Evelyn Muhlhan - another homebirth midwife bites the dust?

[Anonymous]

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

Stand and Deliver. (http://rixarixa.blogspot.com/)

[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 wonder if she'd think differently if she was actually in that situation? It's one thing to ponder something, but a lot different if you're actually facing it!

[Anonymous]

Anonymous wrote:

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 wonder if she'd think differently if she was actually in that situation? It's one thing to ponder something, but a lot different if you're actually facing it!

I think the point of pondering something is to try to figure out what you would think if you were actually in that situation. I think we could all stand with a bit more reflection on our choices and motivations for things. Even if you come to exactly the same conclusions you have now, it's a good self-awareness exercise.

[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.

But how is this all that different from contemplating what you'd do if you found severe defects at the 20wk sono or an amnio? Personally, my husband and I agreed that I would carry to term (or it's natural end) any pregnancy that did not threaten MY life, even if the pregnancy itself was not viable. However, while we did not talk about it, I think we would also consider withholding care in the form of drastic interventions for a birth at 24-25 weeks without some certainty of survival.

[Anonymous]

At 20w a baby/fetus cannot survive outside the womb. At 28w a baby has a 90%+ chance of survival.

Before spending a few months in the NICU with my DD I might not have felt this way, but now when I read this post I just imagine my own daughter, who was born breathing on her own, being denied the very simple things she needed to live (a warm environment, an NG tube, some supplemental o2). If you gave birth to a pink, breathing 2lb baby, would your really say-well, I don't think we're going to the hospital, this baby wasn't meant to live, and anyway going back and forth to the NICU would really be a hassle?

How is it okay for a woman not to bring a 28w preemie to the hospital for care, but it's not okay for a mom to throw a full term infant in a trashcan? In both cases the child will likely live a healthy life with care, but will die without care.

[Anonymous]

Just because someone makes a philosophical, very scientific, very educated decision to withhold care from a premature baby because it may turn out to be disabled, because schlepping to a NICU 40 minutes away is a major hassle with a toddler still attached to boob, and because well, it's "her" preference, of which she is completely aware, does not make it any more deserving of my respect than a 15-year old meth addict who threw the baby in a trashcan to die.

I'm not interested in reasons of people who let their babies "pass peacefully" after birth. I don't care if they have blogs.

Sometimes this world can use a bit less navel-gazing, and a bit more connection to the immediate human drive to do everything to help the baby survive.

[Anonymous]

Anonymous wrote:Just because someone makes a philosophical, very scientific, very educated decision to withhold care from a premature baby because it may turn out to be disabled, because schlepping to a NICU 40 minutes away is a major hassle with a toddler still attached to boob, and because well, it's "her" preference, of which she is completely aware, does not make it any more deserving of my respect than a 15-year old meth addict who threw the baby in a trashcan to die.

I'm not interested in reasons of people who let their babies "pass peacefully" after birth. I don't care if they have blogs.

Sometimes this world can use a bit less navel-gazing, and a bit more connection to the immediate human drive to do everything to help the baby survive.

I haven't had to make this decision. Years ago I found a blog by a woman who had had a premature baby, maybe Helen something? She loved her son dearly, fiercely, but said that I'd she knew back then what she knew know through her grim and ongoing experiences, she wonders what she would have done differently, maybe nothing differently. But she felt like the doctors really didn't lay out the long term, and she, a new mother, wasn't in a position to know what questions to ask. She said that the ongoing care for her now adult son, who I think would be classified as disabled, thought not severely, was an incredible lot of work. Without knowing a particular baby's prognosis, it's unfair to lump the heartbroken parents in with a "15 year old meth addict".

And this thread is officially waaaay off topic, which I have just contributed to.

[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.

Unfortunately this isn't true:

http://radicaldoula.com/2010/01/13/woman-forced-into-court-ordered-hospital-confinement-and-c-section/

http://www.aclu.org/reproductive-freedom/coercive-and-punitive-governmental-responses-womens-conduct-during-pregnancy

And at our own GWUH

http://advocatesforpregnantwomen.org/articles/angela.htm

[Anonymous]

i worked with her, and i worked with Slone and associates..... she took too many risks at home knowing that the consequences and yes i am sure tmedical staff reported her because after SHE FAILED at home, she brought her pts in with the baby's on the brink of death... then her pts get mad when you have to do things like administer oxygen (because they cant do skin to skin) an i mostly blamed her for this because @ mercy, we heard about the education her pts received and instead of covering all the risks, they talk about the nurses and doctors like they were anti- birthplans and horrible at what they do. We see the worst case scenerio, we see the babies who show decline in status and die (so you can have your plan fulfilled). I am not against what she does but educate your pts and prepare them to be flexible when things do not appear safe. I will never forget the father screaming and spitting in my face as i stimulated his baby (who ended up being a full code and is no attempt to breath during the first minute) his words were "STOP WIPING OFF THE VERNIX,,, SHE SPECIFICALLY REQUESTED SHE DID NOT WNT THE VERNIX WIPED OFF" no you idiot ... stimulation and drying is the first and most natural way too attempt to resuscitate a baby... things like that piss me off. go deliver in an ocean and keep making excuses for her but she was unsafe and in my opinion to educated to prioritize the "unsafe" wishes in a plan ahead of a baby's safety. My mother a complete breech delivery of my older sister (1st born) and lost her 3rd baby (All born in a 3rd world country where 90% of baby's are born at home but we have the highest maternal morbidity and mortality rate)... there are risks and they should be acknowledged and planned for as best as possible. Dont take a birthing class and think you know more than those who have studied this inside out for years

[Anonymous]

I. Utilizing Intramuscular Oxytocin to stimulate labor in a term pregnancy;
II. Using fundal pressure in the second stage of labor to attempt to cause descent of
the fetus;
III. Using vaginal chlorhexadrine, rather than intravenous penicillin, in labor to treata known group B beta hemolytic strep vaginal carrier to prevent early onset GBS neonatal sepsis;
IV. Misdiagnosing fetal station resulting in an unnecessary episiotomy. The physical exam on admission to Hospital B was a fetus impacted in the vagina at + 1 station which was incompatible with the report that the fetus had been crowning when the episiotomy was performed...

... Patient B delivered a male infant ("Baby B") by LSTCS, with a vertex fetal presentation and occiput posterior ("OP") position at birth. The APGAR scores were 1 at 1 minute and 5 at 5 minutes and cord/Initial blood gas was ph 7.1; pC02 63; p02 10; BE -13. Baby B was limp and cyanotic on delivery with nuchal

this one of 5 complaints and thank God she was just banned from delivering at my hospital about a year before all this went down... Yes her cult didnt report her but the teams that had to CLEAN UP HER HORRIBLE MESS did.... In many of these cases if she had changed the plan as needed the outcomes would not have been so grim but she took toooooo many risks... STOP BEING SELFISH TO YOUR PLAN... make a plan but be willing to flex a little when needed... we all want healthy screaming babies that i would be happy to place on the abdomen and delay all medical interventions WHEN THE BABY IS HEALTHY.... it is selfish to stick to ur way knowing the baby is in danger and then look to the HORRIBLE HOSPITAL STAFF to fix it after things get screwed but who can blame you when the birthing guru who you trust tells you it si all ok and we shouldnt go to the hospital because you wont get your way... & OMG, the BIRTHING GURU PERFORMED AN EPISIOTOMY.... lol with the baby still sky high!@ least the docs know when to do one (ps- minutes after an epis, the perineum start to swell and looks like hot dog buns, and there is no need to do that untill the baby is at the perineum otherwise, its bleeding and swellinf time) what was she thinking!

[Anonymous]

Anonymous wrote:i worked with her, and i worked with Slone and associates..... she took too many risks at home knowing that the consequences and yes i am sure tmedical staff reported her because after SHE FAILED at home, she brought her pts in with the baby's on the brink of death... then her pts get mad when you have to do things like administer oxygen (because they cant do skin to skin) an i mostly blamed her for this because @ mercy, we heard about the education her pts received and instead of covering all the risks, they talk about the nurses and doctors like they were anti- birthplans and horrible at what they do. We see the worst case scenerio, we see the babies who show decline in status and die (so you can have your plan fulfilled). I am not against what she does but educate your pts and prepare them to be flexible when things do not appear safe. I will never forget the father screaming and spitting in my face as i stimulated his baby (who ended up being a full code and is no attempt to breath during the first minute) his words were "STOP WIPING OFF THE VERNIX,,, SHE SPECIFICALLY REQUESTED SHE DID NOT WNT THE VERNIX WIPED OFF" no you idiot ... stimulation and drying is the first and most natural way too attempt to resuscitate a baby... things like that piss me off. go deliver in an ocean and keep making excuses for her but she was unsafe and in my opinion to educated to prioritize the "unsafe" wishes in a plan ahead of a baby's safety. My mother a complete breech delivery of my older sister (1st born) and lost her 3rd baby (All born in a 3rd world country where 90% of baby's are born at home but we have the highest maternal morbidity and mortality rate)... there are risks and they should be acknowledged and planned for as best as possible. Dont take a birthing class and think you know more than those who have studied this inside out for years

You sound like a nutcase. Are you saying you were one of the nurses at the delivery of one of Evelyn's transport patients? Don't you think what you are yelling about here could be considered a HIPAA violation? Not only are you are ranting like a lunatic, you sound like you do not understand very much about modern homebirth midwifery or the families that choose it.

[Anonymous]

Its not a HIPAA violation unless she attaches a person's name or personally identifiable information to it.

And, she doesn't sound like a nutcase, she sounds like someone for whom English is possibly a second language but her logic is pretty clear here.

Homebirth advocates have a very serious blindspot in that they insist on sweeping bad birth outcomes under the rug. Its all about "trust birth" as if the very real suffering past and present of women whose bodies are supposedly made for birthing are just anomalies. Calling people who speak a negative opinion crazy doesn't change that history. Doesn't change the latest research on apgar scores or seizure risks being respectively lower and higher for home births either. Doesn't change some of the very real bad stories out there.

Simply put: the woman took risks. People who believed in her paid a price for that. Frankly, I think shoddy midwives should face the same risks that shoddy obs or crappy dentists do, sue them into the ground and publicize their mistakes, revoke licenses, jail time for the grossly negligent.

[Anonymous]

Anonymous wrote:Its not a HIPAA violation unless she attaches a person's name or personally identifiable information to it.

And, she doesn't sound like a nutcase, she sounds like someone for whom English is possibly a second language but her logic is pretty clear here.

Homebirth advocates have a very serious blindspot in that they insist on sweeping bad birth outcomes under the rug. Its all about "trust birth" as if the very real suffering past and present of women whose bodies are supposedly made for birthing are just anomalies. Calling people who speak a negative opinion crazy doesn't change that history. Doesn't change the latest research on apgar scores or seizure risks being respectively lower and higher for home births either. Doesn't change some of the very real bad stories out there.

Simply put: the woman took risks. People who believed in her paid a price for that. Frankly, I think shoddy midwives should face the same risks that shoddy obs or crappy dentists do, sue them into the ground and publicize their mistakes, revoke licenses, jail time for the grossly negligent.

Shove it, Dr. Amy.

I would be appalled if the nurse who assisted at the birth of my child - regardless of the choices my midwife and I made - spewed her nastiness at the world as the nurse above is doing.

I am sure this nurse witnesses unfortunate events every day. Why is she not posting the details of what happened with every other birth which has gone wrong at her hospital? She should be ashamed of herself for posting in such a manner, and she is lucky her supervisors are not reading. Since this is a public case, it would not be difficult to determine the names of the families involved.

[Anonymous]

Because the topic isn't "every birth I've ever witnessed that went wrong" its what this particular homebirth midwife did that was grossly negligent.

Also- I didn't get that from dr Amy- it's a study that just came out.

Anyway- crying HIPAA violation and name calling don't change the facts- this woman's negligence. She deserves to be punished. It's that simple.

[Anonymous]

Anonymous wrote:Because the topic isn't "every birth I've ever witnessed that went wrong" its what this particular homebirth midwife did that was grossly negligent.

Also- I didn't get that from dr Amy- it's a study that just came out.

Anyway- crying HIPAA violation and name calling don't change the facts- this woman's negligence. She deserves to be punished. It's that simple.

But see, you are not in any way qualified to determine that what this midwife did was "grossly negligent." You assisted at the ultimate resuscitation of this baby; you were NOT present for all of the prenatal care, for the informed consent conversations with the family, the early labor or even the late labor. All you have witnessed is a tiny blip on the screen - the actual moment of the baby's arrival. Not only should you be wise enough to refrain from making ranting comments like you made above, you should also recognize that you do not have enough information to make a final decision about the midwife. Yes, it is possible for a baby to be crowning and then later, to move back upward to a +1 station. Is it common? Of course not, but it is possible. It's also possible that this particular family specifically chose not to receive antibiotics for the GBS; it is a choice that many homebirth (and even some hospital birthing) families make. Because a homebirth situation does not follow certain protocols which are common at hospitals, does not equal negligence. You simply do not have the information - nor the clarity of mind, apparently - to be evaluating this case.