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Discussion Starter #1
So, I've been reading more about home birth (which we are not considering) vs free standing birth center vs hospital birth center vs conventional hospital.

From a link here, I ended up on a website called "Hurt by Homebirth" and have been reading some of the stories there. I have also been on a few other sites that vilify homebirth and even the idea of not having a doctor do the delivery.

There is a disturbing trend in many of the horror stories - completely incompetent care by the birth attendants and parents who blindly follow everything they are told without doing any research themselves.

No one wants to say "why didn't you know xyz?" to someone who just lost their baby, but basic research on some of this stuff would seem to me to raise major red flags. Yes, some things should be known by the care giver, but basic things can also be researched by the family as well. Like "do you carry insurance in case of a problem" would seem to be a very basic question. I ask that from people who work on my house, why wouldn't I ask that of the person delivering my baby???

I'm just very conflicted. Babies die as a result of incompetent care in hospitals AND at home. I don't find it fair to use the tiny percentage of disaster to justify the "home birth is crazy" attitude.
 

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Knowledge is a tricky thing.

I feel I have pretty thorough knowledge about birth- not every aspect (just visited the spinning babies website and was amazed by the depth if knowledge there that is beyond my expertise for sure) but in general- a very firm grasp of pregnancy and birth, due to an assortment of educational and professional experiences.

My DD was born at 27 weeks. I arrived at the hospital basically fully dilated. I did not know I was in labor. Somewhat I can attribute that to being preterm, or maybe that's how women in my family have babies (I was born sort of precipitously, at full term).

But really, in retrospect, I knew something was going on for a few hours. But it didn't look like the many many labors I'd seen, it wasn't happening when it was supposed to, I was in denial perhaps. It's a concept called something like "premature closure" (I think) where you decide what's going on ( in my case I thought maybe the start if a uti- each contraction just felt like I had to pee) and close your mind to other possibilities.

If both you and your provider have a specific bias about what's going on, knowledge won't make you see past that. (My midwife didn't have any harmful bias in this situation, but I also didn't speak to her until I was in the waiting room if my local ER so sort of a moot point.)

If you and you midwife both feel birth is always to be trusted, every variation or complication will just be viewed as as something to be overcome with just some more trust- drink some tea, try some position, take some deep breaths. If you and your OB feel birth is safest with interventions, same thing- just start some pitocin, use the vacuum, cut the nucal cord. That's what knowledge alone might get you. But having some perspective, being humble, not knowing everything- maybe then you and your provider will instead look at the situation with fresh eyes, no assumptions, a willingness to ask for help, to admit the birth plan can't happen, that your knowledge is wrong. I don't know how to assess this, per se. Just some philosophy talk.
 

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Homebirth is wonderful and as safe as one can get. It does pay to have an experienced/recommended attendant if you are not UC'ing. I chose my midwife because licensing of midwives was just about to go into effect, which risked any mother with more than 1 c-section out of a legally attended homebirth in our state. She was "getting licensed" but really wasn't ready to be, IMO. So, I settled, and I got what I settled on.

My one and only homebirth was a great labor and birth (because the midwife was not even in the room for most of it) but the aftermath was horrible. She panicked, because she had taken me, a VBA2C, and I delivered a big baby, and I think she wanted me to fail like she had failed her VBAC attempt. However, I had already had 2 vag births before my sections, and 1 VBA2C at the hospital before my homebirth.

Anyway, she was supposed to have an assistant at the birth. Rather, she brought her 16 year old daughter to "assist". Which, all this is fine if it's what I had OK'd. I hadn't. Next, she brought a doula friend of hers, which I had never met. I never asked for a doula, and I didn't need one. I had wanted a quiet/no onlooker birth. As soon as the baby came out he got great APGAR, went to my chest and then she had her daughter take him to the kitchen to bathe him. She said "it was time to seriously get to work on the placenta". She sent my girls out of the room, and told me in a very low, serious voice, "I'm going to give you pitocin". I asked, since my one only fear with homebirth was hemorrhage, "Oh no, am I bleeding badly?" She responded, "No, I just want to be sure you don't". My husband then about fainted in fear, because he knew that the only time to be concerned was if I needed drugs for bleeding. He didn't understand, and I didn't either. Then she said, "Actually, it would be better to also give you methergine". She gave me methergine and the tetonic contractions started...way worse than the transition/birth of a 10 lb 9 oz infant.

I labored for 2 hours on the placenta, with contractions every 2 minutes apart. I told her "something is wrong, this is worse than labor". she said, "yes, afterpains are bad after you've had a few babies". I said "this isn't afterpains. I think my placenta is trapped. I felt it detach". Then, I began getting weak and pale..my blood was pooling behind an entrapped placenta from a cervix that had closed from methergine use before the 3rd stage was complete. She then called another midwife to give me a catheter. Still covered in birth fluid and blood, they tried for 10 minutes to cath me while I writhed in pain from a small tear and contractions. I told them, "I emptied my bladder, it's not full" but they said it would help the placenta come out. Finally after 2 hours I demanded to be transferred to the hospital. With a cord dangling out of me and no underwear on, I went to the ER.

She berated me for that.

When I got there in my vehicle, my husband took me in. The doc asked me what meds I had been given. Not knowing anything yet about methergine side effects or that what she did was a mistake, I told him, "methergine and pit". He said, "methergine?" She got very angry and said I could have ruined her career by saying that. That's when I knew she had done seriously wrong.

My blood loss was estimated to be very low, but I was at risk for hemorrhage at any point since the placenta was preventing clamping down and trapping blood and clots. I was prepped with a spinal where she told me, "you went through a homebirth and now you want pain meds?" I told her yes, this was way worse than the birth. Thankfully, he manually dilated my cervix and took out an intact, large, healthy placenta. I did not need a D&C. He said my cervix closed from the methergine and that you NEVER administer that before a completed 3rd stage.

Months went by before I talked to her. Then she claimed she never gave me anything. :) She said her only mistake was taking me as a client. :( Very hurtful after what she had caused. The only problem is, she went to a peer review the week after my birth and told all the midwives. So now all the wonderful midwives I have met know the truth about her.

Now, if I were to have a homebirth again, I'd know how to make it safe. Hire a competent midwife, as the alternative of UC'ing would be far safer than having a midwife present who will damage you and/or baby. I didn't nurse or hold my baby until 6 hours after birth. He was wet nursed by her best friend she called in immediately when I went into surgery as if she thought I'd die..he wasn't even rooting...she told my husband, "we don't know how badly her body is failing right now. He needs to get to breast." Knowing how important it was for me to breastfeed, my husband consented..he was petrified he was losing me and she pretended the whole time it was my body failing because of a VBAC!...it was a bad experience.

Thankfully, I do NOT hold homebirth or MIDWIFERY responsible. I hold HER responsible, yet I've forgiven her. I can't live bitter. It's between her and her conscience and future clients. Homebirth is safe and wonderful! Knowledge of birth does not rule out mistakes, human error or problems...however, being sure about your midwife can eliminate much of that. :thumb
 

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Discussion Starter #4 (Edited)
@Rachet; - I agree completely, especially in regards to unexpected occurrences.

But I'm not even talking about that, some of the stuff being "missed" is basic. Who are you insured through? Who are you licensed with? What is your transfer rate? What are your overall birth statistics? What hospital do you transfer with/have a relationship with? And then check the information. Sure, some of that could be lied about, but I don't think those are "in depth" at all. I have a contract with my doula that specifies when she will come to my house before the birth, who her back up is, how long she will stay, how often she will need to leave for rest in the case of a prolonged birth, etc. And that's a basic contract.

I'm sorry if this sounds mean, but at some point just saying "I believed everything they said" is just not a defense. This is not 1980 (or even 1990!) basic internet searches will give quite a bit of common information that you need to make an informed decision. Perfect example of "what were you thinking" is all of the stories that include meconium in the fluid. That is a sign of a problem, and not often a minor one.

Yes, I totally understand that in the moment it's hard to make an informed decision especially considering the pain and fatigue involved with birth. But so many of the stories should never have happened in the first place because there was a forest of red flags from the start.
 

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Discussion Starter #5
Thankfully, I do NOT hold homebirth or MIDWIFERY responsible. Homebirth is safe and wonderful! Knowledge of birth does not rule out mistakes, human error or problems...however, being sure about your midwife can eliminate much of that. :thumb
You are a strong woman to know where that dividing line is. From what I'm seeing online sooo many can't make that distinction. I'm very glad that everything turned out ok in the end after a rough start.
 

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I'm all for choices but homebirth does involve TWO lives. Of the five women I know who birthed at home... three have had very poor outcomes.

I'm married to a "just in case" sort of guy... my babies are also his babies. We gave birth in a hospital with a top rated NICU down the hall. My beloved CNM caught the babes. I had no meds or even an IV and it was a glorious experience both times. Each time I was home by noon the next day.

Yes, hospital births can be tricky for some. You go in too early, you get scared and you get stuff done to you and the babe. No one denies that this is a possibility. But at home with only one person to be your sole caregiver and possible source of rescue for you and your babe? Not a chance I'm willing to take.
 

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There is a disturbing trend in many of the horror stories - completely incompetent care by the birth attendants and parents who blindly follow everything they are told without doing any research themselves.
Are the parents then liable for the provider's incompetence?

What responsibility does the certified and/or licensed midwifery professional have to provide save, evidence-based, competent care?

I admit that I don't do all my research when I hire a provider. I just had dental work done last week, I did virtually no research on the dentist. She is licensed, experienced, I assume she is giving me professional, competent, safe dental care. I'm quite happy with the service I received from her.

I would hope if this dentist was incompetent and unsafe, that they would be out of work.

Why should it be different for certified and licensed midwives? Shouldn't I be able to trust that a legally recognized and professional midwife operates within professional standards and safe guidelines? Are parents really at fault if they believe that they are hiring a professional care provider?

Perfect example of "what were you thinking" is all of the stories that include meconium in the fluid. That is a sign of a problem, and not often a minor one.
Maybe I shouldn't get any more dental care until I research all the potential complications of dentistry, so I can alert my dentist to the problem when it arises?

As a health care professional, I am accountable for providing safe and effective care. If we want to call ourselves "professional midwives" we need to start acting like professionals and take some accountability for what happens at home births. Most importantly, when it goes wrong.

I agree with you: the site and the stories are disturbing. So who should be doing something about it? The parents? I don't think so.
 

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There is a disturbing trend in many of the horror stories - completely incompetent care by the birth attendants and parents who blindly follow everything they are told without doing any research themselves.
Are the parents then liable for the provider's incompetence?

What responsibility does the certified and/or licensed midwifery professional have to provide save, evidence-based, competent care?

I admit that I don't do all my research when I hire a provider. I just had dental work done last week, I did virtually no research on the dentist. She is licensed, experienced, I assume she is giving me professional, competent, safe dental care. I'm quite happy with the service I received from her.

I would hope if this dentist was incompetent and unsafe, that they would be out of work.

Why should it be different for certified and licensed midwives? Shouldn't I be able to trust that a legally recognized and professional midwife operates within professional standards and safe guidelines? Are parents really at fault if they believe that they are hiring a professional care provider?

Perfect example of "what were you thinking" is all of the stories that include meconium in the fluid. That is a sign of a problem, and not often a minor one.
Maybe I shouldn't get any more dental care until I research all the potential complications of dentistry, so I can alert my dentist to the problem when it arises?

As a health care professional, I am accountable for providing safe and effective care. If we want to call ourselves "professional midwives" we need to start acting like professionals and take some accountability for what happens at home births. Most importantly, when it goes wrong.

I agree with you: the site and the stories are disturbing. So who should be doing something about it? The parents? I don't think so.
 

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Discussion Starter #9
Are the parents then liable for the provider's incompetence?
No, but the parents are liable for not bothering to look into basic things about the person who they are selecting. Transfer rates, relationship with a hospital, insurance, etc. Basic information.

What responsibility does the certified and/or licensed midwifery professional have to provide save, evidence-based, competent care?
They have full responsibility to provide "competent care" but what they view as competent and what you view as competent might be different. It is on the patient to know that the provider has the same outlook. For personal reasons, I refuse most exams and require mostly "hands off" care. Obviously a "managed care" practice is the completely wrong place for me to be and it would be unreasonable for me to go to a managed care office and then complain that they want to perform every test in the book and do internal exams at every appointment. Some women find that level of care comforting, some find it unbelievably stressful - and it is up to the patient to look into the kind of care they are hiring. I interviewed four different offices, all highly recommended, before I found one that met my needs.

I admit that I don't do all my research when I hire a provider. I just had dental work done last week, I did virtually no research on the dentist. She is licensed, experienced, I assume she is giving me professional, competent, safe dental care. I'm quite happy with the service I received from her.

I would hope if this dentist was incompetent and unsafe, that they would be out of work.
Dental care and home birth aren't exactly comparable. If you had a dentist performing oral surgery in your home, perhaps it would be equivalent. Getting your teeth cleaned doesn't have quite the same risk profile as birth.

That said, my dentist growing up was an ass. He was rough and had crappy interpersonal skills. So, yes, when I chose a dentist as an adult I spoke to a couple of them to find out if we got along.

Why should it be different for certified and licensed midwives? Shouldn't I be able to trust that a legally recognized and professional midwife operates within professional standards and safe guidelines? Are parents really at fault if they believe that they are hiring a professional care provider?
If they didn't do basic due diligence? Yes, they are partially responsible for the choices they make. If they do their homework and are lied to that's a different matter.

Maybe I shouldn't get any more dental care until I research all the potential complications of dentistry, so I can alert my dentist to the problem when it arises?
Um, no. That's not even a remotely accurate analogy. But if you must continue your "dental work compares to child birth" example - if your dentist offered you two different types of procedures and each had specific benefits and risks and you didn't bother to do any research and just said "do whatever you want" then YES you are partially responsible for a less than optimal outcome. If your dentist does a procedure and you are in so much pain that you can't function for normal daily activities, but that dentist says that everything is normal and you need to just suck it up, I'd assume you would seek help elsewhere?

As a health care professional, I am accountable for providing safe and effective care. If we want to call ourselves "professional midwives" we need to start acting like professionals and take some accountability for what happens at home births. Most importantly, when it goes wrong.

I agree with you: the site and the stories are disturbing. So who should be doing something about it? The parents? I don't think so.
Yes, the parents should be doing something about it. Some of the stories I have read have a disturbing lack of due diligence on the part of the parents. Is it entirely their fault their baby was hurt or died? No... but if they hired someone and didn't bother to do basic things like experience, transfers, insurance, then they DO have some accountability for making a very poor choice of provider. AGAIN, being lied to is a whole other issue, but from some of these stories I do more background work on who I let take care of my dogs than some people choosing a birth care provider.

As for births that go wrong - they happen in hospitals too. I personally know of two dead mothers that should still be around to raise their children, and both of those deaths can be attributed to the care in the hospital. One was gross negligence, the other was an unfortunate very rare complication of a "routine induction" of a baby that was "too big" and that baby was just over eight pounds so the induction was unnecessary anyway.
 

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PitBullMom:

We're going to have to agree to disagree, I guess.

I hold professionals to higher standards than you do.

MyFillingQuiver's story is rife with incompetence. Last time I checked midwives were certified and licensed to practice in Idaho. How do the Idaho laws governing the practice of midwifery protect the public from this kind of incompetence repeating itself?

I just flatly disagree that it is the responsibility of the parents to vet their midwives. Particularly when they uphold themselves as "professionals." But it is coming to that, because certification and licensing laws are doing little to 1) assure safe practice, 2) competence, 3) accountability.

PS: Dentists don't clean teeth.
 

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Discussion Starter #11
Clean teeth, pull teeth, drill teeth, cap, crown... whatever. I can't think of a single procedure I have ever had done by my dentist that could come close to childbirth.

Anyway, I'm ok with disagreeing. We both seem to have lots of supporting reasoning for our positions. :)
 

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PitBullMom:

We're going to have to agree to disagree, I guess.

I hold professionals to higher standards than you do.

MyFillingQuiver's story is rife with incompetence. Last time I checked midwives were certified and licensed to practice in Idaho. How do the Idaho laws governing the practice of midwifery protect the public from this kind of incompetence repeating itself?

I just flatly disagree that it is the responsibility of the parents to vet their midwives. Particularly when they uphold themselves as "professionals." But it is coming to that, because certification and licensing laws are doing little to 1) assure safe practice, 2) competence, 3) accountability.

PS: Dentists don't clean teeth.
When I had my homebirth, licensure was required to be pending for the midwife. In other words, the law was in effect, but working retroactively...SO, I do see that as MY failure. I wanted a homebirth so badly, that I had a homebirth despite the fact that in a few months a VBA2C would be "illegal". Many midwives still practice "under the radar" in order to provide care to those they deem good candidates, but the laws risk-out. I am not a candidate for legal homebirth in the state of Idaho. I will not be seeking a homebirth in the future. Interestingly, the incompetence with my homebirth had NOTHING to do with me being a VBA2C, but she was not licensed.
 

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Discussion Starter #13
MyFillingQuiver's story is rife with incompetence.
Yes, it is. Even with through vetting, there would have been no way for her to know that she'd be given an inappropriate medication for her situation. However, blaming that on "homebirth" is folly (and I don't think she is blaming it on homebirth, but putting it squarely on the provider, where it belongs.)

A friend of mine just died, partially because a doctor - in a hospital - prescribed her a drug that is specifically contraindicated for people with liver disease. If you give it to them, their liver and kidneys shut down. She took it for a week before she was re-admitted to the hospital in liver and kidney failure.
 

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Licensure is a political issue. Some people object to the way being licensed ties the midwives hands and may seek that out specifically because they believe (for example) a VBAC at home is safer for them than in a hospital. Insuranse is about compensation, not competancy, and many midwives choose specifically not to carry it,and advertise as such. It is prohibitively expensive in some cases. Transfer rates are not a clear indicator of anything. Low rates may mean a midwife who defines a lot of people as high risk (ie no twins, no VBACs, no first time moms, no one over 35 etc etc), or in contrast it is someone who plays russian roulette a lot (and really only 1/6 is a bullet, right?). A high transfer rate may be someone who is willing to everyone a shot, or someone who can't fix even minor problems at home. A backup plan is only as good as the decision-making point of using that plan. Mortality is typically at such a small rate that it takes a huge sample size to reach statistical sinificance, altough certainly is good to know. But you can make a lot of bad decisions before you have your first bad outcome.

I'm not saying this to be argumentative per se. But I think the issues are more philisophical than knowledge or factual or licensure based. I think home birth outcomes in the US will always be a bit worse than hospital births, because homebirth honors a lot of philosophies that hospitals wont allow. - I don't know if that's good or bad- I mean, obviously bad for those with bad outcomes, but how many empowered beautiful HBACs should be sacrificed to prevent the uterine rupture at home? When do we cross the line from informed conset and risk stratification and autonomy, into fear-mongering and bullying? And what can we reasonably expect of the "average layperson?" Even moms who feel very educated from what they've read and researched etc are in no position to be their own midwife in labor. Otherwise midwives would all have UCs, right? And they don't.

I do think this is a good discussion to have. Blaming moms is an oversimplification but we all need to examine our philosophies thoroughly.
 

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Discussion Starter #15
I don't blame moms/parents, I don't blame homebirth and I don't blame midwives. Sometimes even the best decisions can turn out badly because of a million different variables.

However, I don't absolve moms/parents of all responsibility for vetting their caregivers. There is no single piece of information that tells the whole story of a provider's experience and competence, but when you look at the big picture four or five things might be a good indicator. My mother is a nurse (not a CNM) and she carries a million dollars of insurance personally and has since I was in high school; so that's been more than 20 years. Private insurance is not cheap, but the alternative - destroying your entire financial life - is far more expensive in the long run.

I also don't absolve crappy midwives for being crappy.

There are a LOT of pieces to this puzzle. There are certain risks to birthing at home, which is why I personally am not choosing to do so. However, I fully support every woman's right to choose that birth experience. However, you can't just open a phone book and pick someone and assume that just because they have the right initials after their name that they are competent. And some, not all, of the people blaming homebirth for a tragic birthing outcome seem to have not done much more than that. Sometimes horrible things happen no matter how careful and diligent we are, and sometimes a little due diligence can avoid a tragedy.

You know what they call the person who graduated last in their class at medical school? Doctor.
 

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Liability insurance for a RN is a few hundred dollars per year. For someone (CNM/LPM) attending births it is tens of thousands per year. Some practices/midwives/birth centers will make signing forms about not having insurance a requirement for them caring for you, and some individuals make sure they don't have assets in their own name. It is not at all uncommon.

I don't think people are randomly picking names out of a phone book.

If your midwife told you she'd attended almost a hundred HBACs at home and never had a problem, that would sound reassuring. But the rate for uterine rupture is 1% so it's also not surprising or unexpected. It does't mean the midwife is lying, or that you'd not done your research. It just means bad outcomes are infrequent enough that unless you look at big studies, you don't get accurate data. And then you get some meaningless number like "1%" and you still have to make the decision: do you risk being that 1%, knowing that the outcome would be better if you were in the hospital? Does that make up for all the other things that come with it?

Things like meconium, breech, HBAC, twins- they are all statistically riskier at home. So you read these stories, where people have one of these things (or something else that should be a "red flag"), and you think, how could they have not acted on this? Don't they KNOW it's risky? But when someone's just attended 10 births with meconium, and they've all done fine, and the 11th has meconium, they can be lulled into thinking it will be fine too- especially if your mantra is 'trust birth.' I'm a proponent of home birth with pretty strict exclusion criteria. But if you look around, here especially, that is not a universal philosophy. People are, I guess you could say, "purposefully" taking risks- because they are balancing against the perceived or real risks of the alternative (hospital birth). I think it's unfortunate that the hospital experience is so risky for women, either perceived or actual, and I think that pushes people to make choices they might not have otherwise.
 

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Much agreed, Ratchet. Licensing is a political issue, and only truly comes into play when malpractice has occurred or a tragic ending.

The other issue is truly finding a midwife's ACTUAL competency, experiences, etc. In my case, before she was required to be licensed, she gave me a few references (upon request)...well, duh..am I going to get the references about the way she panics in labor when anything isn't "textbook"? I don't even know what about my labor freaked her out, but if she was freaked, she ought to have sent me back to my OB for a birth at the hospital, rather than taking her own concerns over my birth to the hilt, by managing me as if I were in the hospital with complications and she was attending!

After all the "stuff" died down, I was able to find a few ugly reports of her care online at personal rating sites. Now, since licensing has happened, those have mysteriously disappeared and she has a cult-following of mom's on Facebook..they are just all fortunate their births didn't scare her..that's when we ran into problems. My prayer is that none of her clients ever deviate from "textbook" births, or that her perceptions of such are accurate. For everyone's sake.

I would love for women who may not be comfortable with homebirth, or who would love to be at a hospital and not messed with unless having complications, to be confident having a completely natural birth in a hospital, attended by a midwife or a physician..and know they will be respected. I think that is a huge driver of women to seek homebirth, even when homebirth may not be the safest/well attended choice for them in that particular pregnancy.
 
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And, I have no idea, but I wonder if it the disrespect and hostility from the hospital world that keeps some midwives from transferring appropriately. Like, a confident, competent midwife should never let her pride stop her from getting mom what she needs, but I'm sure that's a component of things.
 

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Yes this^^
I was risked out by a CPM for blood pressure issues before I even went into labor. I knew she was a relatively conservative midwife with a fairly high transfer rate, that I interpreted as "I'm not afraid to send you if you need/want to go, nor am I afraid of what hospital staff will say to me when we get there". (& she said this but not in so many words).
I loved that I had this level of humility with my caregiver (if only the OB I transferred to has been the same way!). And if I ever get pregnant again (highly unlikely) I would choose the same midwife.
 

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Hospital births are not safer for low risk pregnancies. I think a 30% c-section rate and a unusually high maternal and infant death rate in the US speaks to that. I'm sure there are bad midwives but there are also horrible doctors.
 
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