Evelyn Muhlhan - another homebirth midwife bites the dust?

[Anonymous]

Dr. Amy's view on epidurals (that they have no effect in slowing down or stalling labor, or other negative effects, every) discredits her in my eyes.

[Anonymous]

Anonymous wrote:

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.

No, this is not true. For high risk births, the mortality rate for babies and mothers is much high with home births than with hospital births. Please do not confuse a woman's right to determine her medical care with medical science.

[Anonymous]

i had one hospital birth, one home birth, am a doula (at mostly hospital births), and read dr. amy's blog. while her approach and personality are awful, i think she sometimes (not always) makes some good points that have challenged me in a good way. i think home birth supporters have a hard time being self reflective and admitting that home birth carries certain risks that hospital birth does not (just as hospital birth carries certain risks that home birth does not). i have trouble myself sorting through the accusations against various midwives -- i worry that doctors and others are engaging in unfairly motivated "witch hunts" against safe, qualified midwives, but i also worry that some midwives are acting irresponsibility and not communicating risk accurately to clients.

i really struggle with this issue, because i believe on one hand that women should have the ultimate choice regarding how and where and with whom to give birth, but at the same time, i feel uncomfortable with the idea that a woman for whom home birth is extremely risky would be able to go ahead with it, have a midwife attend her, have a horrible outcome, and have no accountability on anyone's part for that horrible outcome. i do feel the baby's safety deserves consideration, but i see how slippery a slope it is once we start giving the baby rights that trump the mother's.

i see that many others in the birth world tend to just jump on the bandwagon to support any midwife who has been accused of irresponsible practice. without knowing all the details, i feel it's impossible for me as a random person to make a judgment as to whether the midwife acted responsibly, generally acts responsibly, etc. i have read some stories where midwives did appear to act irresponsibly, didn't inform mothers of risks, used inappropriate protocols, and then had a bad outcome...and i do feel there should be some way for there to be accountability in those situations. whether the situation with evelyn is one of those, i'm not sure. some of the evidence in dr. amy's post is pretty damning, but I know there are always many sides to a birth story, and many forks in the road where decisions are made.

i get why women want a home birth. i attend births in hospitals regularly and i see the way women are treated, and i see the unnecessary or harmful routine protocols that cause complications. i really enjoyed giving birth at home -- for me as the laboring women, it was free of distraction, stress, strangers, unfamiliarity, and pressure. my baby was healthy and there was so much about how things went that i think was very healthy and wonderful for me and my baby and that would not have happened similarly in the hospital. at the same time i know i took a risk -- there are some things that if they happen at home, you're screwed. when thinking of having another baby i honestly don't know at this point where i'd feel safest and most comfortable.

i think home birth should be an option, and i want it to be safe. i'm not sure the best way to get to that point.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

No, this is not true. For high risk births, the mortality rate for babies and mothers is much high with home births than with hospital births. Please do not confuse a woman's right to determine her medical care with medical science.

Like what, specifically?

No matter what, medical science still should not have the final say in what I do with my (and therefore, my unborn baby's) body.

[Anonymous]

I'm not the person you are talking with 15:10, but really, this is a question? Let's say a woman has multiple section scars and is at higher risk for rupture. Rupture requires surgery as fast as possible. That gives hospitals an advantage.

Or preeclampsia, where the mother may go into a seizure during labor if she isn't properly medicated and even if she is. The seizure requires serious intervention and immediate c-section. Again, surgery is for hospitals.

Are you saying that there are no birth scenarios where the likelihood of needing surgery is high?

[Anonymous]

Anonymous wrote:I'm not the person you are talking with 15:10, but really, this is a question? Let's say a woman has multiple section scars and is at higher risk for rupture. Rupture requires surgery as fast as possible. That gives hospitals an advantage.

Or preeclampsia, where the mother may go into a seizure during labor if she isn't properly medicated and even if she is. The seizure requires serious intervention and immediate c-section. Again, surgery is for hospitals.

Are you saying that there are no birth scenarios where the likelihood of needing surgery is high?

Yes, really this is indeed a question. I was curious to know what that poster determined was "high risk". In my experience, high risk is not black and white. Not everyone agrees about every single medical condition regarding its effect on mom/baby, the incidence of bad outcomes resulting from that condition, or the necessity of certain treatments to alleviate that condition. There are always two sides of the story, even when you consult medical research.

For example, you cited "multiple section scars." The best research we have shows that the chance of uterine rupture -- even in a uterus scarred several times over -- is extremely low; somewhere around 2%. I'm not refuting medical science or ignoring risks; it's just the actual risk of something might be far different than what the public perceives it to be. Therefore, I believe the mother, in consultation with the care provider of her choice, should be allowed to make the decision that she feels is appropriate for her birth.

One of the problems with preeclampsia is that it is wildly over-diagnosed. That said, I've never known a homebirth midwife (and I know many -- even the "underground" types) who have agreed to help a woman birth at home who was TRULY preeclamptic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

No, this is not true. For high risk births, the mortality rate for babies and mothers is much high with home births than with hospital births. Please do not confuse a woman's right to determine her medical care with medical science.

Like what, specifically?

No matter what, medical science still should not have the final say in what I do with my (and therefore, my unborn baby's) body.

No one is saying that a rational, competent adult should not have the autonomy to make medical decisions. HOWEVER, part of making an informed decision means understanding that there are very real risks associated with giving birth, and that some of these risks (uterine rupture, pre-eclampsia, extreme prematurity (32W-), etc.) that require hospital facilities and personnel.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm not the person you are talking with 15:10, but really, this is a question? Let's say a woman has multiple section scars and is at higher risk for rupture. Rupture requires surgery as fast as possible. That gives hospitals an advantage.

Or preeclampsia, where the mother may go into a seizure during labor if she isn't properly medicated and even if she is. The seizure requires serious intervention and immediate c-section. Again, surgery is for hospitals.

Are you saying that there are no birth scenarios where the likelihood of needing surgery is high?

Yes, really this is indeed a question. I was curious to know what that poster determined was "high risk". In my experience, high risk is not black and white. Not everyone agrees about every single medical condition regarding its effect on mom/baby, the incidence of bad outcomes resulting from that condition, or the necessity of certain treatments to alleviate that condition. There are always two sides of the story, even when you consult medical research.

For example, you cited "multiple section scars." The best research we have shows that the chance of uterine rupture -- even in a uterus scarred several times over -- is extremely low; somewhere around 2%. I'm not refuting medical science or ignoring risks; it's just the actual risk of something might be far different than what the public perceives it to be. Therefore, I believe the mother, in consultation with the care provider of her choice, should be allowed to make the decision that she feels is appropriate for her birth.

One of the problems with preeclampsia is that it is wildly over-diagnosed. That said, I've never known a homebirth midwife (and I know many -- even the "underground" types) who have agreed to help a woman birth at home who was TRULY preeclamptic.

But do you understand what risk is? A 2% chance of uterine rupture is serious not because it is so frequent, but because the results are disastrous--i.e., hemmorging to death. I can deal with a 2% chance of requiring an episiotomy--heck, I can even deal with a 20% chance, but a 2% chance of death is far more serious.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm not the person you are talking with 15:10, but really, this is a question? Let's say a woman has multiple section scars and is at higher risk for rupture. Rupture requires surgery as fast as possible. That gives hospitals an advantage.

Or preeclampsia, where the mother may go into a seizure during labor if she isn't properly medicated and even if she is. The seizure requires serious intervention and immediate c-section. Again, surgery is for hospitals.

Are you saying that there are no birth scenarios where the likelihood of needing surgery is high?

Yes, really this is indeed a question. I was curious to know what that poster determined was "high risk". In my experience, high risk is not black and white. Not everyone agrees about every single medical condition regarding its effect on mom/baby, the incidence of bad outcomes resulting from that condition, or the necessity of certain treatments to alleviate that condition. There are always two sides of the story, even when you consult medical research.

For example, you cited "multiple section scars." The best research we have shows that the chance of uterine rupture -- even in a uterus scarred several times over -- is extremely low; somewhere around 2%. I'm not refuting medical science or ignoring risks; it's just the actual risk of something might be far different than what the public perceives it to be. Therefore, I believe the mother, in consultation with the care provider of her choice, should be allowed to make the decision that she feels is appropriate for her birth.

One of the problems with preeclampsia is that it is wildly over-diagnosed. That said, I've never known a homebirth midwife (and I know many -- even the "underground" types) who have agreed to help a woman birth at home who was TRULY preeclamptic.

But do you understand what risk is? A 2% chance of uterine rupture is serious not because it is so frequent, but because the results are disastrous--i.e., hemmorging to death. I can deal with a 2% chance of requiring an episiotomy--heck, I can even deal with a 20% chance, but a 2% chance of death is far more serious.

Of course I understand what a risk is! My point is that no one should determine what the proper course of action for an individual should be. In this particular case, for example, a 2% risk of uterine rupture does not equal a 2% risk of death. In fact, most uterine ruptures DO NOT lead to maternal or neonatal death at all. Only a very small percentage of uterine rupture leads to the 'catastrophic' outcome that we envision. Would I personally attempt a home VBAC after several c/sections? Probably not! However, the risk is low enough that I am willing to allow women to make that decision for themselves.

[Anonymous]

Anonymous wrote:Except in extremely rare cases, no one cares more about her baby than the mother who is about to give birth to it.

We think that about kids in general right, that no one cares more for them than their parents. But we still have laws about what you cannot do to your children if you happen to be one of the rare parents who neglects or hurts your child.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

No, this is not true. For high risk births, the mortality rate for babies and mothers is much high with home births than with hospital births. Please do not confuse a woman's right to determine her medical care with medical science.

Like what, specifically?

No matter what, medical science still should not have the final say in what I do with my (and therefore, my unborn baby's) body.

No one is saying that a rational, competent adult should not have the autonomy to make medical decisions. HOWEVER, part of making an informed decision means understanding that there are very real risks associated with giving birth, and that some of these risks (uterine rupture, pre-eclampsia, extreme prematurity (32W-), etc.) that require hospital facilities and personnel.

Required by whom? My point is that women deserve to make these decisions for themselves, period, even if the situation seems outrageous to you. Hopefully I can use an analogy without being offensive. Do you support abortion? Many women support abortion for a variety of reasons, in fact they will strongly defend it, even if they would not ever choose it themselves; often they even defend it in the most absurd situations (ie, "this baby is coming six months earlier than I planned, so even though I'm happily married, have a stable house, income, and health, I'm going to go ahead and terminate and just try again in six months"). Anyway, I feel this way about birth. If I had a uterine rupture, or severe preeclampsia, or a 32 weeker you can bet your firstborn that I would want to be in the very best medical facility in America. However, I don't think it is my place to judge the medical decisions of another woman, especially when her body is going to birth that baby no matter what. That's between her and her midwife. That said, I've never known a woman to willingly give birth to a 32 weeker at home. I've never known a women who is having signs of uterine rupture to decline going to the hospital. And as I said in a previous post, I've never seen a truly preeclamptic woman not be sent, pronto!, to the hospital by her homebirth midwife.

[Anonymous]

Right, so 16:13 holds true to her stated belief that the full term baby has no rights of its own.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Except in extremely rare cases, no one cares more about her baby than the mother who is about to give birth to it.

We think that about kids in general right, that no one cares more for them than their parents. But we still have laws about what you cannot do to your children if you happen to be one of the rare parents who neglects or hurts your child.

Since no one can absolutely guarantee a perfect outcome from pregnancy or birth, and since there is a great amount of conflicting opinions and evidence regarding childbirth, the decision of how to give birth must be left to the woman. Just because the obstetric world has great influence, does not mean that they should hold that power. Remember, modern midwifery care has equal (and in some cases, better) outcomes than modern obstetrical care.

[Anonymous]

Anonymous wrote:Right, so 16:13 holds true to her stated belief that the full term baby has no rights of its own.

Do you really believe that the unborn baby's rights should be protected over the rights of the mother who carries that baby? Do you really believe the government should be making decisions about our medical care?

[Anonymous]

How do you get "preeclampsia is overdiagnosed"? There are clear diagnostic criteria: BP over 140/90 and 24hr protein over 300. This is not subjective. Every obstetrician I have ever met (and as a 2x PE survivor, I've met a lot) has used these criteria. Meanwhile, the PE forums have multiple stories from midwives who FAILED to diagnose. Please tell me, what is "true" preeclampsia, according to midwives? Do they only believe it's real when you're on the verge of stroke or seizure? 140/90 with a 2+ dip and followup of 300+ on 24hr collection IS preeclampsia. Period. Preeclampsia can progress rapidly to HELLP or eclampsia and put baby in distress.