Midwives in WA - why so medical? - Mothering Forums
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#1 of 24 Old 02-10-2010, 06:41 PM - Thread Starter
 
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For being such a crunchy state, our midwives here seem pretty medically minded/conservative, at least in comparison to what I hear from other women in other states, where midwives are much more open to things like VBACs, breech deliveries, letting moms go more than 2wks overdue without lots of testing/intervention. Is it mainly a legality/malpractice issue? I know midwives here are more regulated than in other states. Is the Seattle Midwifery School/Bastyr more medically minded than other midwifery programs? Are there midwives here (N. Seattle/Snohomish Co. area and/or near Cle Elum) that are more traditional-type midwives who aren't so overly-concerned about things like going past 42 weeks for a homebirth and incorporate more natural remedies/approaches rather than going straight to the IV abx for GBS, vit. K shot, etc. without question....
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#2 of 24 Old 02-10-2010, 07:07 PM
 
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I think you are right on the money with your reasons why. Most of our midwives come from a single school, the malpractice issue is huge, and the pressure within the midwifery community to keep good relationships with the doctors is very real.

That being said, there are midwives out there who practice more in the traditional model, either as their general style or those who truly believe in informed consent and are willing to allow parents to make those decisions. You might have to dig them out but they are available.
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#3 of 24 Old 02-10-2010, 07:13 PM - Thread Starter
 
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Thanks for the reply. I didn't even consider maintaining good relationships with docs...good point.

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That being said, there are midwives out there who practice more in the traditional model, either as their general style or those who truly believe in informed consent and are willing to allow parents to make those decisions. You might have to dig them out but they are available.
Do you know of any who do births in Snohomish County or near Cle Elum?
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#4 of 24 Old 02-10-2010, 07:44 PM
 
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Thanks for the reply. I didn't even consider maintaining good relationships with docs...good point.



Do you know of any who do births in Snohomish County or near Cle Elum?
Sending you a pm with some names

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#5 of 24 Old 02-11-2010, 05:15 AM
 
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Interesting. I have not once felt that my midwives were too medical (going to PSBC in Kirkland), but there are a few things that they said they couldn't do, IE twins, and I figured it to be an insurance/malpractice/legal thing. Other than that, my experience with them so far is that they pretty much let me do things however I want to do them, with guidance as requested. But even that has been a very holistic approach.

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#6 of 24 Old 02-11-2010, 08:30 AM
 
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I has more to do with how the state investigates midwives- at any given time your state has about 90 lms and there are atleast that many active investigations. The state has more than bankrupted the midwifery department due to the investigations- additionally there are no scope of practice protections- the law is a nice neat outline but does not really fill in all that is allowed- nor is there a way for peer review to be a valid way to manage complaints- but if you join one of the state organizations they will hold you to those stated standards- I had a friend who fought the state to honor the challange mechansim, after that lets see she attempted a home breech birth that ended in transfer- mom fine and well, baby fine and well, parents supporting and appearing in court for the midwife- state investigators against- what came out of that was a judge finally saying that breeches were within the alternative scope of practice offered by midwives, just not footling breeches- doctor who testified against her called a complete breech a footling because any time you can feel the feet it is footling in his book. another midwife I know was investigated for NOT doing vaginal checks after PROM... when they show up at your door step- you do not let them in- and you do not hand over files other than the ones specified- you have a lawyer send them to the investigators- very often what mws do is cut deals to not do xyz- and they do not go to court so there is a nurse run investigations department these are not midwives-who decide what a midwife should be able to do in Washington- it isn't malpractice nor is it completely education (sometimes it is) but mostly what is the local standard- and what you can convince a nurse investigator is reasonable- an investigator who uses MDs as advisors--
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#7 of 24 Old 11-07-2010, 02:39 PM
 
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it is really screwed up I had no idea until I was pregnant myself but the majority or the midwifes hear are so focused on how they are looked at by the medical community that many will but that before the well being of there clients.I had a midwife flat out tell me a homebirth could be the best place for me but they couldnt do it becuse they had to think about how it would look for the medical community! I had an awful awful pregnancy with midwifes and this is one of my top complaints. I know there are a few " good midwifes " out there in western wa but they hide . I didn't find on until it was to late last time . currently looking again no luck so far
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#8 of 24 Old 11-07-2010, 02:47 PM
 
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I haven't had a birth for a *Long* time, but I found the midwives in Oregon to be more medically minded than in WA so DD was born in Oregon 11.5 years ago and DS in WA 9 years ago.

 

 

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#9 of 24 Old 11-07-2010, 02:48 PM
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I think I can tell you about the over 42 week thing. I no longer live in WA but I am from there and my DD was born there over 5 years ago. DD went a week over and my CNM told me that she didn't look to induce until 42 weeks. The thing is that a year before my DD was born, a MW had a client who went past the 42 weeks and the baby died. I remember my CNM saying this midwife was irresponsible in the way it was handled. I am sure this incident made MWs in the area look at postdates a little closer.

Anyway, if you want to look up an article about the incident, it was either in the Stranger or the Weekly and I think it happened in 2004. DD was born in 2005.
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#10 of 24 Old 11-07-2010, 02:51 PM
 
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I think I can tell you about the over 42 week thing. I no longer live in WA but I am from there and my DD was born there over 5 years ago. DD went a week over and my CNM told me that she didn't look to induce until 42 weeks. The thing is that a year before my DD was born, a MW had a client who went past the 42 weeks and the baby died. I remember my CNM saying this midwife was irresponsible in the way it was handled. I am sure this incident made MWs in the area look at postdates a little closer.
My midwives in WA were not wanting to go past 42 weeks in 2001, so I'm sure that is not it. That said, they were willing to be flexible with dates as well (early U/S suggested a due date a few days earlier than the one we went with) and were clear that I would have options at that point other than going to a hospital.

 

 

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#11 of 24 Old 11-07-2010, 06:02 PM
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My midwives in WA were not wanting to go past 42 weeks in 2001, so I'm sure that is not it. That said, they were willing to be flexible with dates as well (early U/S suggested a due date a few days earlier than the one we went with) and were clear that I would have options at that point other than going to a hospital.
huh. Well my midwife said specifically that case made it so she would not go past 42 weeks. Actually, she said something to the effect of I'd suggest induction rather strongly if you haven't had the bb at that point.
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#12 of 24 Old 11-07-2010, 06:12 PM
 
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I personally don't think it's screwed up.

I love the Washington State model and I love that midwives here are so well-integrated (compared to the rest of the US) into the health care system. I think they do an excellent job of balancing risk assessment with trust and using their human instinct.

I think our midwives are extremely experienced compared to many lay midwives in some other, unregulated, states (e.g. Oregon) and I found it a lot easier to find midwives in Washington.

I love that they know the body from both sides, the technical specifics to the more ethereal qualities that each person has.

And I think this is one of the reasons homebirth is so accepted in Washington State, AND why we have the best infant and maternal mortality statistics in the country!

Yay, Washington!

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#13 of 24 Old 11-07-2010, 11:48 PM
 
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I'm with Edna. Sure, things could be better - isn't that always the case - but in reality we have it pretty good here.

I never had interventions pushed on me with either of my 2 midwives and I never felt like I was pressured into something I didn't want. In fact, with my last birth my water broke and I didn't go into labor for nealy 17 hours. We went in to see my MW the morning that my dd was born (PROM the night before) and she did the "I have to tell you that you can go to the hospital to be induced" speach, but I could tell she was only saying it because she "had" to and she expected us to say no. She then discussed natural ways to get things going and suggested that I might want to consider them if it was getting close to 24 hours with no labor. Fortunately dd came 2 hours later, before the MW got to my house! But even in a situation where in the hospital I would have been on pitocin and there would have been talk of a c/s, I felt very respected and like I had a choice.

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#14 of 24 Old 11-10-2010, 04:58 AM
 
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Originally Posted by EdnaMarie View Post

I personally don't think it's screwed up.

I love the Washington State model and I love that midwives here are so well-integrated (compared to the rest of the US) into the health care system. I think they do an excellent job of balancing risk assessment with trust and using their human instinct.

I think our midwives are extremely experienced compared to many lay midwives in some other, unregulated, states (e.g. Oregon) and I found it a lot easier to find midwives in Washington.

I love that they know the body from both sides, the technical specifics to the more ethereal qualities that each person has.

And I think this is one of the reasons homebirth is so accepted in Washington State, AND why we have the best infant and maternal mortality statistics in the country!

Yay, Washington!

 

Agreed.  My Midwife is also a Naturopath and her husband whom she practices with is a ARNP. 
 


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#15 of 24 Old 11-16-2010, 10:23 AM
 
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I had wonderful experiences with my Washington midwives.  I love that they communicate well with the medical community--we had to transfer during one of my births and I was so amazed at how the midwife worked together with the hospital folks.  Also thankful that insurance covers midwifery services without hassle.  I think they are required to cover it.  The culture is supportive of midwives, too.  There is so much demand for midwives and I am always discovering people who had/have homebirths (at work, church, etc.).

 

However, I would be very frustrated if I were looking to have an out-of-hospital VBAC, breech, or twins birth in Washington.  Those 3 things are outside of the scope of a licensed midwife working outside the hospital.   I think going past 42 weeks is also in there (I read the law awhile back).  In Oregon, VBACs, breech, and twins not actually forbidden outside of the hospital (I think triplets are), so there can be more options.

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#16 of 24 Old 11-16-2010, 12:41 PM
 
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There are MWs who will do all 3 of those things.  They just don't advertise it.  You have to know where to look.


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#17 of 24 Old 11-17-2010, 09:10 PM
 
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Quote:
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There are MWs who will do all 3 of those things.  They just don't advertise it.  You have to know where to look.


Yep...

 

I'm from Eastern WA, so I don't know about how things are on the West side, but my MW was very, very hands off. While technically she said she couldn't attend breech and twin births she made the comment of "Unless it's a surprise at birth" meaning that as long as it wasn't confirmed to her she would still attend and we'd all play dumb :)

 
 


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#18 of 24 Old 11-17-2010, 10:10 PM
 
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Quote:
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Quote:
Originally Posted by DahliaRW View Post

There are MWs who will do all 3 of those things.  They just don't advertise it.  You have to know where to look.


Yep...

 

I'm from Eastern WA, so I don't know about how things are on the West side, but my MW was very, very hands off. While technically she said she couldn't attend breech and twin births she made the comment of "Unless it's a surprise at birth" meaning that as long as it wasn't confirmed to her she would still attend and we'd all play dumb :)

 
 


My midwife does twins, but she said the exact same thing about breech birth. She only attends births between 37 and 42 weeks, but I think that is one of the rules for licensing in our state. And you'd be surprised what doesn't risk you out. I have a cerclage placed because I've had 2 very early babies due to IC and she still took me on. As long as I make it to term, the OB can remove my cerclage in his office and then she can come attend my hb whenever that happens. :)
 


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#19 of 24 Old 11-19-2010, 01:04 AM
 
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My gut/immediate response was "Blue Cross Blue Shield."  Not as many folks can scrounge up the money for paying totally out of pocket, so if midwives want to be able to accept medical insurance...


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#20 of 24 Old 11-21-2010, 02:12 PM
 
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Like many have said...It's not black and white.  It's super difficult for WA MWs to do breeches and twins out of hospital, for example, because of malpractice and licensing issues.  VBAC is another thing that is not covered by malpractice.  However many MWs here do VBAC still.  Same with postdates past 42 weeks--My MW I used and apprenticed with while I was training to be a MW myself usually consults with an OB if it's getting to 42 weeks, however as long as everyone is still safe and healthy, it's OK with her to go a little over.  But this isn't just a black and white "Yes, it's always OK to go to 43 weeks" thing.  She does proper testing and consultation, and talks with the mama about home induction techniques like homeopathy.  I think a MW consumer in this state just needs to interview her MW well before choosing her.  There are many different practice styles, even though we all graduated from the same school.


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#21 of 24 Old 11-23-2010, 06:04 PM
 
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Anyone found a midwife not so cault up in the medical mess IN SEATTLE Ive been looking and everyone except one seem to be out of town TTC a second and really want a stable midwifery situation baring any REAL need for a hospital

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#22 of 24 Old 11-24-2010, 09:56 PM
 
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Graceie-

 

There are a number of excellent midwives in Seattle. If you search for previous threads asking for recommendations for a homebirth MW in Seattle, you'll find several starting points. You could also start a new thread.


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#23 of 24 Old 11-25-2010, 09:48 AM
 
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A great WA MW resource.

 

http://www.washingtonmidwives.org/

 

 


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#24 of 24 Old 11-26-2010, 07:00 PM
 
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I think midwives in general are becoming more medical.  The medical system has basically co-opted midwifery and midwives are being absorbed into it via licensure, certification and insurance.  When a midwife get's a license from the state she agrees to follow their rules which are often contrary to what mothers want or need.  MEAC accreditation has standardized education and not in a good way.  Basically the radical, fringe midwives who were there to help women find a way out of the system have become a cog in the same wheel; focused on risk, liability and protocol.

 

Just so you know, there are still midwives out there who truly believe in birth and in women, you just have to find them :-)

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