Evelyn Muhlhan - another homebirth midwife bites the dust?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

It has always been weird to me that doctors not affiliated with the child in question get to be the complaining party when things like this happen.

it's because they are in the position to know when proper procedure wasn't followed. They are peers, and are able to determine whether the midwife took unnecessary risks.

This is the whole problem -- who is to say that their procedure is the absolute best and only way to do things? Why do they get to determine what proper procedure is for ALL birth attendants? Their way is not infallible. Their way still results in the occasional tragic outcome. They should not have the last say over how other people deliver babies, period.

I get that you don't want doctors to judge midwives because of perceived conflict of interest, but to me it sounds like you're saying that in theory, standards of practice may exist, but in practice, they don't, since people can't agree on the ultimate authority and source of these standards. The necessary consequence of this de facto lack of standards in midwifery care is that when things go terribly wrong, people get to nod and say, yeah, birth is natural, tragedies sometimes happen, everyone get a hanky and go home. That is, no one, including the midwife, is liable for breaking standards of practice since there aren't any to begin with.

Let's make this really basic.

Do you believe that sometimes midwives make mistakes?

How do we know that they make mistakes? Against what standard do we compare them?

Should there be professional consequences for midwife mistakes, including ban on practicing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:
No no no! The two situations you present are completely different. The government cannot force any person to undergo a medical procedure against their express wishes, not even for the benefit of another person. For example, you can't be forced to donate a kidney to your dying child if it's against your religious beliefs, even if you are the only viable donor. Thus, the government also cannot force a woman to give birth in a hospital / under certain conditions (a medical procedure) against her wishes, even for the benefit of the child. TOTALLY different from laws against abuse or withholding medical treatment from children (laws which I fully support).

However, this absolute right to personal control over your own medical treatment does NOT extend to a right to force medical professionals to provide assistance. Medical professionals should absolutely be able to refuse to treat patients who are asking them to violate professional standards of care or codes of conduct.

There are quite a few underage people who have been forced by court order to undergo chemo.

Here is one:

http://articles.cnn.com/2009-05-29/us/minnesota.forced.chemo_1_chemotherapy-alternative-medicine-minnesota-boy?_s=PM:US

I'm the poster you're quoting, and I'm sorry, I should have stated that the govt. cannot force a competent adult. They can intervene when the person is underage, or if the person has been ruled mentally incompetent. But for the vast majority of pregnant women or cancer patients (that is overage and competent), they can't intervene.

[Anonymous]

Anonymous wrote:No one has said the baby's rights shift to 100 percent or that home birth be outlawed. You aren't discussing this in good faith.

You also seem to think we'll be scared by the difficult line-drawing problem into accepting the infant has zero rights. But you can't seriously think we aren't all aware of the line drawing problem. It is the inherent problem in reproductive rights and makes it all harder than examples like giving a kidney to someone else.

Actually both of those arguments have been made in this thread:

12/13/2011 17:59 wrote:absolutely--the right of a term/viable baby to have a reasonable chance of surviving delivery should absolutely, 100% trump the rights of a woman to decide what type of delivery she has.

12/14/2011 10:23 wrote:I am suprised that home birthing hasn't been outlawed

And I'm not saying the infant has zero rights, or that there is some difficult line to draw here that we are afraid of. In fact, it doesn't matter where you draw the personhood line: even a belief that life begins at conception and that a day-old fetus has full personhood is still compatible with saying that you can't force a mother to undergo a medical procedure against her will for the benefit of her child, another full person. A child in need of a kidney clearly has full personhood rights, yet you still can't force that child's mother to donate the needed kidney. The needs of one do not trump the rights of the other to determine their OWN medical care.

If anything I would think that the kidney example is the harder one--because not donating is almost certain death for the child, whereas a "reckless" labor & delivery only carries a somewhat higher risk of death.

[Anonymous]

You can't force a mother to go through a medical procedure she does not want, but this doesn't equal that a midwife's choices should a midwife's methods, even when tragic outcomes are observed.

[Anonymous]

I have read almost all of this thread and I'm a bit confused. Why is it that doctors should be held to a standard of care but midwives should not? Did I miss something?

[Anonymous]

Anonymous wrote:You can't force a mother to go through a medical procedure she does not want, but this doesn't equal that a midwife's choices should a midwife's methods, even when tragic outcomes are observed.

No, of course not, and I never said that. In fact, in my original post about not forcing a mother to undergo a medical procedure she does not want, I also said

this absolute right to personal control over your own medical treatment does NOT extend to a right to force medical professionals to provide assistance. Medical professionals should absolutely be able to refuse to treat patients who are asking them to violate professional standards of care or codes of conduct.

[Anonymous]

Anonymous wrote:I have read almost all of this thread and I'm a bit confused. Why is it that doctors should be held to a standard of care but midwives should not? Did I miss something?

I think only a very few people are saying this. I'm pretty sure I'm not the only one on this post who believes that midwives SHOULD be licensed and held to professional standards of care, but also that those standards should be developed in conjunction with other midwives, and not just OBs, and that any judgments against midwives also involve other midwives, not just OBs.

I also think there should be penalties against people (including other medical practitioners) who file frivolous complaints. Not saying that was the case here, and it would still be hard to prove, but perhaps at least having that on the books would make some people think twice. It would also be good to start fostering greater interdisciplinary respect--there are too many OBs and midwives who do not respect the profession and practice of their colleagues, and THAT only contributes to poorer care and the experiences of such women when OB/MW care overlaps.

[Anonymous]

Anonymous wrote:

Anonymous wrote:No one has said the baby's rights shift to 100 percent or that home birth be outlawed. You aren't discussing this in good faith.

You also seem to think we'll be scared by the difficult line-drawing problem into accepting the infant has zero rights. But you can't seriously think we aren't all aware of the line drawing problem. It is the inherent problem in reproductive rights and makes it all harder than examples like giving a kidney to someone else.

Actually both of those arguments have been made in this thread:

12/13/2011 17:59 wrote:absolutely--the right of a term/viable baby to have a reasonable chance of surviving delivery should absolutely, 100% trump the rights of a woman to decide what type of delivery she has.

12/14/2011 10:23 wrote:I am suprised that home birthing hasn't been outlawed

And I'm not saying the infant has zero rights, or that there is some difficult line to draw here that we are afraid of. In fact, it doesn't matter where you draw the personhood line: even a belief that life begins at conception and that a day-old fetus has full personhood is still compatible with saying that you can't force a mother to undergo a medical procedure against her will for the benefit of her child, another full person. A child in need of a kidney clearly has full personhood rights, yet you still can't force that child's mother to donate the needed kidney. The needs of one do not trump the rights of the other to determine their OWN medical care.

If anything I would think that the kidney example is the harder one--because not donating is almost certain death for the child, whereas a "reckless" labor & delivery only carries a somewhat higher risk of death.

I don't think your kidney example provides a good frame of reference. A child in need of kidney transplant has a chance, no matter how tiny, that a compatible kidney will be volunteered by someone else. A baby stuck inside a mother who opposes a C-section for some reason can't really hop to some other woman's uterus. I do think you have to make some kind of allowance for the reality that a ready-to-be-born baby is connected to its mother in a far more inextricable way than an already born child.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:No one has said the baby's rights shift to 100 percent or that home birth be outlawed. You aren't discussing this in good faith.

You also seem to think we'll be scared by the difficult line-drawing problem into accepting the infant has zero rights. But you can't seriously think we aren't all aware of the line drawing problem. It is the inherent problem in reproductive rights and makes it all harder than examples like giving a kidney to someone else.

Actually both of those arguments have been made in this thread:

12/13/2011 17:59 wrote:absolutely--the right of a term/viable baby to have a reasonable chance of surviving delivery should absolutely, 100% trump the rights of a woman to decide what type of delivery she has.

12/14/2011 10:23 wrote:I am suprised that home birthing hasn't been outlawed

And I'm not saying the infant has zero rights, or that there is some difficult line to draw here that we are afraid of. In fact, it doesn't matter where you draw the personhood line: even a belief that life begins at conception and that a day-old fetus has full personhood is still compatible with saying that you can't force a mother to undergo a medical procedure against her will for the benefit of her child, another full person. A child in need of a kidney clearly has full personhood rights, yet you still can't force that child's mother to donate the needed kidney. The needs of one do not trump the rights of the other to determine their OWN medical care.

If anything I would think that the kidney example is the harder one--because not donating is almost certain death for the child, whereas a "reckless" labor & delivery only carries a somewhat higher risk of death.

I don't think your kidney example provides a good frame of reference. A child in need of kidney transplant has a chance, no matter how tiny, that a compatible kidney will be volunteered by someone else. A baby stuck inside a mother who opposes a C-section for some reason can't really hop to some other woman's uterus. I do think you have to make some kind of allowance for the reality that a ready-to-be-born baby is connected to its mother in a far more inextricable way than an already born child.

But a baby inside a mother opposed to a c-sec also still has a chance, and probably a pretty decent one. If a mother can choose a c-sec when there are zero medical indications for one, despite the additional risk to their child, I don't see why they can't also choose the reverse. I *don't* feel any allowance should be made, and I think once you do it's a slippery slope before you are legally banning pregnant women from smoking, drinking, taking OTC drugs, riding in a car, etc...

We have the right to decide what to do with our own bodies. Period.

[Anonymous]

I'm actually OK with banning smoking and drinking for pregnant women. I know it will never happen, but if it did, I'd be fine with it.

Perhaps my example with a C-section wasn't right in your eyes. I don't know, pick another complicated scenario where a woman definitely should be under specialized medical care. Multiples? Severe breech? Basically, you're saying that a mother has an unrestrained right to make medical decisions over her birthing process, even if these decisions lead to certain death of her baby, am I correct? Is this because you have trouble envisaging decisions during birthing that will *absolutely* lead to the baby's death?

[Anonymous]

Anonymous wrote:I'm actually OK with banning smoking and drinking for pregnant women. I know it will never happen, but if it did, I'd be fine with it.

Perhaps my example with a C-section wasn't right in your eyes. I don't know, pick another complicated scenario where a woman definitely should be under specialized medical care. Multiples? Severe breech? Basically, you're saying that a mother has an unrestrained right to make medical decisions over her birthing process, even if these decisions lead to certain death of her baby, am I correct? Is this because you have trouble envisaging decisions during birthing that will *absolutely* lead to the baby's death?

But honestly, what situation are you envisioning here? I honestly cannot ever imagine a homebirther choosing such a thing. As I've said before, I have NEVER met a homebirther -- even one on the so-called "fringe" -- who would choose her homebirth over the safety of her baby. Homebirthers choose their birth because they feel it is the safest for both themselves and their baby. And, for the record, breech babies (not sure what you mean by "severe" breech) and multiples have throughout all of history been born safely at home; and they still today can be born safely at home with a skilled midwife.

[Anonymous]

The one group that has shown the greatest improvement in outcomes with the rising c-section rate is breech babies.

[Anonymous]

"I've been musing about what I would do if I were to go into preterm labor. The answer is obvious if the baby were 30 weeks: go to a hospital with a good NICU. My own cutoff for an out-of-hospital birth would be around 36-37 weeks, depending on the particular situation, access to oxygen and a midwife skilled at recognizing signs of respiratory distress or other prematurity-related complications."

"But what about 28 weeks? 26? 24? 22? At what point would I allow the baby to pass on peacefully, rather than attempting heroic efforts at resuscitation with a small chance of survival and high likelihood of major disabilities if the baby were to live? My own gray area is between 24-28 weeks. By time a baby hits 26 weeks gestation, survival rates are between 80-90%, and about 15% of those surviving babies will have major disabilities as a result of prematurity. I think this would be the earliest point at which I would consider intervening."

"Still, survival rates and even major disability rates are not the only practical or moral considerations that I would have to account for. Having a very premature baby, in my own family setting, would mean I would have to commute to a hospital with an advanced enough NICU: probably 40 minutes away and most likely an hour or more. The stresses on our family, the realities of trying to spend my time in a NICU while caring for a nursing toddler, and the emotional and financial drains that an extremely premature baby would entail are all things I'd have to carefully think about." -From a natural birth blogger

Late to the conversation here. I started my pregnancy under the care of very good CNM and then was transferred to OB/hospital care when my pregnancy got very complicated. I'm very sympathetic to natural birth and I believe strongly in a woman's right to choose or decline her own medical care. I'm also the mom of a 29w preemie who is everything to me. When I read the quote above on a blog it just made me sick to my stomach that someone (and someone who obviously loves and want children) would consider withholding care from a 28w preemie. I don't quite know where I'm going with this-I guess I do believe in the right of women to choose their own standard of care, but I'm also personally pretty horrified by what some of hose choices look like.

[Anonymous]

Anonymous wrote:"I've been musing about what I would do if I were to go into preterm labor. The answer is obvious if the baby were 30 weeks: go to a hospital with a good NICU. My own cutoff for an out-of-hospital birth would be around 36-37 weeks, depending on the particular situation, access to oxygen and a midwife skilled at recognizing signs of respiratory distress or other prematurity-related complications."

"But what about 28 weeks? 26? 24? 22? At what point would I allow the baby to pass on peacefully, rather than attempting heroic efforts at resuscitation with a small chance of survival and high likelihood of major disabilities if the baby were to live? My own gray area is between 24-28 weeks. By time a baby hits 26 weeks gestation, survival rates are between 80-90%, and about 15% of those surviving babies will have major disabilities as a result of prematurity. I think this would be the earliest point at which I would consider intervening."

"Still, survival rates and even major disability rates are not the only practical or moral considerations that I would have to account for. Having a very premature baby, in my own family setting, would mean I would have to commute to a hospital with an advanced enough NICU: probably 40 minutes away and most likely an hour or more. The stresses on our family, the realities of trying to spend my time in a NICU while caring for a nursing toddler, and the emotional and financial drains that an extremely premature baby would entail are all things I'd have to carefully think about." -From a natural birth blogger

Late to the conversation here. I started my pregnancy under the care of very good CNM and then was transferred to OB/hospital care when my pregnancy got very complicated. I'm very sympathetic to natural birth and I believe strongly in a woman's right to choose or decline her own medical care. I'm also the mom of a 29w preemie who is everything to me. When I read the quote above on a blog it just made me sick to my stomach that someone (and someone who obviously loves and want children) would consider withholding care from a 28w preemie. I don't quite know where I'm going with this-I guess I do believe in the right of women to choose their own standard of care, but I'm also personally pretty horrified by what some of hose choices look like.

I dunno, I don't really have a problem with the piece you quoted. I read her blog fairly regularly, and she's very involved in the birth community. This is obviously something that she's thinking about, both personally but also philosophically. I think that it is all to the good for women to really evaluate their choices and values, the options before them and potential situations they might find themselves in, rather than just assuming that everything will be fine and not examining the consequences for any of the situations that arise.

I personally had never considered how I would react to, feel about and deal with pre-term labor until just now. I was an incredibly overconfident first time mom. I skimmed over the chapters about complications and emergencies. It never occurred to me that I would ever need any interventions or that I would have any complications. I think that partially, my confidence was what helped me to have a natural birth free of complications, but I can only say that from this side of it - I can only say that because it worked out. I am the first to admit that if things had gone south, I would have been completely unprepared to deal with it and it would probably have been a lot scarier as a result. I think that it's good to consider all options and outcomes - because whether it's sickening to you or not, it is this woman's choice whether to intervene or not. I think often thinking through all the options a situation presents helps us to refine our preferences and feelings if and when that situation presents itself. Obviously you, PP, made the choice that I probably would also make. I suspect that the woman whose blog you quoted, ultimately, would make the same choice, though I have to say having read her blog for a while that she definitely makes choices I would not make. That said, unlike some of the other naive fringe natural birthers, she is very educated, very scientific and has a very complete understanding of the issues at play, and out of that whole fringe, I think I respect her choices more than others as a result.

[Anonymous]

Blog name, please? (I read lots of birth blogs, but I don't remember seeing this post).