Reply to Evelyn Muhlhan - another homebirth midwife bites the dust?

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Reply to "Evelyn Muhlhan - another homebirth midwife bites the dust?"

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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, [b]are expected to adhere to well-known standards of care. [/b] 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.  [/quote]

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.

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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, [b]and it is alleged that Evelyn violated them.[/b]  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?” 
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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.

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