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Midwife charged in DC? Karen Carr, CPM...
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Anonymous
You marketing department may have bought into this but you need to get a grip on your nursing and medical staff. You have to get rid of smug, opinionated nurses who completely piss off patients in both camps. The nurses seem to want patients to have an epidural more than anyone. They seem to have the attitude that since 90% of patients get an epidural that you are wasting their time for not getting one when they suggest it. The ob/gyn does not care about pain relief or how many times the nurse has to get up and reposition the monitor. The nurses will not force you but they will suggest how you might be more comfortable laying in bed or how an internal monitor might be easy on you. They don't do anything to actually help a mother deliver naturally. The ones who have midwives, took extensive classes and have a supportive partner or a doula have a shot at natural child birth but the ones listening to or relying on the nursing staff will have a bad experience. The no separation protocal is a PITA for nurses. Older ones will use whatever wiggle room you give them to get out of this and do what they have alwasy done. The nurses who are supportive of natural birth, breast feeding, or rooming in can be just as bad in the other direction. I had a friend who did not want to breastfeed. While this would not have been my decision, it was hers. Her nurse gave her a terrible hard time about it. If you want more business you need to retrain them that patient education is not patient indoctrination and to check their own opinions at the door. |
Anonymous
I will double check but I was told that The Univ of MD Medical Center in Baltimore was going to start allowing vba2c. They also have (from what I have heard) an amazing MW group there. Again, this is what I was told, I have not checked into it myself! 
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Anonymous
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Lamenting the System
TUESDAY, MAY 10, 2011 AT 9:39AM Hop on over to http://www.theunnecesarean.com/blog/2011/5/10/lamenting-the-system.html she asks for a respectful debate on this May 2011 green journal (Obstetrics and Gynecology journal) By Jill Arnold In the May 2011 Green Journal, OB-GYN Annette Fineberg wrote a commentary titled “An Obstetrician’s Lament.” She begins with a few stories of pregnant women in her life who were making decisions about their pregnancies and births. Two women were pregnant with twins and the other was preparing for a breech birth after an “easy first birth” and all believed or discovered that they had no options in the hospital but a cesarean. Fineberg has observed what she believes to be a trend at the level of the press of touting the benefits of giving birth at home and feels that obstetricians contribute to this trend. In her words, “our lack of experience as obstetricians colored by our fear of liability is narrowing women’s choices, and sometimes motivating them to ignore fetal and maternal safety in an effort not to be coerced into unnecessary interventions” and “many obstetricians do not have the willingness, time, or skills to provide maternal choices.” While she highlights the decrease in maternal mortality in the last century as a strongpoint of modern obstetrics, Fineberg also notes that in spite of the U.S. spending more per capita on health care than any other country in the world, infant and maternal mortality rates are higher in the U.S. than in all of western Europe, with the world’s third highest cesarean rate to boot. She cites a recent study which found that “nearly half of all primigravidas attempting vaginal delivery are induced, and half of cesarean deliveries for dystocia are done before 6 cm of dilation, presumably before active labor.” Fineberg calls obstetrics an art and a privilege and implores her colleagues to seek out mentoring if they lack basic skills such as forceps and breech extractions. She advocates for offering “real choices” to patients and being willing to admit what is truly evidence based versus what is merely tradition and culture. While she feels that collaborating with midwives is a positive, she encouraged other obstetricians to stop the trend of becoming simply cesarean-performing machines in part by “hav[ing] conversations with [their] patients that are not one sided and allow for true informed consent.” A few quotes from the article: “A colleague of mine in another state watched the residents she was supervising emotionally bully a young woman and her mother into a cesarean delivery.” “We can all agree that VBAC, twins, and breech should not be managed at home, yet we frequently demand complete control of the situation and eliminate some appropriate choices in the hospital.” “Most midwives know from experience that Friedman’s curve is too strict.” “The Term Breech Study closed the door on vaginal breech delivery even for the lowest-risk women in most obstetricians’ minds…” “We need to recognize and own those aspects of obstetric management that are driving our skyrocketing cesarean delivery rate but having no positive effect on maternal or infant morbidity and mortality.” “Many of the obstetric disasters we have all seen and which color our perspective (which David Grimes has called “numerators in search of denominators”) are at least in some part iatrogenic if examined deeply enough.” I sent the article to a group of OB-GYN friends last week and asked if they would be willing to write up a response to the article, whether critical or complimentary, formal or informal. Their work will be featured daily this week. Respectful contributions to the discussion are welcome on subsequent posts. |
Anonymous
Thanks! Very interesting. Finally a useful contribution to the discussion after pages and pages of self righteous descriptions of personal birth choices and extraordinarily long, boring, idiotic attempts at humor. |
Anonymous
Um, I live in a pretty typical community (nor urban or rural) and I visited 8 hospitals when I was last pregnant. EIGHT. And each one offered exactly what this poster said. I believe the point was through the hospital’s financially vested interest of attracting customers, WE can more easily get what WE want. And the hospital I did end up choosing gave me NO trouble whatsoever about an unmedicated birth, removing my monitor, positioning, anything. When a complication arose anyway (unmedicated, not virus related), emergency personnel was immediately available. I felt at home there with the accommodations, and safe with the staff. L&D was quite isolated from the rest of the establishment (as MANY are now doing) to lower contamination risk. Really, my labor was the same as it would have been at home, and the delivery as preventatively prepared as it would be in any hospital. The food was great, the bed was big, my husband has sleeping accommodations, and I was waited on hand and foot for my EVERY need. I was never involuntarily separated from my child but did allow my husband to go with her for some tests instead of wheeling myself there. They offered to take her to the nursery every night to give me a chance to rest but when I declined, they helped settle her in the bed with me to co-sleep. They came in to help whenever I nursed. Maybe I was lucky – or maybe there’s a reason why the majority of women still go to hospitals. Though horror stories exist on both sides, the majority of women DO know their options and their experiences at hospitals don’t generally prompt them to never return. There was no lie in that poster’s post. Because hospitals want the money, they’re trying to please our every whim and we can make that work FOR us. Unless you tell me your midwife works pro-bono, I’ll assume the same goes for them. No need for paranoia or fear mongering here just b/c you prefer being at home. |
Anonymous
Oh, well let me retract the past 22 years of my life then. I'm sure I was just sadly misinformed. Alas, everyone. The corporate hospital marketing conglomerati has struck. The same poster who alleged herself as a purported "hospital administrator" has now returned in a marketing department shapeshifter who composes a purely idyllic piece of prose to represent herself as a satisfied mother who just loved the pastoral wholeness of the medical/pharmaceutical complex. I stand here proudly as a beacon of truth and light, in a dark room no less, but standing tall. |
Anonymous
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Anyone here ever heard of Poe's Law? Where you can't tell the parodies from the True Believers? That's where this thread has ended up - See below. Time to put it to bed for God's sake.
From Wikipedia: Poe's law, named after its author Nathan Poe, is an Internet adage reflecting the fact that without a clear indication of the author's intent, it is difficult or impossible to tell the difference between sincere extremism and the satirical parody of extremism. |
Anonymous
| or, you could just call them trolls. get lost already. |
Anonymous
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You know what's not a parody? At this very moment, Karen Carr is prepared to catch a baby inside a home with an anxious, excited, and frightened young mother-to-be. It's the young woman's first pregnancy. Odds are everything will go fine. If not, 911 will be called.
For 102 pages of comments and bluster, what has really changed? |
Anonymous
Honestly, I would scratch out the word "young"... odds are that this is not a young mother given the area we live in. And I hope that at least someone is willing to accept that a breech home birth for a 43 year old first time mom might not be a viable option even if it is the only option that will allow her to have a vaginal birth in this region. That's just how I feel about it personally after 102 pages. |
Anonymous
I thought that poster was sarcastic at first but I'm not so sure anymore. |
Anonymous
According to Karen Carr's record, 911 won't be called fast enough. |
Anonymous
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When a Home Birth Ends in Tragedy, Can the Midwife Go to Jail?
What the case of a Baltimore midwife tells us about midwifery and the law. http://www.slate.com/id/2293389 |
Anonymous
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There is a great discussion going on here:
http://www.theunnecesarean.com/blog/2011/5/10/lament-in-stereo.html By Lauren A. Plante, MD, MPH I was startled to read Dr Annette Fineberg’s essay “An Obstetrician’s Lament” in the May issue of Obstetrics & Gynecology, not because I disagree with anything she had to say in it, but because it appeared in our premier journal and therefore reached about 50,000 other OBGYNs. A couple of years ago, at the start of the “patient-choice cesarean” controversy, I coauthored a piece entitled “Patient-choice vaginal birth?” and didn’t even try submitting it to Obstetrics & Gynecology: we just assumed the editors wouldn’t consider it and submitted it to a family practice journal instead. But either Dr Fineberg’s eloquence or the simple passage of time has brought this once-taboo subject out in the open for the rest of us to think about. On the one hand, obstetricians always claim we want the best for mothers and babies; on the other hand, we assume we always know what that is. Our practice style is typically high-intervention and low-interpersonal, and after a while the other styles become both less visible and less acceptable to us. We are the keepers of the sacred steel, and if your baby doesn’t just fall out we can carve her out of you. Smile and be grateful, okay? Most of us have limited and ever-lessening experience with natural birth. Sometimes I hear my residents telling one another about a precipitous labor and delivery, by which they seem to mean nothing happened that required their participation. They don’t actually recognize normal labor and birth, though I can’t realistically blame them, because what they see in our hospital doesn’t bear much resemblance to normal. They’re quick off the trigger, because that’s what’s rewarded: when you’re managing a board full of women in labor, it’s more like traffic control than anything else. Room 4 hasn’t delivered yet? Well, did you start pit? Or, is the OR free yet? Because we’ve got the next three C-sections lined up, so let’s move it along. I used to assign medical students just to labor-sit—-just plan to spend their shift with the same laboring woman, learn the process, learn some patience, be there for her. But usually a senior-level resident will countermand that order, pull the medical student to do something rather than just be somewhere. Dr. Fineberg points out that OBGYNs are often considered the bad guys. We didn’t mean to be. We didn’t choose this specialty to wreak havoc or ride right over women’s wishes. But we weren’t that patient to start with, or we wouldn’t have chosen a largely surgical specialty, and our training often rubbed the idealism right off us. And by this time the discourse is so colored by suspicion on everyone’s part that it’s hard to know how to fix it. We ought to support VBAC, and breech vaginal delivery, and out-of-hospital birth, but our experience is so largely focused on the things that go wrong that we assume catastrophe. And the less welcoming we are to women who want those options, the wider the gulf, and the less safe those options become…because we drive them underground. My residents have certainly never seen a home birth that went well: how could they? They only see the ones that didn’t go smoothly and so were transported to hospital. Sometimes they see the ones that should have been transported much earlier, only the woman and the midwife pushed the envelope that much further just to avoid the inevitably unpleasant interaction with the physician. Sometimes they see a catastrophe, but don’t recognize that it could have been avoided if there was a safe and welcoming backup place. Without the denominator, they’re convinced that the out-of-hospital world is a dangerous place. I recently spent a few days with a midwife who’d been attending births at a birth center for decades. When she was starting out, she said, with an unsupportive and rather grudging backup, she was convinced that she never delayed a hospital transport for fear of that interaction. But when she landed in a supportive and welcoming backup arrangement, she was surprised to find that her transfer rate went up. Not her cesarean rate, just her transfer rate… because she could bring a woman in sooner if either of them had concerns about how labor was proceeding. There’s always a lot of pushback from OBGYNs when anyone starts talking about women’s choices. Generally, women’s choices are better supported by the establishment when those choices further concentrate power within that establishment. The final argument always brings up safety: the dead-baby specter trumps all other considerations. So let’s just stipulate: everyone is interested in safety. The OBGYN who may attend a thousand births in his career is no more interested in safety than the woman who will have two of those births and raise those children. Safety requires skills, respect, transparency, and enough time. If physicians can’t provide those things, we shouldn’t balk when women seek them elsewhere. This post is featured as one of a series of posts by OB-GYNs in response to the May 2011 article, An Obstetrician’s Lament, by Dr. Annette Fineberg. |
Anonymous
No she will call but after the baby is dead because you know, some babies weren't meant to live outside the womb. |