Part of what makes homebirth so hugely different from hospital birth is who is taking the responsibility. If you walk into a hospital you are handing all your responsibility for yourself and your baby to those authorities. With a homebirth, you keep it, or share it with your provider.

As much as the BOBB and the big push has "helped" the homebirth "movement" I feel like it has done it grave injustice. I feel like the attitude is now is more so that people are expecting a hospital birth in the home. They think its "the same" because after all, you have a midwife! Women expect to be "saved" they expect their baby to be "saved" and its not right.

Midwives can not save anyone. The CPM credential does not save anyone. There are loads of DEM's that have waaaay more experience and education than the avg CPM, never-mind the newly certified cpm. CPM does not mean "qualified savior of mothers and babies" And as much as it is the parents responsibility to interview and find the right provide, it is also the mw's responsibility to screen clients. I know a mw who asks every client "what happens if the baby dies?" Well, thats a sobering question for a prenatal, isnt it?! Not many think about that, do they! Usually they're thinking the same thing as the family who goes to the hospital. "well, if anything goes wrong they'll handle it". Handing over the responsibility to a medical "authority" and if they screw up, they have someone to sue. These are not the kind of people who should be having home births. If you expect your "medical provider" to save you or your baby then get to a hospital. End of story.

There are women who will chose to UC and other women who will choose a DEM or a woman who simply has a lot of birth knowledge/experience. The point is, it SHOULD be a choice. Allowing the state or whoever to decide that someone is qualified but someone else isn't, simply takes that choice away.

I wish you'd poke around on the UC board here --there have been quite a few good discussions on responsibility in birth.

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#27 of 31 Old 11-03-2010, 11:40 PM
 
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Multimomma, its not up to you or anyone else to decide how qualified this woman is or isnt to help anyone give birth. It was up to the woman who chose her. Its about responsibility. Part of what makes homebirth so hugely different from hospital birth is who is taking the responsibility. If you walk into a hospital you are handing all your responsibility for yourself and your baby to those authorities. With a homebirth, you keep it, or share it with your provider.

As much as the BOBB and the big push has "helped" the homebirth "movement" I feel like it has done it grave injustice. I feel like the attitude is now is more so that people are expecting a hospital birth in the home. They think its "the same" because after all, you have a midwife! Women expect to be "saved" they expect their baby to be "saved" and its not right.

Midwives can not save anyone. The CPM credential does not save anyone. There are loads of DEM's that have waaaay more experience and education than the avg CPM, never-mind the newly certified cpm. CPM does not mean "qualified savior of mothers and babies" And as much as it is the parents responsibility to interview and find the right provide, it is also the mw's responsibility to screen clients. I know a mw who asks every client "what happens if the baby dies?" Well, thats a sobering question for a prenatal, isnt it?! Not many think about that, do they! Usually they're thinking the same thing as the family who goes to the hospital. "well, if anything goes wrong they'll handle it". Handing over the responsibility to a medical "authority" and if they screw up, they have someone to sue. These are not the kind of people who should be having home births. If you expect your "medical provider" to save you or your baby then get to a hospital. End of story.

There are women who will chose to UC and other women who will choose a DEM or a woman who simply has a lot of birth knowledge/experience. The point is, it SHOULD be a choice. Allowing the state or whoever to decide that someone is qualified but someone else isn't, simply takes that choice away.

I wish you'd poke around on the UC board here --there have been quite a few good discussions on responsibility in birth.
Bold the first: When a thread is started asking us to contact people to support her, yes, I do want to decide how qualified she is before I do so.
Bold the second: No. Even with a hospital birth, you retain rights and privileges. I had a much freer birth with my fifth child in the hospital, than I did with the midwife from my first birth. Because i was educated by then. However, most people don't have five children, and get that kind of practice.
Bold the third: I don't know what this is supposed to mean. Midwives can't save anyone? So, if I have a full on SD, that I couldn't resolve myself, my midwife couldn't help deliver the baby using maneuvers and 'save me'? Could you please explain this?
Bold the fourth: I had my first UC seven and a half years ago. I've had two since. I have been active on the UC board, and read many of the threads on responsibility.

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#28 of 31 Old 11-03-2010, 11:42 PM
 
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Multimomma--

you asked about maternal mortality rates: YES, childbearing women are more likely to die in hospitals than at home
Thanks for the verification and the links. Do you know how the numbers are affected by women who are transfered and/or booted from midwifery care? I'll look at the ICAN website, it's a good one and I didn't think about it for the stats.

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#29 of 31 Old 11-04-2010, 09:10 AM - Thread Starter
 
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Thanks for the verification and the links. Do you know how the numbers are affected by women who are transfered and/or booted from midwifery care? I'll look at the ICAN website, it's a good one and I didn't think about it for the stats.
No, I don't know anything specific to maternal deaths where care originated at home. HOwever--logically thinking, I extremely doubt that the US' overall maternal mortality rate is impacted in any significant degree by homebirth transfers: the US homebirth rate is 1-2%. The 'national average' of homebirth transfers is about 10% (I've seen this cited as a 'normal' rate for prudent care, and have heard many mws state that their own transfer rate is about 10%). So--if we say that the homebirth rate is 2% of all births, and 10% transfer care to hospital, then statistically speaking that is .2% of women who end up in the hospital who originated with homebirth (2 of every 1000 birthing women, home OR hosp. birth plans). Which is a very small number of women--and of course, very few of them die, once at the hospital.

Does that make sense? Let me try this instead, attaching some actual numbers to clarify:

10,000 birthing women total
200 with homebirth plans (2%)
20 who transfer from home to hospital (10% of homebirth-intending women)

So--only 20 of 10,000 women who give birth altogether, were transfers from hb care. Maybe you can see that it is such a small pool of women that even if a few maternal deaths occur relating to hb care specifically, it's not going to raise the overall maternal mortality rate in a visible way.

Over 30yrs, I've only heard a very few maternal death stories at home, or in hospital following transfer of care. Very, very few--and one was the story famous in Florida a few years back, where 'religious mws' let a mom bleed to death over the course of a couple of days, praying over her and exhorting her to have faith that she could be healed by Divine Intervention (but she had a blood clotting disorder...).

Maternal deaths are mainly related to surgery complications and infections (whether originating from surgery or not). A fairly large number of maternal deaths are women with multiple csecs, because csec, and especially multiple csec, significantly elevates maternal risk for MANY issues compared to women who've never had surgery. Again, see the ican site White Papers pages.
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#30 of 31 Old 11-04-2010, 11:37 AM
 
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Thanks MsBlack...very useful!

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