Speaking of having to advocate for ourselves and our babies as patients...

[Anonymous]

Anonymous wrote:Anyone catch Samantha Bee this week on the diminishing access to ANY maternity care in rural areas? Surely additional birth centers in these areas could improve things if we can't pay for actual hospitals..

https://www.rollingstone.com/tv/news/samantha-bee-takes-on-americas-maternal-healthcare-crisis-w515338

No, access to a birth center is not going to bring down maternal mortality. If you're going to have a hemorrahge or pre-eclampsia you need to be in a hospital.

[Anonymous]

Anonymous wrote:

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Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

No one on this thread has ever advocated for more birth centers, or out of hospital births. They’ve simply pointed out that there are many aspects of the midwife model (which in this country is generally hospital based) that mean women get more monitoring and better care. And story after story shows that doctors ignore women’s concerns and test results are either ignored, or do not show how sick women really are.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that the solution to maternal mortality is more birth centers (which is what started this tangent).

No one on this thread has ever advocated for more birth centers, or out of hospital births. They’ve simply pointed out that there are many aspects of the midwife model (which in this country is generally hospital based) that mean women get more monitoring and better care. And story after story shows that doctors ignore women’s concerns and test results are either ignored, or do not show how sick women really are.

I still don't know what you're trying to say. Are you trying to say is all we need is for women to talk more to midwives, and that will solve things? Maybe you need to get more specific about the "midwifery model of care," because the places that have reduced maternal mortality (California, UK) haven't done it by using the "midwifery model of care."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agreed - many of the most tragic cases do not involve a lack of intervention as the root cause. It often is an issue of no one listening to and closely watching the mother, and an over-reliance on test results to show danger signs, when tests can be wrong, or totally ineffective if no one in authority looks at them. I think the midwife culture of large amounts of time spent with mothers (at appts, in labor and after) and a focus on listening to the mother and taking her subjective experience seriously, is something OBs could really learn from. Midwives can screw up like anyone else, but they at least are starting from the viewpoint that the mother’s experience matters and that a healthy baby is not the only goal.

I think Shalon Irving is a good example of this - she was known to be high risk and was pretty closely monitored through her pregnancy, but after giving birth even though she knew something was wrong and told doctors that repeatedly, they ignored her because her tests didn’t seem that abnormal. But had they listened to her and examined her more closely, they may have been able to save her life.

so basically ... she lacked inteventions!! failing to see here how "low intervention" is a solution.

The problem was not that she lacked access to the necessary treatment, the problem was that she was not given that treatment because doctors did not listen to her and instead relied on tests that gave an incomplete picture of her health. The United States has more intervention-heavy medicalized births than anywhere in the world, and yet a terrible maternal mortality rate. Story after story of women dying illustrates the issue is usually not a lack of access to interventions - these women are all giving birth in hospitals. Instead, doctors are failing to listen when the women describe their symptoms and are failing to do basic physical exams to assess maternal well being. The low-intervention midwife model does not involve not intervening for serious health problems - hospital based midwives monitor closely for pre-e, Hemorrhage, infection, all the biggies, and treat those issues aggressively. But they do place a greater focus on maternal wellbeing and on listening to a mother’s subjective experience (the whole natural birth crunchy thing is based on a belief that it is better for mothers). And I would submit that a a belief that women should be listened to, and that their pain should not be ignored, is what is really missing from American health care. The common thread in so many of these deaths is the mothers knew something was wrong and their concerns were ignored by health care providers, sometimes on the basis that the “tests” were not abnormal.

No. We need more interventions, in the form of more intensive and specialist care for mothers with chronic/high risk conditions; as well as protocols (like in California) for detecting, being prepared for and responding to emergencies like PPH and pre-e. Without those things, all the chats in the world with your midwife aren't going to do anything

Why are those approaches mutually exclusive? We should have all of these things like they do in the UK where the maternal mortality rate is HALF of the U.S.'s.

they're mutually exclusive when people claim that they he solution to maternal mortality is more birth centers (which is what started this tangent).

No one on this thread has ever advocated for more birth centers, or out of hospital births. They’ve simply pointed out that there are many aspects of the midwife model (which in this country is generally hospital based) that mean women get more monitoring and better care. And story after story shows that doctors ignore women’s concerns and test results are either ignored, or do not show how sick women really are.

DP here but I am! If more low-risk people used birth centers then hospitals would have more resources including even just staffing and beds for high-risk people who actually need them. And if you become high risk then you transfer seamlessly to the nearby hospital.

I don’t know why people think more technology is going to save you when there are so many examples of it just not being applied appropriately. Look at the lady in the WaPo article. If she’d had a care provider to call, not just some robot at Kaiser HQ, but someone local who knew her history they would have told her to go to the ER much sooner.

[Anonymous]

I'm flabbergasted by Serena Williams' experience! She has a known history of blood clots! What if she had been less firm about what she needed? Ye gods.

As an aside, I delivered at Inova Alexandria twice - scheduled C-sections because of myomectomy. I was a patient with Physicians and Midwives, and saw a doctor at least once a day, and nurses zillions of times. In fact, I was tired of being disturbed. The hospital peds saw my babies at least once a day - I even got a note from one of them about a condition that could have been minor or major depending on the cause. No complaints - I never felt like my health was at risk (I'm AA).