Midwife charged in DC? Karen Carr, CPM...

[Anonymous]

Anonymous wrote:

Anonymous wrote: I have said it before in this discussion (30 something pages ago) and this is exactly how I see it. I would not try breech birth at home myself but I would not take away another woman's right to do so. This includes the right to choose the birth attendant that she wants. Also, I don't see it as an unreasonable risk although there was a very sad outcome in this particular case. The chance of dying or being seriously injured in a car accident during your lifetime is much higher than the chance of losing a singleton baby or seriously injuring a baby during a vaginal breech birth. I do not believe in allowing our government to micromanage us to the point where they make important medical decisions for us. I do feel awful about the baby who passed away. It makes me so sad but that doesn't change the fact that it would be wrong to take away a mother's right to make the decision to have a homebirth if she finds the risk level acceptable for her own family.

What if groups decided othorped surgeons as a whole were a biased group like the OBs are painted to be by many Home Birth advocates here, who base their decision on a generalization of the profession itself? Would it sound reasonable for "specialists" who are not doctors to suddenly perform "home amputations"? No, right? B/c we draw a line somewhere between a natural act (birth) and surgery. The problem is "where do you draw the line", and as a free but REGULATED society where laws are meant to protect people, many won't agree with where to draw that line, and laws can only protect the dumbest via the most educated. Also, your own post suggests an argument. You compare chances of a deadly carwreck with a singleton birth. Since you specified "singleton", I assume you accept the medical stance that any multiples represent increased risk and you'd draw a certain line there. Many would have drawn it with this woman's advanced age / breech baby / first-time birth.

No, I don't think I would draw the line anywhere when it comes to allowing women the right to choose where and how they give birth. I specified singleton only because the statistics I was able to find were on singleton breech birth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: I have said it before in this discussion (30 something pages ago) and this is exactly how I see it. I would not try breech birth at home myself but I would not take away another woman's right to do so. This includes the right to choose the birth attendant that she wants. Also, I don't see it as an unreasonable risk although there was a very sad outcome in this particular case. The chance of dying or being seriously injured in a car accident during your lifetime is much higher than the chance of losing a singleton baby or seriously injuring a baby during a vaginal breech birth. I do not believe in allowing our government to micromanage us to the point where they make important medical decisions for us. I do feel awful about the baby who passed away. It makes me so sad but that doesn't change the fact that it would be wrong to take away a mother's right to make the decision to have a homebirth if she finds the risk level acceptable for her own family.

What if groups decided othorped surgeons as a whole were a biased group like the OBs are painted to be by many Home Birth advocates here, who base their decision on a generalization of the profession itself? Would it sound reasonable for "specialists" who are not doctors to suddenly perform "home amputations"? No, right? B/c we draw a line somewhere between a natural act (birth) and surgery. The problem is "where do you draw the line", and as a free but REGULATED society where laws are meant to protect people, many won't agree with where to draw that line, and laws can only protect the dumbest via the most educated. Also, your own post suggests an argument. You compare chances of a deadly carwreck with a singleton birth. Since you specified "singleton", I assume you accept the medical stance that any multiples represent increased risk and you'd draw a certain line there. Many would have drawn it with this woman's advanced age / breech baby / first-time birth.

No, I don't think I would draw the line anywhere when it comes to allowing women the right to choose where and how they give birth. I specified singleton only because the statistics I was able to find were on singleton breech birth.

Lifetime risk of dying in a car accident in the US: 1/80 - 1/100 (1% - 1.25%)
Risk of baby dying in breech vaginal birth (from California population study): 1/550 (0.18%)
Risk of breech baby dying in elective CS: 1/2419 (0.04%)
Risk of brachial plexus injury in breech vaginal birth: 1/111 (0.9%)
Risk of asphyxia and birth trauma in breech vaginal births: percentages not given, but odds ratios indicate that it's greater than for breech elective CS births, and rates of birth trauma were also higher for breech vaginal births than for cephalic vaginal births

So, of course women can choose what they do with their own bodies. I agree that hospital vaginal breech birth should be more widely available, but it is riskier for the baby than elective CS, which should be acknowledged. I also don't see how a conscientious provider could preside over a breech homebirth. Head entrapment is no joke.

Also, if you were told that your risk of dying in a car accident tomorrow was 1/100, would you still get in your car? The difference between birth and lifetime risks of accidents is that we know when the birth is coming, and we have the knowledge and skills to reduce its risks. If everyone who died in a car accident had a heads up about it several months in advance, I bet the rate of serious car accidents would be a lot lower.

[Anonymous]

I'm interested in whether the people who are vehemently anti-home birth are also pro-life? A lot of the rhetoric seems similar. If you are pro-choice, but believe that high risk women should not be permitted to have homebirths (and that midwives who help them should be prosecuted) how do you justify supporting legislation (or bringing manslaughter charges) that will mean a women loses a significant degree of autonomy just because she is pregnant? Does viability of the fetus mean that a woman becomes a vessel that the state can control? Would you prefer that high risk women either go underground and have illegal or unassisted births, or have to go to a hospital, with no legal alternative?

[Anonymous]

Anonymous wrote:I'm interested in whether the people who are vehemently anti-home birth are also pro-life? A lot of the rhetoric seems similar. If you are pro-choice, but believe that high risk women should not be permitted to have homebirths (and that midwives who help them should be prosecuted) how do you justify supporting legislation (or bringing manslaughter charges) that will mean a women loses a significant degree of autonomy just because she is pregnant? Does viability of the fetus mean that a woman becomes a vessel that the state can control? Would you prefer that high risk women either go underground and have illegal or unassisted births, or have to go to a hospital, with no legal alternative?

I don't know that I'm vehemently anti-homebirth, but I'm vehemently against the current CPM-based model that the US seems to be using. I'm also quite rabidly pro-choice. I think that women have the right to control their bodies whether or not there's a fetus inside.

What makes me really, really mad is that people who don't have to have a high school diploma, much less a college or graduate education in health sciences, have created a certificate that makes them sound like CNMs (Masters level nurses). The only reason I can think of for the shift from DEM (direct entry midwife) to CPM is that CPM looks a lot like CNM. I think that women and babies deserve care from qualified, trained, licensed professionals. If you want to deliver babies, go to university and become a nurse or midwife or doctor, like people in Canada, Europe, and Australia have to do if they want to deliver babies. Why do women in the US have to settle for such poorly trained homebirth midwives? If you want someone with no medical training, call your friend over to help you deliver, but don't pay her and don't call her a midwife.

What makes me really, really mad is the homebirth culture that tells women that hospitals are dangerous and that giving birth at home is safer, and that babies who die in homebirths would have died in the hospital. I've seen that argument used too many times, and it's BS. The rates of neonatal death in the US are higher for homebirth than hospital birth, although the absolute numbers are still pretty low. If you decide that for whatever personal reason you'd rather give birth at home, fine. Just acknowledge that the risks are higher for the baby. If you had a horrible experience in a hospital, file a complaint, start a committee, organize women, and make a difference in your local hospitals. The fact that some women have been treated poorly in hospitals doesn't mean that giving birth at home is safer- it means that the staff at that hospital need to be reprimanded.

Finally, what makes me really, really mad is the fact that MANA has been collecting data on homebirth for years, but won't release its data. For women to truly make informed decisions about where and with whom (CPM, CNM, OB) to have their babies, they need access to the best dataset to date that's tracked the outcomes of homebirths. There's no reason at all why MANA should be able to keep that information from women.

[Anonymous]

I don't know a lot about the MANA data issue but looked on their website and it appears that for a fee ($50) researchers can access their data. Is this somehow bogus? Have any researchers accessed the data and published in any respectable journals?

http://mana.org/statform.html

[Anonymous]

Anonymous wrote:I don't know a lot about the MANA data issue but looked on their website and it appears that for a fee ($50) researchers can access their data. Is this somehow bogus? Have any researchers accessed the data and published in any respectable journals?

http://mana.org/statform.html

This has been addressed upthread- I'll try to find it later. Basically, they tell you what you can find and what you can't find with their data. You have to sign an agreement not to hurt the midwifery model of care. How do you know what you're going to find before you find it?

[Anonymous]

You may not know exactly what the MANA data provides, but if it suggested a clear advantage for home birth, I'm pretty sure the data would be widely available.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Could you direct me to where it is documented that they refused? What is the reasoning? How can claims about home vs hospital safety be accurately made without this data?

Go to this website and check out their handbook for researchers: http://mana.org/pdfs/DORHandbookForResearchers.pdf

Quoting from the handbook:

"The MANA DOR (Division of Research) endorses the principles of Community-Based Participatory Research (CBPR), which is an orientation to research that focuses on relationships between researchers and community partners. CBPR is a collaborative approach in which research takes place in community settings and involves community members in the design and implementation of research projects. Such activities demonstrate respect for the contributions made by community partners and for the principle of ‘doing no harm’ to the communities involved. The MANA DOR is responsible for representing the midwifery community in its relationship with investigators. This community includes not only the midwife providers, but also their clients as equal partners. Therefore the MANA DOR expects all investigators interested in collaboration with this community to consider how they can cooperate with these principles, and to describe how they intend to do so in their request for data access."

The handbook also states that researchers must sign a confidentiality/ non-disclosure agreement and a specific research access contract, so they can't "mine" the database, they can only see the bits that someone from MANA decides they can see.

So, MANA represents the midwifery community, and researchers are expected to "do no harm" to that community. That tells me that only projects likely to find favorable results will be approved, since negative results could harm midwifery, and that if they do find something that MANA doesn't like, they can't publish it because of the agreement they sign to get access to the data. No ethical researcher would agree to those terms.

And as an aside, I'm not sure that MANA's definition of a "community" is what most proponents of Community-Based Participatory Research have in mind.

[Anonymous]

"What if groups decided othorped surgeons as a whole were a biased group like the OBs are painted to be by many Home Birth advocates here, who base their decision on a generalization of the profession itself?"

Unfortunately, there seem to be some areas of medicine that become politicized -- vaccinations, autism and obstetrics (women's health generally) seem to the be the big ones right now. While I am a feminist, I don't like the way feminism is being used to "sell" CPM/homebirth. I think its a faux feminism anyway -- all the language of feminism (birthing "goddesses" and all) but little of its actual substance. Of course the granola/hippie movement from which NCB sprang doesn't have the best feminist record itself, so I guess its not terribly surprising at the core.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm interested in whether the people who are vehemently anti-home birth are also pro-life? A lot of the rhetoric seems similar. If you are pro-choice, but believe that high risk women should not be permitted to have homebirths (and that midwives who help them should be prosecuted) how do you justify supporting legislation (or bringing manslaughter charges) that will mean a women loses a significant degree of autonomy just because she is pregnant? Does viability of the fetus mean that a woman becomes a vessel that the state can control? Would you prefer that high risk women either go underground and have illegal or unassisted births, or have to go to a hospital, with no legal alternative?

I don't know that I'm vehemently anti-homebirth, but I'm vehemently against the current CPM-based model that the US seems to be using. I'm also quite rabidly pro-choice. I think that women have the right to control their bodies whether or not there's a fetus inside.

What makes me really, really mad is that people who don't have to have a high school diploma, much less a college or graduate education in health sciences, have created a certificate that makes them sound like CNMs (Masters level nurses). The only reason I can think of for the shift from DEM (direct entry midwife) to CPM is that CPM looks a lot like CNM. I think that women and babies deserve care from qualified, trained, licensed professionals. If you want to deliver babies, go to university and become a nurse or midwife or doctor, like people in Canada, Europe, and Australia have to do if they want to deliver babies. Why do women in the US have to settle for such poorly trained homebirth midwives? If you want someone with no medical training, call your friend over to help you deliver, but don't pay her and don't call her a midwife.

What makes me really, really mad is the homebirth culture that tells women that hospitals are dangerous and that giving birth at home is safer, and that babies who die in homebirths would have died in the hospital. I've seen that argument used too many times, and it's BS. The rates of neonatal death in the US are higher for homebirth than hospital birth, although the absolute numbers are still pretty low. If you decide that for whatever personal reason you'd rather give birth at home, fine. Just acknowledge that the risks are higher for the baby. If you had a horrible experience in a hospital, file a complaint, start a committee, organize women, and make a difference in your local hospitals. The fact that some women have been treated poorly in hospitals doesn't mean that giving birth at home is safer- it means that the staff at that hospital need to be reprimanded.

Finally, what makes me really, really mad is the fact that MANA has been collecting data on homebirth for years, but won't release its data. For women to truly make informed decisions about where and with whom (CPM, CNM, OB) to have their babies, they need access to the best dataset to date that's tracked the outcomes of homebirths. There's no reason at all why MANA should be able to keep that information from women.

I've made several posts on this site, and I very much agree and second the statements made in the above post. I too an pro-choice, organic food eating, locally grown agriculture, recycler, liberal, etc. I am also becoming very much anti-CPM for the sake of education and safety. It just amazes me that a high school graduate (or dropout) can put up a shingle in my town and offer prenatal advice to pregnant women and deliver a baby in a birth pool set up in a kitchen. I think women deserve better than this back-alley approach.

[Anonymous]

Interesting Letter to the Editor in the WaPo today:

http://www.washingtonpost.com/todays_paper?dt=2011-04-27&bk=A&pg=16


Look under "Local Opinions", The Safety of Giving Birth at Home.

[Anonymous]

This thread has been on my mind, probably because I was 39 weeks when it started. I was planning to give birth in a hospital all along but I very much enjoyed the diversity of opinions. The thread also scared me a little. FF to Monday. I gave birth to a baby boy who was positioned with his hand over his face ( elbow at an angle.) I pushed for 4 hours and required intervention because of the baby's heart rate. I was very thankful to be in a hospital. I know this is just my experience and in no way provides any type of statistic, I just can't imagine having experienced this event at home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm interested in whether the people who are vehemently anti-home birth are also pro-life? A lot of the rhetoric seems similar. If you are pro-choice, but believe that high risk women should not be permitted to have homebirths (and that midwives who help them should be prosecuted) how do you justify supporting legislation (or bringing manslaughter charges) that will mean a women loses a significant degree of autonomy just because she is pregnant? Does viability of the fetus mean that a woman becomes a vessel that the state can control? Would you prefer that high risk women either go underground and have illegal or unassisted births, or have to go to a hospital, with no legal alternative?

I don't know that I'm vehemently anti-homebirth, but I'm vehemently against the current CPM-based model that the US seems to be using. I'm also quite rabidly pro-choice. I think that women have the right to control their bodies whether or not there's a fetus inside.

What makes me really, really mad is that people who don't have to have a high school diploma, much less a college or graduate education in health sciences, have created a certificate that makes them sound like CNMs (Masters level nurses). The only reason I can think of for the shift from DEM (direct entry midwife) to CPM is that CPM looks a lot like CNM. I think that women and babies deserve care from qualified, trained, licensed professionals. If you want to deliver babies, go to university and become a nurse or midwife or doctor, like people in Canada, Europe, and Australia have to do if they want to deliver babies. Why do women in the US have to settle for such poorly trained homebirth midwives? If you want someone with no medical training, call your friend over to help you deliver, but don't pay her and don't call her a midwife.

What makes me really, really mad is the homebirth culture that tells women that hospitals are dangerous and that giving birth at home is safer, and that babies who die in homebirths would have died in the hospital. I've seen that argument used too many times, and it's BS. The rates of neonatal death in the US are higher for homebirth than hospital birth, although the absolute numbers are still pretty low. If you decide that for whatever personal reason you'd rather give birth at home, fine. Just acknowledge that the risks are higher for the baby. If you had a horrible experience in a hospital, file a complaint, start a committee, organize women, and make a difference in your local hospitals. The fact that some women have been treated poorly in hospitals doesn't mean that giving birth at home is safer- it means that the staff at that hospital need to be reprimanded.

Finally, what makes me really, really mad is the fact that MANA has been collecting data on homebirth for years, but won't release its data. For women to truly make informed decisions about where and with whom (CPM, CNM, OB) to have their babies, they need access to the best dataset to date that's tracked the outcomes of homebirths. There's no reason at all why MANA should be able to keep that information from women.

I've made several posts on this site, and I very much agree and second the statements made in the above post. I too an pro-choice, organic food eating, locally grown agriculture, recycler, liberal, etc. I am also becoming very much anti-CPM for the sake of education and safety. It just amazes me that a high school graduate (or dropout) can put up a shingle in my town and offer prenatal advice to pregnant women and deliver a baby in a birth pool set up in a kitchen. I think women deserve better than this back-alley approach.

This premium on secondary education interests me. High school graduates and dropouts are all around you, doing lifesaving and heroic things. My brother is a highschool dropout. Now he's a helicopter pilot, flying medevac choppers. O NOES! Some EMTs are high schoolers. Trust them to save your life? All the kids in the military who are doing very advanced things to protect your lives that I'm certain YOU could not do, because they are trained on the job and very intensively. Midwifery is a very specific skill that can be mastered without PhDs and all that useless extra academia that all fellow masters-degree and phD people would tell you is a colossal waste of time. Why study all the other stuff when the care of pregnant and birthing women and their babies is the sole focus?

[Anonymous]

Anonymous wrote:"What if groups decided othorped surgeons as a whole were a biased group like the OBs are painted to be by many Home Birth advocates here, who base their decision on a generalization of the profession itself?"

Unfortunately, there seem to be some areas of medicine that become politicized -- vaccinations, autism and obstetrics (women's health generally) seem to the be the big ones right now. While I am a feminist, I don't like the way feminism is being used to "sell" CPM/homebirth. I think its a faux feminism anyway -- all the language of feminism (birthing "goddesses" and all) but little of its actual substance. Of course the granola/hippie movement from which NCB sprang doesn't have the best feminist record itself, so I guess its not terribly surprising at the core.

If you looked at the history of childbirth in America, you might see things differently. Far too complicated for me to go into here but it's a pretty obvious story of male doctors systematically taking rights away from women and killing many of them in the process. I'm talking about history here- not the current situation but if you want to talk about the politics of birth effectively, you must look at history. I don't like the woo woo language some homebirth people use either. I don't see homebirth as a romantic or beautiful thing. It is a simple matter of free choice for women. If you don't like it, have your kids in the hospital but don't take more rights away from women. It's not your job to protect women from themselves. Education and free choice is key.

[Anonymous]

"It's not your job to protect women from themselves. Education and free choice is key."

You know, we protect consumers and investors of both genders from fraud and harm in any number of ways -- from the FDA ensuring the food we are eating is not contaminated, to the FDIC which insures depositors up to $100,000 from bank failure. I'm not sure why appropriate parameters of licensing, insurance, mandated disclosures and limitations on scope of practice for homebirth should be the exception. I don't think that infantilizes women -- instead, to my mind, it emphasizes the value of the lives of birthing women and newborns.