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

[Anonymous]

Anonymous wrote:

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?

I was sort of hoping you were joking. You think that people with master's degrees and PhDs poo-poo their education because it involved some "useless extra academia?" And on-the-job training? There is a written account about a mother's homebirth in which the baby was born with breathing problems. The lay midwife was new and had never before experienced a baby being born with breathing problems. That is on-the-job training that I would not want my child exposed to. Do you want someone to learn about resuscitation by practicing on your child when he stops breathing? There is a news account in which a lay midwife told the reporter that she often trained her apprentices in the car on the way to a birth.

The military analogy is not a fair comparison. I'm glad your brother has found a career path and is able to make a living. The military has order and rank and accountability. They don't take a high school drop out and turn him into a general after he watches a Ricki Lake war movie and buys a used uniform.

[Anonymous]

"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?"

In part, your point is silly -- its like deciding to become an airplane mechanic who only works on the left engine of airplanes. The body works together as a whole, so to think you can focus on the reproductive process without a very sound and deep understanding of the entire body and its processes is crazy to me.

[Anonymous]

You know, when my computer goes wonky, there are a couple of things I know to try that frequently work to fix the problem. I don't understand WHY they work, and I don't know which is most likely to fix the problem I'm having so I often have to try all of them.

Is this type/level of knowledge "good enough" to be a professional homebirth midwife? Because that's the sense I have of their skill level -- techniques and tricks rather than intrinsic knowledge of how the body works.

[Anonymous]

Anonymous wrote:You know, when my computer goes wonky, there are a couple of things I know to try that frequently work to fix the problem. I don't understand WHY they work, and I don't know which is most likely to fix the problem I'm having so I often have to try all of them.

Is this type/level of knowledge "good enough" to be a professional homebirth midwife? Because that's the sense I have of their skill level -- techniques and tricks rather than intrinsic knowledge of how the body works.

And this is not how OBs and CNMs are either? OBs don't have all the answers. OBs still don't know what causes pre-eclampsia or preterm labor, or CPD or shoulder dystocia, so they try a bunch of stuff to fix it. do they not? Oh wait, now they just do a c-section. But the GOOD, KNOWLEDGEABLE OBs will try various things- body positioning, meds, vacuum, etc. Some positions and techniques-the Gaskin Maneuver, for example-were invented and perfected by the lowly, stupid lay midwives.

I was just at a birth where the attending CNM trained the new CNM- fresh out of school- on vaginal stitching techniques right there on the new mom. Repair took twice as long as normal. Stitches had to be taken out and redone. BUT SHE's A CNM SO SHE MUST BE ALL-KNOWING? RIGHT? That's how people learn. an OB/GYN or CNM fresh out of school and who has just watched her thousands of births on the side is no better, nay, is much more dangerous, than a CPM that has caught thousands of babies on her own.

Everyone is assuming that CPMs don't have education and don't know how the body works. That is the first assumption that is false so it's not worth entertaining this argument, really.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You know, when my computer goes wonky, there are a couple of things I know to try that frequently work to fix the problem. I don't understand WHY they work, and I don't know which is most likely to fix the problem I'm having so I often have to try all of them.

Is this type/level of knowledge "good enough" to be a professional homebirth midwife? Because that's the sense I have of their skill level -- techniques and tricks rather than intrinsic knowledge of how the body works.

And this is not how OBs and CNMs are either? OBs don't have all the answers. OBs still don't know what causes pre-eclampsia or preterm labor, or CPD or shoulder dystocia, so they try a bunch of stuff to fix it. do they not? Oh wait, now they just do a c-section. But the GOOD, KNOWLEDGEABLE OBs will try various things- body positioning, meds, vacuum, etc. Some positions and techniques-the Gaskin Maneuver, for example-were invented and perfected by the lowly, stupid lay midwives.

I was just at a birth where the attending CNM trained the new CNM- fresh out of school- on vaginal stitching techniques right there on the new mom. Repair took twice as long as normal. Stitches had to be taken out and redone. BUT SHE's A CNM SO SHE MUST BE ALL-KNOWING? RIGHT? That's how people learn. an OB/GYN or CNM fresh out of school and who has just watched her thousands of births on the side is no better, nay, is much more dangerous, than a CPM that has caught thousands of babies on her own.

Everyone is assuming that CPMs don't have education and don't know how the body works. That is the first assumption that is false so it's not worth entertaining this argument, really.

How awful for the poor woman who had to have her stitches done twice! Thank God my OB knows how to do them right the first time. I'm not into being a guinea pig, I like experienced medical providers.

[Anonymous]

Anonymous wrote:"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?"

In part, your point is silly -- its like deciding to become an airplane mechanic who only works on the left engine of airplanes. The body works together as a whole, so to think you can focus on the reproductive process without a very sound and deep understanding of the entire body and its processes is crazy to me.

No, it's like becoming an airplane mechanic that only works on the hydraulics, or the wheels, or the engine, or the fuel. Which is how it is. No airplane mechanic can service a whole airplane. Just like no OB/GYN can do heart surgery.

[Anonymous]

Anonymous wrote:"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.

That's a pretty funny statement considering what a good job the FDA does of that! I believe it does infantilize women when you tell them that they have to give birth in a hospital and submit to medical procedures that they don't want. I recognize that many women are happy to do so and, if I were having a breech baby, I would feel forced to do so for reasons of safety. But you are really comparing apples and oranges here when you talk about banks and midwives. Money is controlled by the government. It doesn't exist without government. Our bodies should belong to us. If you tell a woman that she can't have her baby where and how she wants to, then you are in effect telling her that the baby's life comes first and is under the protection of the state. She no longer has the right to make decisions for herself and for her unborn child. I understand that plenty of people would love to see that happen. But I wouldn't. Home birth is not an option that uneducated, poor women are likely to choose- it's an option that highly educated and politicized women are choosing more and more. So if you are worried about protecting uneducated women, that isn't really the pertinent issue here. If you think it's ok that a person with cancer might have the right to choose not to go to doctors and may, instead, go to a homeopath or an herbalist, or an acupuncturist, or even a snake oil salesman because that person is the only person who should be making these choices for herself, then you should be willing to allow pregnant women the choice of going to a lay midwife. It isn't the choice you would make but it is a valid choice and it should be every woman's right.

[Anonymous]

As someone said upthread: Most births (home or hospital) will end well. It’s when things go bad that suddenly a hospital’s staff and equipment is imperative. In a risky case like this, where even midwives said “HOSPITAL!”, all participants made poor choices. As someone else said, you don’t see a car wreck coming but you CAN prepare for this one. You can put as much care and concern in finding the right hospital and OB for you as you would in preparing your home and choosing a midwife – so when there are very real and foreseeable risks, WHY PUT THE BIRTH “EXPERIENCE” AHEAD OF SAFETY? How great is this “experience” if someone ends up dead?

Someone upthread said she couldn’t treat her children gently or not resent them if her birth was filled with animosity. PREGNANT WOMEN LURKING HERE: SHE’S PSYCHOTIC and does home birth advocates no favors. If that were true, very few kids would be loved. You’ll love your child regardless of what happens in delivery.

Wanting the medical field to align itself with the wisdom of midwives and work as a team is great. But spitefully excluding them from your support system won’t make it happen – it just endangers you. And believing OBs are C-section-happy doesn’t cancel out safety statistics of a special needs case, and stubbornly ignoring your personal need for one won’t help your child. Principles don’t save lives. And believing OBs’ education is lacking doesn’t make a poorly trained and questionably certified “midwife” more competent.

[Anonymous]

Anonymous wrote:

I was sort of hoping you were joking. You think that people with master's degrees and PhDs poo-poo their education because it involved some "useless extra academia?" And on-the-job training? There is a written account about a mother's homebirth in which the baby was born with breathing problems. The lay midwife was new and had never before experienced a baby being born with breathing problems. That is on-the-job training that I would not want my child exposed to. Do you want someone to learn about resuscitation by practicing on your child when he stops breathing? There is a news account in which a lay midwife told the reporter that she often trained her apprentices in the car on the way to a birth.

Actually I am personally OK with that. Doctors are trained on the job constantly. Whenever I've had a procedure, I've had a student doctor watching it. Every time. Even during my birth with a CNM, there was a student midwife there and I welcomed her. So I'll go ahead and make that choice for myself. It's not for you to make that choice for me.

And yes I do poo-poo my Masters degree and so do all my peers. I didn't learn anything during the basically useless 2 year program (at George Washington University so it's not a quality issue, right?) Everything I ever learned was on the job in my same field of study, while bad things were happening and it was up to me to fix it right then.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"I believe it does infantilize women when you tell them that they have to give birth in a hospital and submit to medical procedures that they don't want. I recognize that many women are happy to do so and, if I were having a breech baby, I would feel forced to do so for reasons of safety. But you are really comparing apples and oranges here when you talk about banks and midwives. Money is controlled by the government. It doesn't exist without government. Our bodies should belong to us. If you tell a woman that she can't have her baby where and how she wants to, then you are in effect telling her that the baby's life comes first and is under the protection of the state. She no longer has the right to make decisions for herself and for her unborn child. I understand that plenty of people would love to see that happen. But I wouldn't. Home birth is not an option that uneducated, poor women are likely to choose- it's an option that highly educated and politicized women are choosing more and more. So if you are worried about protecting uneducated women, that isn't really the pertinent issue here. If you think it's ok that a person with cancer might have the right to choose not to go to doctors and may, instead, go to a homeopath or an herbalist, or an acupuncturist, or even a snake oil salesman because that person is the only person who should be making these choices for herself, then you should be willing to allow pregnant women the choice of going to a lay midwife. It isn't the choice you would make but it is a valid choice and it should be every woman's right.

Dissing the entire field is no more respectful or enlightened than them dissing the entire concept of a home birth. Each are filled with a mix of superior, inferior, average, caring, arrogant, responsible, incompetant, kind individuals you must sift through to get who will be right for you. Saying it's impossible to find the right OB who actually cares and knows what they're doing is as ridiculous as saying finding a safe, educated, experienced and responsible midwife is IMpossible. I'm shocked at the propaganda on this thread about both stances. As for how laws approach this: It's no different than any other law pertaining to "your" body. You can do what you want with it, but it's a blurry line when it comes to your decisions for a child who can't speak for himself yet. And what one does TO OTHERS' bodies is definitely NOT a free thing, nor should it be. You're expected to do everything you're aware of to prevent loss of life. These people were very aware.

[Anonymous]

Anonymous wrote: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.

Well, at home, with nuchal hands often they have you get on your knees and forehead with your butt up in the air to help baby disengage from your pelvis, meanwhile they can do some rebozo work with jiggling and lifting your belly to get baby to bring his hand down, or sometimes they can reach in and push baby's hand out of the way if he's already come through the pelvis like that. (This can be done at a hospital with a doula, too.) Guessing that these options were not presented to you?

[Anonymous]

I am not against on-the-job training in any field. I just don't want someone with no formal medical education in my home learning on my child, especially when an ambulance is 15 minutes away and the hospital is 45 minutes.

[Anonymous]

Anonymous wrote:As someone said upthread: Most births (home or hospital) will end well. It’s when things go bad that suddenly a hospital’s staff and equipment is imperative. In a risky case like this, where even midwives said “HOSPITAL!”, all participants made poor choices. As someone else said, you don’t see a car wreck coming but you CAN prepare for this one. You can put as much care and concern in finding the right hospital and OB for you as you would in preparing your home and choosing a midwife – so when there are very real and foreseeable risks, WHY PUT THE BIRTH “EXPERIENCE” AHEAD OF SAFETY? How great is this “experience” if someone ends up dead?

Someone upthread said she couldn’t treat her children gently or not resent them if her birth was filled with animosity. PREGNANT WOMEN LURKING HERE: SHE’S PSYCHOTIC and does home birth advocates no favors. If that were true, very few kids would be loved. You’ll love your child regardless of what happens in delivery.

Wanting the medical field to align itself with the wisdom of midwives and work as a team is great. But spitefully excluding them from your support system won’t make it happen – it just endangers you. And believing OBs are C-section-happy doesn’t cancel out safety statistics of a special needs case, and stubbornly ignoring your personal need for one won’t help your child. Principles don’t save lives. And believing OBs’ education is lacking doesn’t make a poorly trained and questionably certified “midwife” more competent.

Um... you can avoid a car wreck by never getting in a car if risk is unacceptable to you. It has already been established in this thread that it's much safer to have a vaginal breech birth than it is to let your kid get into a car every day. Your kid has a 1 in 83 chance of dying in a car accident during his/her lifetime and, according to some studies, around 1 in 550 chance of dying in a vaginal breech birth in his/her lifetime since we are only born once. Feel free to talk about licensing requirements, etc. but this argument simply does not add up.

[Anonymous]

Before my son was born, I thought that the birth experience was all about me. I could decide whether to have an epidural or not, I could decide whether to give birth in a hospital or at home, I would look back on his birth as a defining experience. Turns out the birth is really about the baby, his needs and how he comes into the world. When my son turned breech at 32 weeks, my home-birth plans were thrown into question, and when he decided to start kicking down the door at 32.5 weeks my midwife counseled me that the best thing to do for him was go to the hospital where we ended up with an emergency c-section and a month in the NICU. I am still coming to terms with what happened, and I have questioned every step of the processes a million times in retrospect, but I understood pretty much right away that I needed to shift my focus from what I had envisioned to what needed to happen for the health and safety of my baby. I believe that this shift of focus, learning to let go of our expectations and meet the needs of our children where they are is a fundamental part of becoming a parent. Unfortunately, you can't teach that lesson to someone who hasn't gone through it themselves. The only thing I was right about about my son's birth was that it would be a defining experience, but not at all in the way that I thought it would be.

I am a big supporter of home birth, choice in birth, making educated choices in your own health pursuits, etc. One of the most important pieces of that is choosing medical advisors (OB, midwife, or whomever) whom you trust to help you make the difficult choices. It seems to me in this case (though I admittedly don't know all the intimate details of the medical case), that the parents chose instead to shop around for someone who was willing to support them in their choices to go against medical advice. They should certainly have the right to make that choice, but they should be prepared to face the consequences if they do.

[Anonymous]

"If you think it's ok that a person with cancer might have the right to choose not to go to doctors and may, instead, go to a homeopath or an herbalist, or an acupuncturist, or even a snake oil salesman because that person is the only person who should be making these choices for herself, then you should be willing to allow pregnant women the choice of going to a lay midwife."

They can go see those people, but those people cannot tell the patient that they will cure their cancer -- that is called fraud. Arguably, if those assertions resulted in the patient's death, there might be some charges with regard to manslaughter (hey -- wasn't there a L&O episode about that?)

If a lay midwife represents that there should be no concern about a vaginal breech delivery (or a delivery of any kind) that is also fraud.