My midwife was arrested! Please read...

[wapiti]

That is not saying that those things CAUSED the death of a child, but neither has it been proven that a homebirth CAUSED the death of this child.

 

Others disagree with me, obviously, but IMO, this is a prima facie case. The prevailing standard of care for a breech primip is delivery by c-section. Period.

 

As I stated previously, the midwife could NOT be licensed in VA and provide the quality of care she needed to provide to the patient.

 

What quality of care did the patient need? Perhaps I am mistaken on the facts, but I thought other midwives refused to handle this birth - why?

[Veritaserum]

I agree 100%, this is what I was trying to get across.

 

eta: Nobody has said all doctors and hospitals are like this. But it can be very, very difficult to figure out which ones are the good ones.

 

Especially when docs nod and smile and reassure a pregnant woman that they will do everything she says. Come labor, the doctors do what they want. I had a student who emphasized repeatedly that she did not want an episiotomy. She explicitly stated that she would rather tear. She had a great labor (no drugs, as she wanted), but once the doc came in it went downhill. She told him again that she didn't want an episiotomy. She hadn't been pushing long and baby was coming out just fine. He said ok and then he cut her! :cursing:

[Carol in Cal.]

In the meantime, though, while waiting to change the laws, babies and mothers are being injured every day for no good reason. That's not right.

 

We have to deal with the situation in which we find ourselves. The fact is, I would never have gotten through a completely unmedicated birth, but I got a lot further because I had the kind of respectful support that a midwife gives. Thankfully I got this in a hospital that is known for it, but it could easily have gone another way, and for no other reason than local medical culture. Local medical culture should not trump reasonable maternal choice. Ever.

[A.D.]

Statistics prove that homebirth is safer. Your average first-time-mom-to-be has little way of assessing her true risk when the medical profession wants to speed up nearly all deliveries. It's completely unfair to this mother to assume she was placing her desire for a homebirth of the safety of her baby. Unnecessary interventions (used *regularly* by most hospitals in the US) *also* have risk factors that sometimes end with a still-born baby.

 

From the WP article:

"According to John Kenneth Zwerling, Carr’s attorney, BirthCare advised the mother that the case was too complicated for a home delivery, but she preferred to deliver at home. "

 

She was informed that the birth was too risky for home delivery, and frankly, anyone with an ounce of common sense would have known that. She then went digging around to find an (unlicensed) midwife willing to do the delivery.

This wasn't a seemingly normal birth with unforeseen complications. She and the midwife knew they were taking unnecessary risks with the life of the child, and let their arrogance overrule their common sense.

[Spy Car]

Our Obstetrician (who has my enduring love and gratitude) has never cut a woman in the history of his practice delivering babies. He did not rush the delivery, he took moments to manually pull back tissue to reduce chances of any tearing, and was as gentle and caring as a practitioner could possibly be.

 

I understand this sort of care is all too rare.

 

Bill

[teamturner]

She was informed that the birth was too risky for home delivery, and frankly, anyone with an ounce of common sense would have known that. She then went digging around to find an (unlicensed) midwife willing to do the delivery.

 

 

I thought she has a license to practice but just not in Virginia. If so, I don't think you can make the arguement that she was not trained and licensed in general. To me there is a difference.

[Nakia]

All of these horror stories make me even more thankful for my wonderful OB, the hospital where I delivered my daughters and work (on the postpartum unit), and for my caring and competent nurses. Never once were my wishes not considered or ignored.

 

As for the OP, I am so sorry for Karen, and more so for the parents. What a tragedy. I'm sure that everyone would do things differently if they had it to do over again.

[RachelFlores]

Others disagree with me, obviously, but IMO, this is a prima facie case. The prevailing standard of care for a breech primip is delivery by c-section. Period.

 

 

 

What quality of care did the patient need? Perhaps I am mistaken on the facts, but I thought other midwives refused to handle this birth - why?

 

I'll assume that you are right in the first case and that is likely the reason for the second, BUT is that the BEST standard of care for mother and child? There are a lot of differing statistics on breach birth and what is best for mother and child.

 

I think it comes down to the fact that I don't trust that the "prevailing standard of (medical) care" is always best for *me* and sometimes question whether it is best for the general population. I can totally understand why another mother might feel this way.

[funschooler5]

Especially when docs nod and smile and reassure a pregnant woman that they will do everything she says. Come labor, the doctors do what they want. I had a student who emphasized repeatedly that she did not want an episiotomy. She explicitly stated that she would rather tear. She had a great labor (no drugs, as she wanted), but once the doc came in it went downhill. She told him again that she didn't want an episiotomy. She hadn't been pushing long and baby was coming out just fine. He said ok and then he cut her! :cursing:

 

I had a very similar experience giving birth to my second child. I'd had a quick labor (4 hours) with my first baby, and everything was going fine with my second, but the doctor (who filling in for my doctor) said something about an episiotomy. I said, "I don't need an episiotomy. I didn't need one with my first." He proceeded to argue with me, and when I didn't back down, was completely condescending and sarcastic for the rest of my labor ("Well, go ahead and tear if you want. It's up to you."). :banghead: I delivered DS two hours later, for a total labor time of three hours. I had minimal tearing, and DS weighed 9lb 1oz. What was this doctor's big hurry??

 

My third baby was a homebirth with a midwife who was completely hands-off (at my request). I delivered DD myself, in a birthing pool. It was one of the best experiences of my life.

[Mrs Mungo]

From the WP article:

"According to John Kenneth Zwerling, Carr’s attorney, BirthCare advised the mother that the case was too complicated for a home delivery, but she preferred to deliver at home. "

 

She was informed that the birth was too risky for home delivery, and frankly, anyone with an ounce of common sense would have known that. She then went digging around to find an (unlicensed) midwife willing to do the delivery.

This wasn't a seemingly normal birth with unforeseen complications. She and the midwife knew they were taking unnecessary risks with the life of the child, and let their arrogance overrule their common sense.

 

She chose an unlicensed midwife because licensed midwives cannot carry oxygen. This wasn't someone off the street, it was an experienced midwife.

 

I will again bring up my friend in California. She had a c-section with her first baby. She had two vbacs. Her hospital and doctor (not the same as for the middle two births) insisted that a vbac was too risky. She was over 35 and had previously had a csection. That was end of story as far as the doctor was concerned. When she took in her birth plan he *laughed at her*, tossed it at her and said "this is nothing but a wish list, I'm not entertaining this." She lived too far from a midwife, so she chose an unassisted birth at home instead. That is a case of the doctor and hospital endangering women and babies unnecessarily. It wasn't her arrogance that caused that situation. I'm sure the doctor might say she placed her own desire for a birth at home over having a c-section.

[Rivka]

Statistics prove that homebirth is safer. Your average first-time-mom-to-be has little way of assessing her true risk when the medical profession wants to speed up nearly all deliveries. It's completely unfair to this mother to assume she was placing her desire for a homebirth of the safety of her baby. Unnecessary interventions (used *regularly* by most hospitals in the US) *also* have risk factors that sometimes end with a still-born baby.

 

"Statistics prove that homebirth is safer" only if homebirth is reserved for low-risk situations. It is true that most women would be just as safe, or safer, birthing at home with a midwife. But it is also true that some women and some births really, truly do need intervention.

 

You simply can't use the safety of homebirth for a low-risk situation to argue that homebirth is also safe in a high-risk situation. Nor can you use the problems that often accompany hospital birth (and I am well aware of those problems) to argue that hospital birth is always a bad choice.

 

Birth is normal. But normal things sometimes kill you. Complicated births need to be handled in a medical setting by medical experts. Uncomplicated births? I don't care where you have them, as long as you don't ask me to clean up after you.

[A.D.]

She chose an unlicensed midwife because licensed midwives cannot carry oxygen. This wasn't someone off the street, it was an experienced midwife.

 

I will again bring up my friend in California. She had a c-section with her first baby. She had two vbacs. Her hospital and doctor (not the same as for the middle two births) insisted that a vbac was too risky. She was over 35 and had previously had a csection. That was end of story as far as the doctor was concerned. When she took in her birth plan he *laughed at her*, tossed it at her and said "this is nothing but a wish list, I'm not entertaining this." She lived too far from a midwife, so she chose an unassisted birth at home instead. That is a case of the doctor and hospital endangering women and babies unnecessarily. It wasn't her arrogance that caused that situation. I'm sure the doctor might say she placed her own desire for a birth at home over having a c-section.

 

And that has ZERO to do with this situation. This was clearly a high risk birth, and she was advised by her birthing center to NOT do a home delivery. She then searched until she found a midwife willing to engage in a risky delivery.

This mother and midwife sacrificed that child, and yes, the chances of a safe delivery in THIS case would have been in the hands of a qualified OB and a hospital. A c-section isn't the end of the world.

[Heather in VA]

Agreed.

 

Do all you can to change the laws you don't agree with, and if they can't be changed then break them if you must - but take the consequences without complaint.

 

I agree with this. The problem here is that people lobbied long and hard to successfully get Virginia to allow non-CNM midwives to practice. They require licensing. So women with this midwife's training and experience can become legal here in Virginia by getting a license. This was a hard fought victory for midwives in Virginia. When I had my homebirths (the last in 2003) only homebirths with certified nurse midwives were legal. This is a big change in acceptance. But this midwife chose to continue to practice illegally. Now something like this happens. This is not going to help those states who are trying to get more freedom in birthing. This is the exact kind of thing they point to when they say 'see they don't really care if it's legal or not - they just do what they want even if it's dangerous'.

 

And as far as the 'well it's illegal to carry pitocin and oxygen' excuse. That is just lame to me. It's not any more legal for a unlicensed midwife practicing illegally to carry pitocin and oxygen so that doesn't really make any sense to me. I don't see anyone saying 'gee if I become legal to practice midwifery then it will be illegal for me to carry pitocin and oxygen so I'll continue to practice illegally and illegally carry pitocin and oxygen.' and BTW - the legislation is in the works to allow them to carry pit and oxygen anyway. Again, things like this make it harder for lawmakers to agree to additional rights for midwives when they see them as people who flaunt the law in the first place.

 

Heather

[Mrs Mungo]

"Statistics prove that homebirth is safer" only if homebirth is reserved for low-risk situations.

 

Well...I guess that depends upon if we are using the same definition of the word safer. I mean results in fewer deaths, but I also mean results in fewer interventions and birth injury to mom and baby. Also, what do you mean by high risk? My best friend was considered high risk because she was 35 and overweight. Almost all hospitals consider breech babies high risk. Women are being pushed into high risk categories for dubious reasons. THAT is what makes it hard for women to truly gauge.

 

It is true that most women would be just as safe, or safer, birthing at home with a midwife. But it is also true that some women and some births really, truly do need intervention.

 

I do not deny that at all. I had an emergency c-section with my middle dd. My sister had complications with her second pregnancy and when she asked I strongly urged her to go with the doctor's recommendation of a scheduled c-section because of risks that applied very specifically to her situation.

[Mrs Mungo]

And that has ZERO to do with this situation. This was clearly a high risk birth, and she was advised by her birthing center to NOT do a home delivery. She then searched until she found a midwife willing to engage in a risky delivery.

This mother and midwife sacrificed that child, and yes, the chances of a safe delivery in THIS case would have been in the hands of a qualified OB and a hospital. A c-section isn't the end of the world.

 

You are debating something I'm not debating. I'm not debating whether this woman should have gone to a hospital. *I* would have in her situation. But, I also know a lot about childbirth and risk assessment. Very few first-time moms do.

 

What I'm saying is that I am unwilling to accept the notion that she was arrogant and/or doing something according to her wishes while disregarding the safety of her baby. I'm saying the medical community has made it very difficult for your average woman to truly assess their risk.

 

eta: Note, I didn't say anything in any of my posts about the midwife's choice to take on this mother.

Edited April 20, 2011 by Mrs Mungo

[Veritaserum]

Certainly there are categories of births that are higher risk and would ideally be handled safely in a medical setting. However, if a mother cannot trust the medical birth attendants to practice evidence-based care, is it still the safest choice to use those care givers? Maybe, maybe not. Some situations are black and white (prolapsed cord, prematurity, transverse lie, etc.). Others are gray (VBAC, vaginal breech, etc.).

 

I personally would not choose vaginal breech birth with my first baby, but I understand that both options (vaginal breech or c-section) carry significant risks. The mother must choose which risks are more acceptable and then has to accept the outcome (good or bad). I defend the right of women to make informed decisions regarding reproductive care, even if they choose something I would not. To deny a woman autonomy over her own body is a horrifying thought.

 

I have to think that this mother, like the vast majority of mothers, cared far more about her baby's safety than anyone else could. I'm confident that she made the choice that she felt was the safest for her circumstances. It was not malicious neglect. I agree that the midwife probably should not have agreed to take the case. It's possible that the woman would have chosen an unattended birth instead due to the unacceptable (in her view) hospital options available to her. Perhaps the midwife hoped to improve the baby's chances by being available to help....

[LidiyaDawn]

I was flabbergasted when one person I know chose to induce at 38 weeks, rather than at least waiting until 40 weeks, because her parents would be in town. She wanted them to be able to see the baby before they went back home. Is that really a good reason to risk prematurity issues? Really?

 

 

This kinda makes a good example for the "where do you draw the line" thing, though… People are talking about a woman having the right to CHOOSE what kind of birth she wants, where she wants it, etc etc… the lady in your example made a CHOICE….. know what I mean? So - who draws the line, and where?

 

I have a friend overseas who chose to have a c-section - I had no idea that this was so "controversial" until I mentioned it to someone else here in town and they gave me this completely horrified look and a "lecture" on how wrong it was. So much for a woman's right to choose her birth process there eh?

 

If we support choice in birth methods/etc.. who gets to make the rules as to which choices are supported?

 

Just kinda thinking out loud with this...

[staceyobu]

Others disagree with me, obviously, but IMO, this is a prima facie case. The prevailing standard of care for a breech primip is delivery by c-section. Period.

 

Yes. But the standard of care may not be evidenced based. Here is one article: http://www.aims.org.uk/Journal/Vol10No3/breechCSvsNormal.htm

 

If vaginal birth is as safe for breech babies as c/sections, then women are basically being forced to undergo major surgery or do what this woman did and deliver outside of the hospital.

 

Also, at what point do we allow women to make birthing decisions that increase risk to a fetus? Induction increases risk. Elective c/section increases risk. Epidurals increase risk. When do we deem mother's choice as appropriate and when is it unacceptable due to risk to the fetus?

 

What quality of care did the patient need? Perhaps I am mistaken on the facts, but I thought other midwives refused to handle this birth - why?

Other midwives refused care because this woman is not without risk factors. Anything, ANYTHING can risk you out of a homebirth. Being overweight, previous c/section, being a week overdue, too young, too old, etc, etc, etc. Many midwives play it safe to a ridiculous extent in order to not take any risk with their licensure. That doesn't mean someone is truly too high risk for a homebirth.

[Spy Car]

You are debating something I'm not debating. I'm not debating whether this woman should have gone to a hospital. *I* would have in her situation. But, I also know a lot about childbirth and risk assessment. Very few first-time moms do.

 

What I'm saying is that I am unwilling to accept the notion that she was arrogant and/or doing something according to her wishes while disregarding the safety of her baby. I'm saying the medical community has made it very difficult for your average woman to truly assess their risk.

 

eta: Note, I didn't say anything in any of my posts about the midwife's choice to take on this mother.

 

But Mrs Mungo, was the mother not informed by a local midwife service that her situation was too risky for home delivery? These are people who are not against home births, but rather practitioners of home births.

 

So this mother was not completely ignorant of the risks, and she got that risk assessment from people well disposed (under less risky circumstances) to be in favor of home delivery.

 

Bill

[Veritaserum]

This kinda makes a good example for the "where do you draw the line" thing, though… People are talking about a woman having the right to CHOOSE what kind of birth she wants, where she wants it, etc etc… the lady in your example made a CHOICE….. know what I mean? So - who draws the line, and where?

 

I have a friend overseas who chose to have a c-section - I had no idea that this was so "controversial" until I mentioned it to someone else here in town and they gave me this completely horrified look and a "lecture" on how wrong it was. So much for a woman's right to choose her birth process there eh?

 

If we support choice in birth methods/etc.. who gets to make the rules as to which choices are supported?

 

Just kinda thinking out loud with this...

 

I support a woman's right to choose those things (ideally with accurate information to guide her). If, however, those choices (elective induction or c-section) result in maternal or fetal death, how many people will point to medical birth as the culprit? Not many. No, the woman whose baby dies because she agreed to non-medically necessary induction gets sympathy while the woman whose baby dies at a home birth gets blamed. :glare:

[ktgrok]

Others disagree with me, obviously, but IMO, this is a prima facie case. The prevailing standard of care for a breech primip is delivery by c-section. Period.

 

 

 

What quality of care did the patient need? Perhaps I am mistaken on the facts, but I thought other midwives refused to handle this birth - why?

 

Because they were CNM's who have to work UNDER a doctor's orders, and the doctors they work for wouldn't allow it.

[ktgrok]

Others disagree with me, obviously, but IMO, this is a prima facie case. The prevailing standard of care for a breech primip is delivery by c-section. Period.

 

 

 

What quality of care did the patient need? Perhaps I am mistaken on the facts, but I thought other midwives refused to handle this birth - why?

 

The most recent studies show that surgical birth really isn't safer IF the attendent is trained in vaginal birth, as this one was. Canada just recently went back to promoting vaginal breech birth.

[Mrs Mungo]

But Mrs Mungo, was the mother not informed by a local midwife service that her situation was too risky for home delivery? These are people who are not against home births, but rather practitioners of home births.

 

So this mother was not completely ignorant of the risks, and she got that risk assessment from people well disposed (under less risky circumstances) to be in favor of home delivery.

 

Bill

 

Let me rephrase then. I am aware of many situations in which a licensed midwife could not take on a mother due to x or y risk factor or she would risk her license. This is where unlicensed midwives and/or unattended births enter the picture. This does not necessarily translate to any of these people really believing the birth is too high risk vs. a CYA situation. Birth centers are notoriously risk-adverse. This results in a situation that is similar to the situation you have with doctors who are downright hostile toward homebirth. Does that clarify my position?

 

I'm not saying everyone did everything right in this situation. I'm saying that I am unwilling to call the mom arrogant and treat her concerns in a flippant manner.

 

I support a woman's right to choose those things (ideally with accurate information to guide her). If, however, those choices (elective induction or c-section) result in maternal or fetal death, how many people will point to medical birth as the culprit? Not many. No, the woman whose baby dies because she agreed to non-medically necessary induction gets sympathy while the woman whose baby dies at a home birth gets blamed. :glare:

 

Exactly.

[Heather in VA]

Because they were CNM's who have to work UNDER a doctor's orders, and the doctors they work for wouldn't allow it.

 

I don't know where you get the idea that these people work with a doctor. They don't. They have an independent practice of homebirth and birth center midwives. They don't work for doctors. They aren't told by doctors what to do and what not to do. BirthCare and Women's Health only does homebirths and births at their own birth center (not attached or associated with a hospital in any way ). And they only employ midwives - not doctors.

 

Heather

[joannqn]

A c-section isn't the end of the world.

 

Unless the mom and/or baby die from surgical complications/infection/etc.

[Heather in VA]

The most recent studies show that surgical birth really isn't safer IF the attendent is trained in vaginal birth, as this one was. Canada just recently went back to promoting vaginal breech birth.

 

There is a difference between vaginal breech birth and vaginal breech birth in a first time mom at home. There are several doctors in the area who do vaginal breech birth (I live near the woman in question) but at least moving the birth to a hospital setting can increase your options if something goes wrong in this high risk situation so you can lower the risk of this tragic outcome.

 

Heather

[Perry]

Also, at what point do we allow women to make birthing decisions that increase risk to a fetus? Induction increases risk. Elective c/section increases risk. Epidurals increase risk. When do we deem mother's choice as appropriate and when is it unacceptable due to risk to the fetus?

 

Doctors would be far more willing to take some risks if *they* weren't at risk for getting sued every time they turn around.

[ktgrok]

I don't know where you get the idea that these people work with a doctor. They don't. They have an independent practice of homebirth and birth center midwives. They don't work for doctors. They aren't told by doctors what to do and what not to do. BirthCare and Women's Health only does homebirths and births at their own birth center (not attached or associated with a hospital in any way ). And they only employ midwives - not doctors.

 

Heather

 

Because they are CNM's, and legally CNM's HAVE to work under a doctor. That is they only way they practice. There may not be doctor's at the birth center, but someone somewhere is signing off on this birth center.

[staceyobu]

But Mrs Mungo, was the mother not informed by a local midwife service that her situation was too risky for home delivery? These are people who are not against home births, but rather practitioners of home births.

 

So this mother was not completely ignorant of the risks, and she got that risk assessment from people well disposed (under less risky circumstances) to be in favor of home delivery.

 

Bill

 

Different midwives take on different sets of risks according to state laws, whether or not they work under a physician, how much they are willing to risk their license, etc. A woman is not necessarily risked out because she is too risky. Rather, a practice may take on very selective clients so that if something goes wrong it will be very hard for someone to place blame on them.

 

Also, be careful with the idea that midwife=homebirth supporter. Many actually use the term "medwife" to refer to someone who is a midwife but practices "according to the system". There are people with midwife credentials that practice managed birth in hospital settings.

[RachelFlores]

Certainly there are categories of births that are higher risk and would ideally be handled safely in a medical setting. However, if a mother cannot trust the medical birth attendants to practice evidence-based care, is it still the safest choice to use those care givers? Maybe, maybe not. Some situations are black and white (prolapsed cord, prematurity, transverse lie, etc.). Others are gray (VBAC, vaginal breech, etc.).

 

I have to think that this mother, like the vast majority of mothers, cared far more about her baby's safety than anyone else could. I'm confident that she made the choice that she felt was the safest for her circumstances. It was not malicious neglect. I agree that the midwife probably should not have agreed to take the case. It's possible that the woman would have chosen an unattended birth instead due to the unacceptable (in her view) hospital options available to her. Perhaps the midwife hoped to improve the baby's chances by being available to help....

 

:iagree: Very well said!

[wapiti]

I'll assume that you are right in the first case and that is likely the reason for the second, BUT is that the BEST standard of care for mother and child? There are a lot of differing statistics on breach birth and what is best for mother and child.

 

I think it comes down to the fact that I don't trust that the "prevailing standard of (medical) care" is always best for *me* and sometimes question whether it is best for the general population. I can totally understand why another mother might feel this way.

To disagree with the standard of care is one thing - that's fine; for a professional to fail to meet that standard, that professional will have to deal with the consequences if things don't go well.

 

The best standard of care for the mother and child in this particular case is obvious. Yes, hindsight is 20/20, but catastrophic results like this are a large part of what made the standard of care what it is. This case is an argument in favor of the current standard of care, not against it.

 

FWIW, once upon a time I was a primip with a breech baby. The ECV failed. I had a section. I'm all in favor of vaginal births, and sure, I hated the recovery from the section, but I'd do it all over in a heartbeat. I went on to have four VBACs (or is it five? one was for twins).

 

There is a lot of room for improvement in this country in the treatment of birth, especially with the lack of cooperation amongst midwives and doctors and hospitals in many areas. It's unfortunate that both midwife and mother felt driven to the situation that occurred in this case, but that doesn't change the results of their decision.

[Heather in VA]

Because they are CNM's, and legally CNM's HAVE to work under a doctor. That is they only way they practice. There may not be doctor's at the birth center, but someone somewhere is signing off on this birth center.

 

No there isn't. I had 2 births with these women and they do not work with doctors. It may be that way somewhere else, but it isn't that way here.

[Perry]

No there isn't. I had 2 births with these women and they do not work with doctors. It may be that way somewhere else, but it isn't that way here.

Varies by state. Some states allow independent practice.

[staceyobu]

Doctors would be far more willing to take some risks if *they* weren't at risk for getting sued every time they turn around.

 

Yes. I agree.

[wapiti]

The most recent studies show that surgical birth really isn't safer IF the attendent is trained in vaginal birth, as this one was. Canada just recently went back to promoting vaginal breech birth.

 

In this case, it's pretty hard to argue that surgical birth would not have been safer.

 

Because they were CNM's who have to work UNDER a doctor's orders, and the doctors they work for wouldn't allow it.

 

And why wouldn't they allow it?

 

There's plenty of room for debate on what the standard of care ought to be, but had the current standard of care been met in this case, it is highly likely that baby would be alive today. No, no one can say anything with 100% certainty, but I think it's safe to say highly likely.

[RachelFlores]

Doctors would be far more willing to take some risks if *they* weren't at risk for getting sued every time they turn around.

 

Doctors are much more likely to take INTERVENTION risks than to do nothing. If something goes wrong they bring out their list of interventions to say they tried everything they could, whether the mother/ family wanted that or not. Interventions cover a doctor's arse and often have little to do with the needs of the patient. That is why many interventions (IV and fetal monetoring come to mind) are part of hospital policy no matter how low the patient risk is.

[Heather in VA]

You know, I am finding it very offensive that so many people are willing to give the midwife who attended this birth where a baby died, who has been working illegally for years in several states and by all accounts here regularly takes patients that many midwives consider to be too high risk for homebirth the benefit of the doubt that she was really doing what she thought was best for the mother and baby (and frankly I do think she thought it was best - whether she was right or not is another question) BUT the homebirth midwives who were caring for her and decided that she was at lower risk in a hospital setting must just be 'working for the man' or 'don't really want homebirths - they are really not homebirth supporters'. They are being vilified just because they didn't say 'sure whatever you want' to the mom when their training and experience said it was wrong?

 

Just because they made an informed, experienced decision doesn't make them evil or anti-birth choice. If we want to continue to have freedom in our choices, we have to recognize that freedom requires responsibility - it's not just a license to do whatever we want and anyone who doesn't let us do whatever we want is anti-freedom.

[Heather in VA]

Varies by state. Some states allow independent practice.

 

That is probably true, but in this state with the group she was seeing - they are independent. The OP concerning this said that they only declined her because they had a doctor looking over them saying they had to. They didn't.

[staceyobu]

 

There's plenty of room for debate on what the standard of care ought to be, but had the current standard of care been met in this case, it is highly likely that baby would be alive today. No, no one can say anything with 100% certainty, but I think it's safe to say highly likely.

 

I really don't know how you can argue this. I have seen babies die that were born in a hospital. A hospital birth does not equal a healthy baby. The current standard of care still results in death of infants and mothers.

[ktgrok]

In this case, it's pretty hard to argue that surgical birth would not have been safer.

 

 

 

.

 

But that is hind sight. Shecould have had gone in for the c-section and died from a surgical complication. It happens. There is no way to eliminate the risks.

[staceyobu]

You know, I am finding it very offensive that so many people are willing to give the midwife who attended this birth where a baby died, who has been working illegally for years in several states and by all accounts here regularly takes patients that many midwives consider to be too high risk for homebirth the benefit of the doubt that she was really doing what she thought was best for the mother and baby (and frankly I do think she thought it was best - whether she was right or not is another question) BUT the homebirth midwives who were caring for her and decided that she was at lower risk in a hospital setting must just be 'working for the man' or 'don't really want homebirths - they are really not homebirth supporters'. They are being vilified just because they didn't say 'sure whatever you want' to the mom when their training and experience said it was wrong?

 

Just because they made an informed, experienced decision doesn't make them evil or anti-birth choice. If we want to continue to have freedom in our choices, we have to recognize that freedom requires responsibility - it's not just a license to do whatever we want and anyone who doesn't let us do whatever we want is anti-freedom.

 

You are definitely right. I think there are just too many unknowns in this situation to really determine who is right. People who live in the area and know the midwives involved would be better able to judge. My post was more just a general disclaimer that not all midwives are crunchy homebirth advocates. In general, someone being risked out by a midwife practice doesn't equal stupidity in a decision to homebirth anyways.

 

The birth center I delivered my second at was required to risk out all vbacs. Those moms could still have homebirths with other midwives though. They weren't necessarily too risky for out of hospital birth... the factors were much more complex than that. And, I don't think the CNMs I delivered with were any less terrific for risking those clients out.

[Mrs Mungo]

You know, I am finding it very offensive that so many people are willing to give the midwife who attended this birth where a baby died, who has been working illegally for years in several states and by all accounts here regularly takes patients that many midwives consider to be too high risk for homebirth the benefit of the doubt that she was really doing what she thought was best for the mother and baby (and frankly I do think she thought it was best - whether she was right or not is another question) BUT the homebirth midwives who were caring for her and decided that she was at lower risk in a hospital setting must just be 'working for the man' or 'don't really want homebirths - they are really not homebirth supporters'. They are being vilified just because they didn't say 'sure whatever you want' to the mom when their training and experience said it was wrong?

 

According to my limited understanding of the Virginia law, there is an advisory board that decides the standard of care. They have their licenses and insurance to think about. I don't blame them at all for risking this woman out. But, I don't *know* whether or not it was their training and experience or the law and their insurance. Of course, I wasn't the one calling them "medwives" and such, but I do not vilify them at all. They are working within the system they have.

[wapiti]

But that is hind sight. Shecould have had gone in for the c-section and died from a surgical complication. It happens. There is no way to eliminate the risks.

 

Of course all risk cannot be eliminated. But it can be reduced. Risks are relative.

[UnsinkableKristen]

If birth were the easiest, safest thing in the world then the number one cause of death in women for the greater part of history would not have been childbirth.

 

There is always going to be risk when delivering a baby. I think it just as foolish to assume a homebirth will occur without any problems as it is to assume a hospital birth will.

 

It is wonderful when risk can be minimized (by more intervention or by less) but foolish to assume it can ever be removed. I think BOTH sides are guilty of thinking theirs is the "safest".

[ktgrok]

Of course all risk cannot be eliminated. But it can be reduced. Risks are relative.

 

Yes, and the standard of care often is NOT the least risky option, especially when you look at both maternal and fetal morbitity/mortality. For instance, the risk to the baby is slightly higher in a VBAC than a repeat C-section. But the risk of the mother dying is 400% higher in a reapeat c-section than a VBAC. But the standard of care in my area is C-section. Not because it is safer. Because they are less likely to be sued for a dead mother than a dead baby.

 

Same goes here. Recent studies have shown that the risk is about equal for vaginal or surgical breech birth. Add in the other complications of surgical birth and really it's a toss up, with slight benefit to the vaginal birth if you consider both mother and baby. But people are more likely to sue for a bad outcome after a vaginal breech than for a bad outcome after a surgical breech. And then you have a standard of care. It's not always concious, but it happens. Dr's are people too, and have to protect themselves.

[joannqn]

Doctors would be far more willing to take some risks if *they* weren't at risk for getting sued every time they turn around.

 

Doctors are much more likely to take INTERVENTION risks than to do nothing. If something goes wrong they bring out their list of interventions to say they tried everything they could, whether the mother/ family wanted that or not. Interventions cover a doctor's arse and often have little to do with the needs of the patient. That is why many interventions (IV and fetal monetoring come to mind) are part of hospital policy no matter how low the patient risk is.

 

 

:iagree:

 

Many of the problems we're seeing today is a sue happy public. Only by producing a list of interventions can a doctor say they "tried everything" to ensure the mom/baby lived. If the lack of intervention truly was the safest route and a doctor took the intervention-less route, we'd sue him for not trying everything. Doctor's are in a no-win situation sometimes. I just wish I could go to a doctor and tell them, "Please help me make the best decision for me and my beliefs without worry of a malpractice lawsuit. I'm not going to sue you even if something bad happens."

[Heather in VA]

You are definitely right. I think there are just too many unknowns in this situation to really determine who is right. People who live in the area and know the midwives involved would be better able to judge. My post was more just a general disclaimer that not all midwives are crunchy homebirth advocates. In general, someone being risked out by a midwife practice doesn't equal stupidity in a decision to homebirth anyways.

 

The birth center I delivered my second at was required to risk out all vbacs. Those moms could still have homebirths with other midwives though. They weren't necessarily too risky for out of hospital birth... the factors were much more complex than that. And, I don't think the CNMs I delivered with were any less terrific for risking those clients out.

 

This is probably why I'm a bit emotional about some of the comments being made about the midwives at BirthCare because I do know them. I had two births with them. They are very much homebirth advocates. When they do decide they need to refer, they have a list of doctors (not that they work with but that their clients have dealt with over the many years they have practiced) that are low-intervention supportive. They want the woman to have the least intervention possible while still being safe. In this case I would suspect they referred her to one of a couple of doctors I know around her who are willing to attempt vaginal delivery with breech. I can't not imagine that they just said - well he's breech - have a happy c-section. They probably prepped her for the idea that the chance of a c-section was significantly higher - which obviously it is. Even if she had this baby in the hospital with a pro-vaginal breech birth doctor, it would have ended up a c-section when the baby got stuck.

[Perry]

Doctors are much more likely to take INTERVENTION risks than to do nothing. If something goes wrong they bring out their list of interventions to say they tried everything they could, whether the mother/ family wanted that or not. Interventions cover a doctor's arse and often have little to do with the needs of the patient. That is why many interventions (IV and fetal monetoring come to mind) are part of hospital policy no matter how low the patient risk is.

I agree to a point. Much of what is done is done to CYA. But they don't feel as though they have a choice, when they're getting sued left and right.

 

Also, please understand that because midwives generally do the low risk cases, they are unlikely to see the really bad outcomes. The obstetricians see Really Bad Things happen all the time, and are going to have a much different perspective on risk. It isn't all CYA. Of course they want the best outcome for the babies.

 

After my husband delivered his first close call (a baby with severe shoulder dystocia) his perspective was forever changed. He doesn't do OB anymore, because it's just not worth the risk. Or the stress.

[staceyobu]

This is probably why I'm a bit emotional about some of the comments being made about the midwives at BirthCare because I do know them. I had two births with them. They are very much homebirth advocates. When they do decide they need to refer, they have a list of doctors (not that they work with but that their clients have dealt with over the many years they have practiced) that are low-intervention supportive. They want the woman to have the least intervention possible while still being safe. In this case I would suspect they referred her to one of a couple of doctors I know around her who are willing to attempt vaginal delivery with breech. I can't not imagine that they just said - well he's breech - have a happy c-section. They probably prepped her for the idea that the chance of a c-section was significantly higher - which obviously it is. Even if she had this baby in the hospital with a pro-vaginal breech birth doctor, it would have ended up a c-section when the baby got stuck.

 

That's understandable. I was definitely not making references that these particular midwives were overly medical in their approach. I think in general people have the idea that using a midwife equals a natural birth. You really have to judge midwives as carefully as doctors. In my vicinity, I know of direct entry midwives that illegally use pitocin to speed up delivery. But, many people use them thinking they will be getting the all natural approach. Who would think a DEM would hurry along your delivery with illegal pitocin? Unfortunately, it is really hard to find these things out. What midwife will admit in an interview that she does this? And what doctor will admit that he likes to section people at five to get home for dinner? It's hard for the ordinary person to navigate the system. Which, in my opinion, is why the system needs to work to provide evidence based care. Because then you are getting good care even if you couldn't figure out all the details before picking a health care provider.

[coffeefreak]

I just want to address the people who are saying that the hospital or doctor can not force care upon you against your will; you don't know what you are talking about. Just because it didn't happen to you doesn't mean that it doesn't happen. My first hospital birth was horribly mismanaged and the doctor did eventually lose his license for falsifying records. During my second hospital birth I was strapped to a gurney and had barbaric things (things that would have been considered torture if done by anyone else anywhere else) done to me against my will. I lost a serious amount of blood after delivery and they didn't even know because I had been left alone (not even in a room) without any care at all.

 

Doctors and hospitals absolutely can and will violate patients rights and informed consent laws. Of course, this is antedotal but there are thousands more stories just like mine and where else are they going to come from other than the patients. Doctors certainly aren't going to be reporting this stuff themselves and it is almost impossible to report anything if the baby is born healthy because the excuse is always that whatever was done was in the best interest of the baby (even when that is not the case). Once a baby is viable, the medical system usually insists that the infant's rights override the mother's and they can pretty much do whatever they want using that as an excuse.

 

The truth of the matter is that most babies can be delivered safely in the back seat of a taxi. Most births are not emergencies and do not require western medical care. Now if women could trust doctors to believe that and act on it then we could trust then when they say that something different needs to be done. Unfortunately, that is not the case which leaves women in the horrible position of trying to figure it out themselves and then decide if they want to give up all autonomy at a hospital and possibly actually incure greater risks or take their chances at home and usually have a safer delivery.

 

I agree 100%, this is what I was trying to get across.

 

eta: Nobody has said all doctors and hospitals are like this. But it can be very, very difficult to figure out which ones are the good ones.

 

:iagree:

I couldn't have said it better myself. I just wanted to add, insurance complicates the matter. With both our girls, I had no choice of where to give birth. It was Hospital X, or pay 100% out of pocket. I had a CNM both times and both births went very well. However, my friends that delivered at hospital X with Dr's have varied experiences. With both daughters, I had nurses talking about me like I couldn't hear them about how stupid I was to have no drugs. One nurse even complained because she didn't understand why my midwife INSISTED they move a tub into my room, and asked me why I was so "special." Without my midwife, I would have had the drugs forced on me, especially with baby number 2 who took 36 hours to make an appearance. She would have been a C-section baby for sure.

 

The other thing I wanted to add was, most hospitals no longer allow video taping of births for good reason - to protect the DR. They allow video of before and after, but once a Dr enters the room, the camera has to be turned off. We signed several documents saying we understood that, and that if we taped the "procedure" and the hospital found out, the tape because property of the hospital and the Dr involved. I'm SURE this minimizes the lawsuits involved.

 

I am so sad for the Midwife in this case. I can't imagine she was OK emotionally after the baby died, and now this! A good book to read about the history of Midwifery in this country is Baby Catcher by Peggy Vincent. It chronicles her experience in Midwifery, including her case where she was sued over circumstances that were not HER fault, but a DR'S (I don't want to give the story away).

 

Sue, we'll be praying for your Midwife.