Anonymous
Post 12/14/2011 12:06     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
I don't get the objection. The docs involved at the hospital are raising their concerns. One ER doc does not get to revoke her license. There will be a hearing.
Anonymous
Post 12/14/2011 11:53     Subject: Re:Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:
It has always been weird to me that doctors not affiliated with the child in question get to be the complaining party when things like this happen.


it's because they are in the position to know when proper procedure wasn't followed. They are peers, and are able to determine whether the midwife took unnecessary risks.


I'm sorry, but I disagree. See the rest of my posts about peer review and specialization. If a woman transfers into the emergency department of a hospital after a failed home birth, or a successful home birth and a baby with complications, she will be evaluated first and foremost by the staff of the emergency department. By and large, those are not obstetrical personnel. They're ER personnel.

Also, I doubt they are always in a position to know when proper procedure was followed or not. When emergencies happen, a lot of time proper procedure goes out the window. If we are talking about manual removal of the placenta being outside the standard of care, that happens in hospitals. It happens in birth centers.

I don't disagree that there are situations where protocol is not followed or where unnecessary risks were taken. I just believe that there are many situations in which people make different judgment calls about things, especially during emergencies. I am hesitant to believe anything I read on Dr. Amy's blog because I find her to be a totally repulsive person who I disagree with (both ideologically and tactically), but the list of complaints she came up with sound to me to be about 50% legitimate and 50% BS. Cue finger pointing about how would I know since I'm not a midwife or an OB, but there is a huge difference of opinion on whether HBAC is a good idea or not. It's professionally controversial, which indicates to me that the standard of care is evolving and cannot be pointed to as the one, unchanging gold standard for practice.
Anonymous
Post 12/14/2011 11:53     Subject: Re:Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:
It has always been weird to me that doctors not affiliated with the child in question get to be the complaining party when things like this happen.


it's because they are in the position to know when proper procedure wasn't followed. They are peers, and are able to determine whether the midwife took unnecessary risks.


This is the whole problem -- who is to say that their procedure is the absolute best and only way to do things? Why do they get to determine what proper procedure is for ALL birth attendants? Their way is not infallible. Their way still results in the occasional tragic outcome. They should not have the last say over how other people deliver babies, period.

Anonymous
Post 12/14/2011 11:47     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Surely there are scenarios where the OBs realize the midwife has made a gross error and the woman does not. Or the woman feels guilty and does not have the heart to blame anyone else.

I agree that we can assume some of these reports by doctors are problematic but likewise I would not assume midwife innocence in every case where the woman does not complain.
Anonymous
Post 12/14/2011 11:46     Subject: Re:Evelyn Muhlhan - another homebirth midwife bites the dust?
It has always been weird to me that doctors not affiliated with the child in question get to be the complaining party when things like this happen.


it's because they are in the position to know when proper procedure wasn't followed. They are peers, and are able to determine whether the midwife took unnecessary risks.
Anonymous
Post 12/14/2011 11:37     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:Who determines recklessness? One option is the organization that certifies midwives. Another option, which you can't avoid no matter what regime we have, is a prosecutor, judge, and jury. In extreme cases a woman may seek criminal charges if she thinks her birth attendant has been criminally negligent.

How do the prosecutor and jury decide what has crossed that line? They would hear evidence from experts. I take it you would want to bar OBs as experts and limit it to midwives. I doubt a court would accept that but the midwife could certainly present evidence from those who found her actions appropriate.

The idea of who gets to judge professional proficiency comes up in all areas. I see why you think it is harder here because of bias from the OB community but that doesn't mean we should throw up our hands and let anyone call themselves a midwife.


I agree with your post, for the most part. The thing that really bothers me about so many of these cases that become controversial is that the complaints are not coming from the parents, who are concerned they've been treated unfairly. They're coming from other medical professionals - doctors, staff of hospitals, etc. I understand that those people are the ones who have to "clean up the mess" from failed homebirths, but they are not the parents of the child. They are not the clients of the midwife. They are not affiliated with the situation. It has always been weird to me that doctors not affiliated with the child in question get to be the complaining party when things like this happen.

And this is not a case of "letting anyone call themselves a midwife". This is a woman who has 20+ years of being a CNM. My issue is more that no other CNMs sit on the review board for the professional organization sanctioning her. My best friend is a RN. There is a big difference between the job performed by a CNM, an OR nurse, an ER nurse, etc. CNM is a specialization that you get post-regular nursing school. For a review board to adequately judge the skills of this CNM, she needs to be reviewed by at least one other person that shares her specialization.

I wonder how the CNM posting earlier feels about this aspect of things.
Anonymous
Post 12/14/2011 10:41     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:
Anonymous wrote:absolutely--the right of a term/viable baby to have a reasonable chance of surviving delivery should absolutely, 100% trump the rights of a woman to decide what type of delivery she has.
Just as the rights of an newborn to survive/thrive should trump the rights of parents to abuse that child.


No no no! The two situations you present are completely different. The government cannot force any person to undergo a medical procedure against their express wishes, not even for the benefit of another person. For example, you can't be forced to donate a kidney to your dying child if it's against your religious beliefs, even if you are the only viable donor. Thus, the government also cannot force a woman to give birth in a hospital / under certain conditions (a medical procedure) against her wishes, even for the benefit of the child. TOTALLY different from laws against abuse or withholding medical treatment from children (laws which I fully support).

However, this absolute right to personal control over your own medical treatment does NOT extend to a right to force medical professionals to provide assistance. Medical professionals should absolutely be able to refuse to treat patients who are asking them to violate professional standards of care or codes of conduct.
I agree with this, although I would change "be able to" to "be compelled to, under pain of losing his or her license."
Anonymous
Post 12/14/2011 10:36     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Who determines recklessness? One option is the organization that certifies midwives. Another option, which you can't avoid no matter what regime we have, is a prosecutor, judge, and jury. In extreme cases a woman may seek criminal charges if she thinks her birth attendant has been criminally negligent.

How do the prosecutor and jury decide what has crossed that line? They would hear evidence from experts. I take it you would want to bar OBs as experts and limit it to midwives. I doubt a court would accept that but the midwife could certainly present evidence from those who found her actions appropriate.

The idea of who gets to judge professional proficiency comes up in all areas. I see why you think it is harder here because of bias from the OB community but that doesn't mean we should throw up our hands and let anyone call themselves a midwife.
Anonymous
Post 12/14/2011 10:32     Subject: Re:Evelyn Muhlhan - another homebirth midwife bites the dust?
You rant is based on opinions not medical science. I am suprised that home birthing hasn't been outlawed a lot of the issue is law makers not wanting to touch the rights of the unborn due to abortion rights issues


What exactly is not based on medical science? Please do tell. Have you ever attended a homebirth? Or do you just categorically think they are all horrifically dangerous?
Anonymous
Post 12/14/2011 10:29     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:No one has said the baby's rights shift to 100 percent or that home birth be outlawed. You aren't discussing this in good faith.

You also seem to think we'll be scared by the difficult line-drawing problem into accepting the infant has zero rights. But you can't seriously think we aren't all aware of the line drawing problem. It is the inherent problem in reproductive rights and makes it all harder than examples like giving a kidney to someone else.


You didn't answer the question: who do YOU think should have the right to determine what is "reckless"? And, why should they have that right? I'm very curious! I'm not debating for nothing; I'm interested in hearing what you think.
Anonymous
Post 12/14/2011 10:23     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:So, what's a "term" baby? 37 weeks? Under your logic, babies could be allowed to be born at home at 36 weeks and 6 days then? That would make sense? Or would they have the "right" to hospital care at earlier points of gestation? If so, how early are you suggesting we give fetuses these "rights"? Where do you draw the line? Conception? Potential for conception? Oral contraceptives should therefore be illegal because babies have the "right" to potentially be born, but only in hospitals, huh?

Again, this is about women's rights. Stripping them of options and making certain things "illegal" because of the opinions (read: pocketbooks) of obstetricians is insane. The woman should be the only decider when it comes to decisions about her reproductive health, whether she wants to give birth with an OB or if she wants her mom to catch the baby in the comfort of her own bedroom. If you start giving "term babies" the "right" to a hospital birth, you're going down a slippery slope.


CNM here again and I fundamentally disagree. As a CNM attending a birth I have TWO patients: the mother and the child. I believe I have a moral responsibility to that child to be born in a safe manner that gives it the best shot at a meaningful and productive life. What could be more selfish than to saddle a child with a lifetime of disability because of the mother's reckless decisions at the time of delivery? It's almost easier for me to agree that a woman's right to birth as she chooses should trump the right of her fetus to live. It's much harder for me say that her right to birth trumps the right of another human being (her child) to not have a lifetime of disability.

Thankfully, much of even the natural birth community agrees with me. And even the fringe that would value the "birth experience" over all other things IN THEORY sings a different tune when they are the client and they are bleeding or their child's heart beat is failing.


But my question is, who gets to determine what is reckless? The obstetric community has one set of OPINIONS (backed by research and experience) about what is safe and what isn't, yet despite their careful protocols, they cannot guarantee a perfect outcome. Lay midwives have a very different set of OPINIONS (backed by research and experience) about what is safe and what isn't, and their outcomes are very similar to the obstetricians -- usually everyone turns out fine but they can't guarantee perfection either. So considering all this, who do you suppose should be the arbiter of what is considered reckless? If midwives and doctors can disagree, why would it be okay for the government to choose one side and legislate that?

And honestly, I think it's a little insulting that you are equating "reckless midwives" or poorly informed/selfish mothers with a "lifetime of disability". The reality is that the history of obstetrics in this country is absolutely riddled with unnecessary procedures that have caused horrible damage to both babies and their unsuspecting mothers. Thankfully, today we have lay midwives, CNMs, and obstetrics alike producing pretty good outcomes, but to pretend that one or the other holds all the right answers is disrespectful to both professions. Which, brings us back full circle: the only one who can be the final judge of what is in her and her baby's best interest is the mother herself, hopefully in consultation with the care provider of her choice. This isn't said in disrespect to the rights of the baby; but instead it is the only logical answer.

I also don't know how many homebirth women you've ever worked with (any?) but having worked with so many, I could not even name one of them (or their midwife!) who somehow values her birth experience more than the life of her baby. Truly, this is a fictional scenario created to try to dismiss the very legitimate, difficult, and individual decisions that some women make.



You rant is based on opinions not medical science. I am suprised that home birthing hasn't been outlawed a lot of the issue is law makers not wanting to touch the rights of the unborn due to abortion rights issues
Anonymous
Post 12/14/2011 10:19     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
No one has said the baby's rights shift to 100 percent or that home birth be outlawed. You aren't discussing this in good faith.

You also seem to think we'll be scared by the difficult line-drawing problem into accepting the infant has zero rights. But you can't seriously think we aren't all aware of the line drawing problem. It is the inherent problem in reproductive rights and makes it all harder than examples like giving a kidney to someone else.
Anonymous
Post 12/14/2011 10:16     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:
Anonymous wrote:So, what's a "term" baby? 37 weeks? Under your logic, babies could be allowed to be born at home at 36 weeks and 6 days then? That would make sense? Or would they have the "right" to hospital care at earlier points of gestation? If so, how early are you suggesting we give fetuses these "rights"? Where do you draw the line? Conception? Potential for conception? Oral contraceptives should therefore be illegal because babies have the "right" to potentially be born, but only in hospitals, huh?

Again, this is about women's rights. Stripping them of options and making certain things "illegal" because of the opinions (read: pocketbooks) of obstetricians is insane. The woman should be the only decider when it comes to decisions about her reproductive health, whether she wants to give birth with an OB or if she wants her mom to catch the baby in the comfort of her own bedroom. If you start giving "term babies" the "right" to a hospital birth, you're going down a slippery slope.


CNM here again and I fundamentally disagree. As a CNM attending a birth I have TWO patients: the mother and the child. I believe I have a moral responsibility to that child to be born in a safe manner that gives it the best shot at a meaningful and productive life. What could be more selfish than to saddle a child with a lifetime of disability because of the mother's reckless decisions at the time of delivery? It's almost easier for me to agree that a woman's right to birth as she chooses should trump the right of her fetus to live. It's much harder for me say that her right to birth trumps the right of another human being (her child) to not have a lifetime of disability.

Thankfully, much of even the natural birth community agrees with me. And even the fringe that would value the "birth experience" over all other things IN THEORY sings a different tune when they are the client and they are bleeding or their child's heart beat is failing.


But my question is, who gets to determine what is reckless? The obstetric community has one set of OPINIONS (backed by research and experience) about what is safe and what isn't, yet despite their careful protocols, they cannot guarantee a perfect outcome. Lay midwives have a very different set of OPINIONS (backed by research and experience) about what is safe and what isn't, and their outcomes are very similar to the obstetricians -- usually everyone turns out fine but they can't guarantee perfection either. So considering all this, who do you suppose should be the arbiter of what is considered reckless? If midwives and doctors can disagree, why would it be okay for the government to choose one side and legislate that?

And honestly, I think it's a little insulting that you are equating "reckless midwives" or poorly informed/selfish mothers with a "lifetime of disability". The reality is that the history of obstetrics in this country is absolutely riddled with unnecessary procedures that have caused horrible damage to both babies and their unsuspecting mothers. Thankfully, today we have lay midwives, CNMs, and obstetrics alike producing pretty good outcomes, but to pretend that one or the other holds all the right answers is disrespectful to both professions. Which, brings us back full circle: the only one who can be the final judge of what is in her and her baby's best interest is the mother herself, hopefully in consultation with the care provider of her choice. This isn't said in disrespect to the rights of the baby; but instead it is the only logical answer.

I also don't know how many homebirth women you've ever worked with (any?) but having worked with so many, I could not even name one of them (or their midwife!) who somehow values her birth experience more than the life of her baby. Truly, this is a fictional scenario created to try to dismiss the very legitimate, difficult, and individual decisions that some women make.

Anonymous
Post 12/14/2011 10:00     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:Thankfully, much of even the natural birth community agrees with me. And even the fringe that would value the "birth experience" over all other things IN THEORY sings a different tune when they are the client and they are bleeding or their child's heart beat is failing.


THIS, PP. I completely agree. I'm 11:30 from yesterday and I have long thought that the fridge that professes to value the birth experience over everything else is posturing, politically. It has value, sure, because that viewpoint results in conversations like this one, that allow people like me to further refine our own beliefs about these issues.
Anonymous
Post 12/14/2011 09:28     Subject: Evelyn Muhlhan - another homebirth midwife bites the dust?
Anonymous wrote:So, what's a "term" baby? 37 weeks? Under your logic, babies could be allowed to be born at home at 36 weeks and 6 days then? That would make sense? Or would they have the "right" to hospital care at earlier points of gestation? If so, how early are you suggesting we give fetuses these "rights"? Where do you draw the line? Conception? Potential for conception? Oral contraceptives should therefore be illegal because babies have the "right" to potentially be born, but only in hospitals, huh?

Again, this is about women's rights. Stripping them of options and making certain things "illegal" because of the opinions (read: pocketbooks) of obstetricians is insane. The woman should be the only decider when it comes to decisions about her reproductive health, whether she wants to give birth with an OB or if she wants her mom to catch the baby in the comfort of her own bedroom. If you start giving "term babies" the "right" to a hospital birth, you're going down a slippery slope.


CNM here again and I fundamentally disagree. As a CNM attending a birth I have TWO patients: the mother and the child. I believe I have a moral responsibility to that child to be born in a safe manner that gives it the best shot at a meaningful and productive life. What could be more selfish than to saddle a child with a lifetime of disability because of the mother's reckless decisions at the time of delivery? It's almost easier for me to agree that a woman's right to birth as she chooses should trump the right of her fetus to live. It's much harder for me say that her right to birth trumps the right of another human being (her child) to not have a lifetime of disability.

Thankfully, much of even the natural birth community agrees with me. And even the fringe that would value the "birth experience" over all other things IN THEORY sings a different tune when they are the client and they are bleeding or their child's heart beat is failing.