Evelyn Muhlhan - another homebirth midwife bites the dust?

[Anonymous]

Anonymous wrote:

Anonymous wrote:There's two issues being conflated here. Women have the right to choose to give birth at home, regardless of the circumstances, or that in some cases, it is ill-advised. Medical professionals (including midwives), on the other hand, are expected to adhere to well-known standards of care. In certain situations, that can require them to insist that the patient give birth at a hospital, or decline to provide care if they refuse to leave the home. Evelyn was suspended because of complaints that she failed to adhere to the standard of care. She's not being prosecuted (to my knowledge) - she faces licensing ramifications because the she failed to comply with the licensing board's standard of care.

Short version - I suppose it was inevitable, but there's no reason this discussion needed to turn into a debate about the relative merits of home v. hospital birth.

According to whom? Why does a doctor -- whose protocols are often based on liability issues, bad or ever-changing research, or personal opinions - get to dictate how a midwife must practice? Just because doctors have come up with a "standard of care" does NOT mean that this is best course of action for every woman giving birth. We deserve to make our own decisions and have the attendant of our choosing at our births, regardless of what ACOGs opinion is about various pregnancy or birth complications.

Evelyn was suspended because the doctors who witnessed these transfers got pissed off and jumped at the opportunity to take down an excellent, well-respected, highly-educated homebirth midwife. These doctors have without doubt experienced some of these same exact tragic outcomes in their own practice, yet they are not turning in their licenses. The reality of birth is that sometimes bad things happen - to midwives and doctors alike. However, doctors will use those tragedies against the midwives. It is insane and does not serve women at all, and encourages midwives to delay transport in potentially dire circumstances. Futhermore, the board that suspended her license does not even consist of her peers -- no homebirth midwives (and if I remember correctly, no midwives at all!) sit on that board. As with all other medical professionals, a provider should be reviewed by others who have the same credentials.

According to whom? The entity that gave her the license. Was that not clear?

I understand that you don’t feel this is the way things SHOULD be. You don’t think that doctors should have any input into how a midwife conducts her business. Fair enough, although I disagree. But – and I can’t emphasize this enough – that is not how things ARE. The fact is, the licensing board DOES define standards of care, and it is alleged that Evelyn violated them. Even if you do get the governing structure changed going forward (and I’m not sure how successful you’ll be) it’s not going to do anything for her. Isn’t it better to deal with reality, and not how you think things should be? Tru to change them, sure, but right now, deal with the circumstances that exist.

And to an outsider, the persecution complex is really off-putting. Assuming that doctors are out to get midwives is pretty insulting, and I’m not even a doctor. And saying “bad things happen” is so facile – of course they do, but there are procedures in place that are designed to limit the number of times that we have to shrug off the death of an infant with, “oh, well, shit happens.” If someone doesn’t follow the established standard of care, do you really think it’s appropriate to just excuse that failure with, “bad things happen?”

[Anonymous]

Anonymous wrote:Midwifery is truly one of the oldest professions, and seeks to assist in a natural stage of life which will occur regardless of who is watching or assisting. It is also an event that in a few very rare cases - no matter who is assisting - will result in some tragedy.

Yes, you are correct when you state the two obvious cases. Most home births result in a successful outcome and would have in a hospital as well. And yes, a small minority of home births result in tragedy that would have also occurred in a hospital setting. But you are conveniently omitting an other case. A small minority of home births result in a tragic outcome that could have been avoided had a physician's standard of care been followed and the birth occurring at a hospital. Further, I'm not afraid to state the counter case, which is a small minority of birth's occurring at a hospital under a physician's standard of care, resulting with a tragic outcome that would have been avoided if the birth were performed at home. However, if the number of cases for avoidable negative outcomes in home births outnumbers the cases for avoidable negative outcomes in hospital births, that would indicate a clear argument for home birth licensing requirements.

[Anonymous]

I'm 11:30 and probably a couple other places on this thread. I am NOT 12:26 and do not agree with her position. I believe that there should be licensing requirements for midwives because I believe that regulation, training and and standards of care are the best ways that we as consumers have of evaluating a particular practitioner's ability. I think that NARM is a good start, but it's still got a ways to go.

That said, 12:58, I think it's really interesting that you feel there is some kind of home birth agenda on this board. Every time there is a thread about home birth, extremely angry posters seem to come out of the woodwork to tell women who birth at home (and women like me, who had babies at birth centers with midwives) that they're being irresponsible, arrogant, selfish, prioritize having a good birth story over having a healthy baby, etc. That has happened several times in this thread, and it's only 4 pages. I remember the Karen Carr thread and posted there a lot too - how long did that one get? 30 pages? 35?

I think that everyone coming on this board has some kind of personal axe to grind, and that is confusing to me. Why should I care where your baby was born? Why should I care if you had an epidural? Why would we even talk about it unless we both want to talk about it? One of my best friends strongly believes that all babies should be born in hospitals. She told me this once, long after my daughter was born. I felt judged, but I didn't respond, because every time people like me faced with situations like that respond, we get accused of having an agenda.

As for your comment that assuming doctors are out to get midwives being insulting, I agree that it is a blanket insult that ALL doctors are out to get ALL midwives, since that's certainly not true. However, there are doctors who are threatened by midwives, who don't like working with midwife clients, who are rude and condescending to midwife clients who need to transfer their care for whatever reasons. Just as you told the poster you were responding to, I understand that you don't feel this is the way things SHOULD be, but - and I can't emphasize this enough - that is how things sometimes ARE.

[Anonymous]

Anonymous wrote:I'm 11:30 and probably a couple other places on this thread. I am NOT 12:26 and do not agree with her position. I believe that there should be licensing requirements for midwives because I believe that regulation, training and and standards of care are the best ways that we as consumers have of evaluating a particular practitioner's ability. I think that NARM is a good start, but it's still got a ways to go.

That said, 12:58, I think it's really interesting that you feel there is some kind of home birth agenda on this board. Every time there is a thread about home birth, extremely angry posters seem to come out of the woodwork to tell women who birth at home (and women like me, who had babies at birth centers with midwives) that they're being irresponsible, arrogant, selfish, prioritize having a good birth story over having a healthy baby, etc. That has happened several times in this thread, and it's only 4 pages. I remember the Karen Carr thread and posted there a lot too - how long did that one get? 30 pages? 35?

I think that everyone coming on this board has some kind of personal axe to grind, and that is confusing to me. Why should I care where your baby was born? Why should I care if you had an epidural? Why would we even talk about it unless we both want to talk about it? One of my best friends strongly believes that all babies should be born in hospitals. She told me this once, long after my daughter was born. I felt judged, but I didn't respond, because every time people like me faced with situations like that respond, we get accused of having an agenda.

As for your comment that assuming doctors are out to get midwives being insulting, I agree that it is a blanket insult that ALL doctors are out to get ALL midwives, since that's certainly not true. However, there are doctors who are threatened by midwives, who don't like working with midwife clients, who are rude and condescending to midwife clients who need to transfer their care for whatever reasons. Just as you told the poster you were responding to, I understand that you don't feel this is the way things SHOULD be, but - and I can't emphasize this enough - that is how things sometimes ARE.

I am 12:58 – I agree that there’s a lot of venom going both ways. The anti-home-birth-at-all-costs crowd is as irrational as 12:26 and others. But I wasn’t responding to them, and my comments about the persecution complex were directed at the following statement, which I don’t believe serves anyone’s best interests:

"Evelyn was suspended because the doctors who witnessed these transfers got pissed off and jumped at the opportunity to take down an excellent, well-respected, highly-educated homebirth midwife. These doctors have without doubt experienced some of these same exact tragic outcomes in their own practice, yet they are not turning in their licenses. The reality of birth is that sometimes bad things happen - to midwives and doctors alike. However, doctors will use those tragedies against the midwives. It is insane and does not serve women at all, and encourages midwives to delay transport in potentially dire circumstances."

And while I appreciate the attempt to turn my own words against me, I don’t believe I ever said that all doctors welcomed midwives with open arms – go back and check if you don’t believe me. Such a statement would be incredibly naïve. What I said was that reflexively ascribing ulterior motives to every doctor who files a complaint against a midwife is insulting, intellectually lazy, and does your cause no service. Here, one baby died, and other mothers and babies arrived at the hospital in significant distress, and there are numerous allegations that the standard of care was not followed. Dismissing the complaints as, “well, they’re just out to get all midwives” leaves a bad taste in my mouth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm 11:30 and probably a couple other places on this thread. I am NOT 12:26 and do not agree with her position. I believe that there should be licensing requirements for midwives because I believe that regulation, training and and standards of care are the best ways that we as consumers have of evaluating a particular practitioner's ability. I think that NARM is a good start, but it's still got a ways to go.

That said, 12:58, I think it's really interesting that you feel there is some kind of home birth agenda on this board. Every time there is a thread about home birth, extremely angry posters seem to come out of the woodwork to tell women who birth at home (and women like me, who had babies at birth centers with midwives) that they're being irresponsible, arrogant, selfish, prioritize having a good birth story over having a healthy baby, etc. That has happened several times in this thread, and it's only 4 pages. I remember the Karen Carr thread and posted there a lot too - how long did that one get? 30 pages? 35?

I think that everyone coming on this board has some kind of personal axe to grind, and that is confusing to me. Why should I care where your baby was born? Why should I care if you had an epidural? Why would we even talk about it unless we both want to talk about it? One of my best friends strongly believes that all babies should be born in hospitals. She told me this once, long after my daughter was born. I felt judged, but I didn't respond, because every time people like me faced with situations like that respond, we get accused of having an agenda.

As for your comment that assuming doctors are out to get midwives being insulting, I agree that it is a blanket insult that ALL doctors are out to get ALL midwives, since that's certainly not true. However, there are doctors who are threatened by midwives, who don't like working with midwife clients, who are rude and condescending to midwife clients who need to transfer their care for whatever reasons. Just as you told the poster you were responding to, I understand that you don't feel this is the way things SHOULD be, but - and I can't emphasize this enough - that is how things sometimes ARE.

I am 12:58 – I agree that there’s a lot of venom going both ways. The anti-home-birth-at-all-costs crowd is as irrational as 12:26 and others. But I wasn’t responding to them, and my comments about the persecution complex were directed at the following statement, which I don’t believe serves anyone’s best interests:

"Evelyn was suspended because the doctors who witnessed these transfers got pissed off and jumped at the opportunity to take down an excellent, well-respected, highly-educated homebirth midwife. These doctors have without doubt experienced some of these same exact tragic outcomes in their own practice, yet they are not turning in their licenses. The reality of birth is that sometimes bad things happen - to midwives and doctors alike. However, doctors will use those tragedies against the midwives. It is insane and does not serve women at all, and encourages midwives to delay transport in potentially dire circumstances."

And while I appreciate the attempt to turn my own words against me, I don’t believe I ever said that all doctors welcomed midwives with open arms – go back and check if you don’t believe me. Such a statement would be incredibly naïve. What I said was that reflexively ascribing ulterior motives to every doctor who files a complaint against a midwife is insulting, intellectually lazy, and does your cause no service. Here, one baby died, and other mothers and babies arrived at the hospital in significant distress, and there are numerous allegations that the standard of care was not followed. Dismissing the complaints as, “well, they’re just out to get all midwives” leaves a bad taste in my mouth.

Fair enough. The thought of doctor persecution of this midwife actually did cross my mind, mostly because the complaints seem to be from the same hospital, but I don't have all the facts. It's possible that the poster you were quoting actually knows something about this case in particular. Regardless, I have heard of other midwives who have been similarly sanctioned in other states where it HAS been a doctor or group of doctors who see midwives as competition (irresponsible and dangerous competition at that) and have lodged complaints against them every time they transfer in a patient with complications. It DOES happen, and that's why it occurred to me when I read about this story. Whether that's what happened or not, I have no idea since I'm not acquainted personally with any of the doctors who complained. I think that ignoring the physicians who believe all midwives are unskilled is just as damaging as believing that all doctors are out to get midwives/patients of midwives. Doesn't mean that those things are not sometimes false, but doesn't mean they're not true sometimes either.

In any case, thanks for being rational about things and enjoying my tongue in cheek turning of your phrase. Honestly I just thought it was a good phrase and said what I wanted to say better than I could have

[Anonymous]

11:30, glad to hear you aren't 12:26. I suddenly felt I had experienced a bait and switch in the discussion.

[Anonymous]

In any case, thanks for being rational about things

Right back at you, 13:56. Hopefully this civility will permeate this thread. Any takers on that wager?

Anyone?

Drat.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There's two issues being conflated here. Women have the right to choose to give birth at home, regardless of the circumstances, or that in some cases, it is ill-advised. Medical professionals (including midwives), on the other hand, are expected to adhere to well-known standards of care. In certain situations, that can require them to insist that the patient give birth at a hospital, or decline to provide care if they refuse to leave the home. Evelyn was suspended because of complaints that she failed to adhere to the standard of care. She's not being prosecuted (to my knowledge) - she faces licensing ramifications because the she failed to comply with the licensing board's standard of care.

Short version - I suppose it was inevitable, but there's no reason this discussion needed to turn into a debate about the relative merits of home v. hospital birth.

According to whom? Why does a doctor -- whose protocols are often based on liability issues, bad or ever-changing research, or personal opinions - get to dictate how a midwife must practice? Just because doctors have come up with a "standard of care" does NOT mean that this is best course of action for every woman giving birth. We deserve to make our own decisions and have the attendant of our choosing at our births, regardless of what ACOGs opinion is about various pregnancy or birth complications.

Evelyn was suspended because the doctors who witnessed these transfers got pissed off and jumped at the opportunity to take down an excellent, well-respected, highly-educated homebirth midwife. These doctors have without doubt experienced some of these same exact tragic outcomes in their own practice, yet they are not turning in their licenses. The reality of birth is that sometimes bad things happen - to midwives and doctors alike. However, doctors will use those tragedies against the midwives. It is insane and does not serve women at all, and encourages midwives to delay transport in potentially dire circumstances. Futhermore, the board that suspended her license does not even consist of her peers -- no homebirth midwives (and if I remember correctly, no midwives at all!) sit on that board. As with all other medical professionals, a provider should be reviewed by others who have the same credentials.

According to whom? The entity that gave her the license. Was that not clear?

I understand that you don’t feel this is the way things SHOULD be. You don’t think that doctors should have any input into how a midwife conducts her business. Fair enough, although I disagree. But – and I can’t emphasize this enough – that is not how things ARE. The fact is, the licensing board DOES define standards of care, and it is alleged that Evelyn violated them. Even if you do get the governing structure changed going forward (and I’m not sure how successful you’ll be) it’s not going to do anything for her. Isn’t it better to deal with reality, and not how you think things should be? Tru to change them, sure, but right now, deal with the circumstances that exist.

And to an outsider, the persecution complex is really off-putting. Assuming that doctors are out to get midwives is pretty insulting, and I’m not even a doctor. And saying “bad things happen” is so facile – of course they do, but there are procedures in place that are designed to limit the number of times that we have to shrug off the death of an infant with, “oh, well, shit happens.” If someone doesn’t follow the established standard of care, do you really think it’s appropriate to just excuse that failure with, “bad things happen?”

My point was that it shouldn't be up to the doctors to allege anything -- as they are making judgements based on what THEIR choices would be, without considering that midwives might have different protocols. Furthermore, it is NOT a midwifery board who has suspended her license while they investigate; again it is a nursing board, upon complaints from doctors, who are judging her based on a doctors standard of care. This is what I disagree with.

Also, I might not been careful enough with my wording, as I definitely do not believe that all doctors hate midwives. In fact, I know there are many doctors who are supportive and have been extremely helpful to midwives. Also, some doctors are amazing at what they do and I am so grateful we have them! However, I do believe that there are many doctors who really do dislike midwives and homebirth, and will do everything they can to delegitimize their work and force them out of practice. Again, there are some very deep political issues involved here.

Lastly, I am not trying to glibly brush off a death with a "shit happens." Not at all! However, I have been in the birth world long enough to know that the standard of care is developed based on many, many things which may or may not reflect what is truly best for any individual baby or mother. And, even if the standard of care is followed to a T, some babies and mothers might still die - this is not a casual shrug off, but again having witnessed thousands of births myself, it is a result of facing the brutal truth of what can happen during pregnancy, birth or postpartum. Honestly, in my opinion 'standard of care' should be a framework from which to make decisions for the individual case you are faced with; not a rule book which cannot ever be bent. And ultimately, a woman should be able to make the choices that she believes are in the best interest for her body and for her baby, regardless of what her doctor (or midwife) believes may be best - and I believe that she should still have a right to have a midwife assist her in those cases.

[Anonymous]

Anonymous wrote:11:30, glad to hear you aren't 12:26. I suddenly felt I had experienced a bait and switch in the discussion.

Wait, I'm 12:26 and what did I do that made me so bad?! I realize I have an unusual position, but I am definitely not irrational or naive. I've been involved with childbirth both professionally and politically for a long time, and I've witnessed so many interesting, disturbing, heartbreaking, infuriating situations it would make your head spin. I really do respect others opinions but in this situation, I honestly believe that it is not simply a matter of a bad midwife getting investigated.

[Anonymous]

Anonymous wrote:

Anonymous wrote:11:30, glad to hear you aren't 12:26. I suddenly felt I had experienced a bait and switch in the discussion.

Wait, I'm 12:26 and what did I do that made me so bad?! I realize I have an unusual position, but I am definitely not irrational or naive. I've been involved with childbirth both professionally and politically for a long time, and I've witnessed so many interesting, disturbing, heartbreaking, infuriating situations it would make your head spin. I really do respect others opinions but in this situation, I honestly believe that it is not simply a matter of a bad midwife getting investigated.

11:30 and I had been going back and forth. If she had written your post it would have been inconsistent with some of the content and the point of her earlier posts.

[Anonymous]

12:26, you don't seem irrational, I didn't mean to suggest that. But can I ask, what rights do you think a full term baby has, if any, and who has the power to enforce those rights, if anyone, other than the mother?

[Anonymous]

I love Dr. Amy. I would never take any risks with my unborn child (proud recipient of 3 C-sections) but believe other women should have the right to choose. I don't think homebirthers are selfish and arrogant although I wonder about motivations when there are complicating factors like VBAC, gestational diabetes, etc. I figure that most people are comfortable with a higher degree of risk than I am.

[Anonymous]

Anonymous wrote:12:26, you don't seem irrational, I didn't mean to suggest that. But can I ask, what rights do you think a full term baby has, if any, and who has the power to enforce those rights, if anyone, other than the mother?

It's an interesting and valuable question, which I have definitely spent some time pondering but have difficulty coming to an absolute answer on. I do believe that unborn babies have the right to life, but unfortunately we have a problem in that doctors cannot guarantee a perfect outcome. In fact, they have similar outcomes in terms of maternal/infant morbidity and mortality as homebirth midwives do - there is not a huge difference; for some things homebirth is better, and in other things the hospital is best - but overall the stats are similar, and for the foreseeable future will always include a small number of bad outcomes. So while we might say that full-term babies have a "right to life", there isn't any way to absolutely protect that right.

So, given that, the reasonable thing is that as long as a mother is healthy (meaning, not drugged out or mentally incompetent), and her intent is to have a healthy baby, I believe we have to entrust her to make the best decisions possible for herself and her unborn baby. Given these circumstances, I think it would be a horrendous invasion of personal privacy for the government - or worse, a doctor - to step in and force a woman to birth in a particular way. Except in extremely rare cases, no one cares more about her baby than the mother who is about to give birth to it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:11:30, glad to hear you aren't 12:26. I suddenly felt I had experienced a bait and switch in the discussion.

Wait, I'm 12:26 and what did I do that made me so bad?! I realize I have an unusual position, but I am definitely not irrational or naive. I've been involved with childbirth both professionally and politically for a long time, and I've witnessed so many interesting, disturbing, heartbreaking, infuriating situations it would make your head spin. I really do respect others opinions but in this situation, I honestly believe that it is not simply a matter of a bad midwife getting investigated.

11:30 and I had been going back and forth. If she had written your post it would have been inconsistent with some of the content and the point of her earlier posts.

I'm 11:30 and I agree. It would have been TOTALLY inconsistent for me.

I am interested to hear more from 12:26, though, on the subject of regulation. Is it all regulation you are opposed to, or just shitty regulation? Are you okay with having a non-governmental body doing the regulation? I don't think that a government regulator is necessary for effective regulation, and I am with you on stronger regulation for midwives who want to use drugs of some kind - it's important to administer those things correctly, after all.

[Anonymous]

Anonymous wrote:I love Dr. Amy. I would never take any risks with my unborn child (proud recipient of 3 C-sections) but believe other women should have the right to choose. I don't think homebirthers are selfish and arrogant although I wonder about motivations when there are complicating factors like VBAC, gestational diabetes, etc. I figure that most people are comfortable with a higher degree of risk than I am.

Dr. Amy is vile and, to a disturbing degree, absolutely HATES homebirth and even low-intervention childbirth. For that reason I see her as completely anti-choice and anti-woman. I'm sorry to see that anyone can take her seriously and worse, feel "love" for that woman.

At any rate, your assumption about risk seems a bit misguided to me. Statistically speaking, cesareans come at a higher risk to both mom and baby. They certainly are not the lowest risk option, not by a long shot. However, I do understand that some women will have an emotional reaction that a cesarean FEELS less risky to them, and I fully support their right to choose a c/s if that is what seems best to them.