Anonymous wrote:Fair enough, 11:30, but when people point out that a midwife has been questioned for home birth practices, the immediate reaction on this board seems to be that we shouldn't license or control midwives in any way because it interferes with the freedom of choice of the mother.

I'm not advocating that we jail women who home birth under dangerous circumstances but I wonder if you think we should have licensing requirements.

I support 11:24.

I actually don't believe in licensing requirements for homebirth midwives. Midwifery is truly one of the oldest professions, and seeks to assist in a natural stage of life which will occur regardless of who is watching or assisting. It is also an event that in a few very rare cases - no matter who is assisting - will result in some tragedy. That said, I would like to see a greater society acceptance for the normal life-process that birth is. The only control I would like to see is one which requires homebirth midwives to be clear about their background and training. If homebirth midwives want to be able to use a (very few, specific types of) medication, then I think they need to have passed a course or examination which ensures they use these things correctly. That is truly the extent that I want the government involved in what my homebirth midwife is allowed to do.

Anonymous wrote: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, are expected to adhere to well-known standards of care. 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.

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.

Fair enough, 11:30, but when people point out that a midwife has been questioned for home birth practices, the immediate reaction on this board seems to be that we shouldn't license or control midwives in any way because it interferes with the freedom of choice of the mother.

I'm not advocating that we jail women who home birth under dangerous circumstances but I wonder if you think we should have licensing requirements.

I support 11:24.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

I'm sorry, but no, it's not a difficult question. You don't get to make decisions about my body in the interest of my baby.

If you want to convince the many people who disagree with you, just stating your view is unlikely to do it. I'm pro-choice in many ways but a full term baby is not the mother's to dispose of as she sees fit. Maybe the science will show that home VBACs are safe enough that she gets to make the call. That's fine.

But let's say there was a condition for which homebirth led to infant death 20 percent of the time versus 1 percent of the time in a hospital. The baby has enough rights that I would ask the government to forbid homebirth in that scenario.

Children are people who have rights the government protects. Parents get a lot of leeway, yes. Parents have the right to make risky calls. But above a certain risk level, the government intervenes. A full term baby is not an embryo, it is a person.

What about the scenario where it is safer to have a baby a home? This is true in the case of meconium aspiration, which is three times as likely to occur in a hospital setting than at home. How come our government isn't taking up the cause and insisting that women who are risk for meconium aspiration deliver at home? There are dozens of other interventions and complications that are much more likely to occur in a hospital setting, yet no one ever talks about the safety of homebirth.

The reality is that there is a massive political machine at work here. Doctors, even when their protocols lead to greater problems or are not evidence-based, are championed as the ultimate life-saver and have enormous political, financial, and societal resources. The bottom line is that I never want a doctors opinion for my health to supercede my right to decide which type of healthcare to pursue - for myself OR for my children.

I'm the PP at 10:59. Thanks, PP, for saying the things that I didn't in my post.

The thing that I really hate about arguments like this usually, and the thing that relieves me about the way this one has gone, is that it almost always turns into a "rights of the unborn child" vs "rights of the mother" argument. It becomes about one of those things trumping the other one, without a lot of conversation about evidence based medicine, evolving standards of care, etc. I think that the tragedies get played up in the media and our own collective mind to mean that's all home birth ever is - dangerous, irresponsible, ill advised. I know a lot of women who have had babies at home, and only one of those outcomes has been anywhere close to the frightening disasters described in this suit. Even that duo is fine now, 4 years later. I think it's too easy to pay attention only to the worst case scenario and to forget what the PP said, that most births result in positive outcomes for everyone, regardless of where they take place.

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, are expected to adhere to well-known standards of care. 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.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

I'm sorry, but no, it's not a difficult question. You don't get to make decisions about my body in the interest of my baby.

If you want to convince the many people who disagree with you, just stating your view is unlikely to do it. I'm pro-choice in many ways but a full term baby is not the mother's to dispose of as she sees fit. Maybe the science will show that home VBACs are safe enough that she gets to make the call. That's fine.

But let's say there was a condition for which homebirth led to infant death 20 percent of the time versus 1 percent of the time in a hospital. The baby has enough rights that I would ask the government to forbid homebirth in that scenario.

Children are people who have rights the government protects. Parents get a lot of leeway, yes. Parents have the right to make risky calls. But above a certain risk level, the government intervenes. A full term baby is not an embryo, it is a person.

What about the scenario where it is safer to have a baby a home? This is true in the case of meconium aspiration, which is three times as likely to occur in a hospital setting than at home. How come our government isn't taking up the cause and insisting that women who are risk for meconium aspiration deliver at home? There are dozens of other interventions and complications that are much more likely to occur in a hospital setting, yet no one ever talks about the safety of homebirth.

The reality is that there is a massive political machine at work here. Doctors, even when their protocols lead to greater problems or are not evidence-based, are championed as the ultimate life-saver and have enormous political, financial, and societal resources. The bottom line is that I never want a doctors opinion for my health to supercede my right to decide which type of healthcare to pursue - for myself OR for my children.

We agree that there must be a high level of patient choice. I think a non-epidural birth, where possible, is the safest route but I would never forbid other women from getting epidurals. Most women choose hospital births, obviously. We can say that doctors mislead, and sometimes they do, but I blame women for failing to educate themselves.

I also agree that standard delivery protocol sometimes takes into account what the docs want over what is best for mother and child. I would love to fix that. It doesn't change my view that some homebirths are unreasonably unsafe for the baby.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

I'm sorry, but no, it's not a difficult question. You don't get to make decisions about my body in the interest of my baby.

If you want to convince the many people who disagree with you, just stating your view is unlikely to do it. I'm pro-choice in many ways but a full term baby is not the mother's to dispose of as she sees fit. Maybe the science will show that home VBACs are safe enough that she gets to make the call. That's fine.

But let's say there was a condition for which homebirth led to infant death 20 percent of the time versus 1 percent of the time in a hospital. The baby has enough rights that I would ask the government to forbid homebirth in that scenario.

Children are people who have rights the government protects. Parents get a lot of leeway, yes. Parents have the right to make risky calls. But above a certain risk level, the government intervenes. A full term baby is not an embryo, it is a person.

What about the scenario where it is safer to have a baby a home? This is true in the case of meconium aspiration, which is three times as likely to occur in a hospital setting than at home. How come our government isn't taking up the cause and insisting that women who are risk for meconium aspiration deliver at home? There are dozens of other interventions and complications that are much more likely to occur in a hospital setting, yet no one ever talks about the safety of homebirth.

The reality is that there is a massive political machine at work here. Doctors, even when their protocols lead to greater problems or are not evidence-based, are championed as the ultimate life-saver and have enormous political, financial, and societal resources. The bottom line is that I never want a doctors opinion for my health to supercede my right to decide which type of healthcare to pursue - for myself OR for my children.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

I'm sorry, but no, it's not a difficult question. You don't get to make decisions about my body in the interest of my baby.

If you want to convince the many people who disagree with you, just stating your view is unlikely to do it. I'm pro-choice in many ways but a full term baby is not the mother's to dispose of as she sees fit. Maybe the science will show that home VBACs are safe enough that she gets to make the call. That's fine.

But let's say there was a condition for which homebirth led to infant death 20 percent of the time versus 1 percent of the time in a hospital. The baby has enough rights that I would ask the government to forbid homebirth in that scenario.

Children are people who have rights the government protects. Parents get a lot of leeway, yes. Parents have the right to make risky calls. But above a certain risk level, the government intervenes. A full term baby is not an embryo, it is a person.

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

I'm sorry, but no, it's not a difficult question. You don't get to make decisions about my body in the interest of my baby.

Anonymous wrote:

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

Okay, but who exactly would be the right person to forbid a woman from VBACing at home? The government? A doctor?

As soon as doctors figure out how to have the same VBAC success rates as homebirth midwives, perhaps I'd be interesting in hearing their commentary. The other consideration about this is that uterine rupture and subsequent fetal death occurs in the hospital; in fact it most often occurs in the hospital because the vast majority of VBACs do it in the hospital. Tragic outcomes usually have nothing to do with birth location. Though thankfully, childbirth almost always results in a healthy mom and baby - again, usually regardless of birth location.

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

This is a difficult question. One of the charges against her comes from a VBAC at home that resulted in rupture and infant death.

Should a woman be allowed to attempt a VBAC at home? I don't know. There is another party involved, a term baby.

Anonymous wrote:Took the words right out of my mouth. Thanks for posting, PP. I followed the epic thread about the last homebirth midwife disaster with interest, and although I would never think of having a baby while not also in a hospital, one thing I took away from the thread was that CNMs were more trustworthy than lay midwives. I guess not.

I will never understand why it is so important for people to give birth at home, particularly those in the examples above with known complications like group B strep, hypertension, obesity, prior C-section, etc. The terrible outcomes that result are tragedies by the truest definition of the word - that the participants, whether mother, father, midwife but most likely all three - have the tragic flaws of pride, selfishness and overconfidence to rank their "birth story" over the best possible care for their newborns and themselves.

I'm not sure why I'm bothering to respond to you, but here goes.

You will "never understand"? That's fine. No one is asking for your understanding or approval. I personally have never understood why people cling to this notion that everything is better, safer, easier in a hospital. My baby was born in a birth center, with CNMs. It was about as uncomplicated as they come. I cannot imagine now going to a hospital with an OB to have a baby.

Your assumption that every mother who chooses to give birth to their child in any venue other than a hospital is prideful, selfish and overconfident as well as your assumption that any of those mothers care more about their birth story than the health and safety of their child are both insulting and naive. Do you really think that a birth that ends with a ruptured uterus and a dead baby would be a GOOD birth story?

The Skeptical OB is the most rabid, fanatical anti-natural birth, anti-midwife site on the entire internet. The medical facts look ugly and tragic, but they are still only one side of the story. Even the best OBs and midwives will face tragedy sometimes, so the additional facts are crucial to determining the degree of fault. Using the facts known so far to indict the entire community of midwives, even the profession of midwifery, is irresponsible and unfair.

This whole thing is bazaar. But then again, so is hiring a woman with many complaints logged against her is stupid. She also doesn't sound very bright if she did not get adequate liability coverage. Stupid is as stupid does.

Anonymous wrote:This is not really about Evelyn, it's about reproductive rights, including where a woman has a right to give birth.

Yes, and I am absolutely horrified at those charges, because they show that medical professionals are willing to attack home birth merely because women are choosing something different than what they recommend - especially when what THEY recommend is often not even evidence-based. I honestly don't see where Evelyn did anything WRONG; in each of those cases things were going poorly and she appropriately transferred to the hospital, and in most cases mom and baby turned out fine. Again, the doctor decides he doesn't like the protocols of the midwife, gets pissed when she (rightly) transfers to a hospital, complains and then he gets to make her stop practicing, strip her of her license, and take her livelihood away. You could take each and every one of these situations that were stated, and explain why it is still a reasonable option for a woman to choose homebirth. Medical professionals should not have the right to dictate where we give birth, even if we are obese, or might have a large baby, or have a prior c/s, or have a breech baby. This is absolutely a political fight. Doctors/hospitals HATE homebirth and think they should have the right to dictate to all of us how we give birth. They completely remove the individual woman from the equation, when in fact we are the ones that should be able to make these choices for ourselves.

Women and babies die in our hospitals every day in this country giving birth, yet there are no reports flaunting the errors (or just bad luck) of the physicians attending those births. Why in God's name should THEY have the right to flaunt the errors (or just bad luck) of midwife attended homebirths?