Sebastian, at birth Oct 2006
well after living my life for the last year and two months i have been hard pressed to re examine many things that i held as facts. Death challenged many "facts" i thought i knew, and rocked me to my core. In the rubble left i have been carefully and painstakingly reconstructing something of worth from the pieces. i want, i need my daughter's name to matter. i need the world to change in some way because of her.
i know without a shadow of a doubt Aquila would be alive had i chosen a hospital birth from the beginning with her. i am pretty sure that my daughter would also be alive had i chosen a better educated, more competent midwife, and had thus transferred in a timely matter.
I cannot change the past however... i can only attempt to change the future. I believe that homebirth in America needs a serious revamp. Homebirth is not going anywhere. even though many people seem to think i want it to go away, they would be wrong. i do not. i fully grasp what is good and what potential for benefit lies in midwifery care and even in homebirth.
BUT
first off , until some major changes happen people need real information on what is up with the midwifery system, and what risks there are in homebirth. they need to know that study after study shows that homebirth has 3 times the neonatal death rate
here
over hospital birth. They need to know that homebirth should only be for low-risk woman - Currently every midwife i know will take a woman carrying twins and breeches, moms with histories of shoulder dystocia, diabetes, pre-eclampsia, GBS positive etc, etc, etc......
People need to understand that a CPM is nothing close to a CNM in training and skills.
I think ultimately we need three things-
#1 to create a uniform, nation wide standard for what is a midwife , what they can and can not do and how they must be governed.
#2 to abolish the title of CPM and have only midwives with a CMN or like degree.
#3 to integrate midwifery care into the health care system by covering midwifery care on all insurances (like Florida), and on Medicaid. But in the same token- require midwives to be just as well trained and as responsible as other providers who are- by upping the training to CNM level and by requiring malpractice insurance (also like Florida).
as i tell my children , if you want to be treated like an adult (professional), then act like one
some of you are now saying, 'why malpractice insurance?'
and some of are even saying things like this " malpractice insurance requirements will run midwives out of business and cause unnecessary lawsuits!"
really?
i guess you have never met a baby with extensive brain damage caused by a providers negligence...i have.
why should the parents have to pay what they in no way can afford so that midwives can practice without any liability?
because, sure a parent could try to sue a midwife with no insurance...but good luck finding a lawyer..and if she does? well the lawsuit will never get paid out, so the parent will still not get the money needed to care for the damaged child. how fair is that? you say that a midwife should not have to pay to protect her clients? don't most small business carry liability insurance? Aren't you and i and every other driver legally required to carry driver insurance?
If malpractice insurance runs midwives and home births out of business, than why is Florida's homebirth/midwifery community still alive and kicking?
Florida law requires all midwives to carry a certain level of liability insurance.
Florida law also requires all insurance providers to cover homebirth.
sounds like a win for both 'sides" doesn't it?
what do you think?
48 comments:
It certainly sounds reasonable to me. I think the only reason it's taken this long to have a national conversation about midwifery is that only 1/2% of births are midwife-attended home births and in the popular consciousness it is still associated with a very rural or religiously fundamentalist population that doesn't appreciate being meddled with.
I think this is an inevitable consequence of its becoming more mainstream.
Liz,
Would you Please write a book - do something - I don't mean to say that you are not doing something now - I just think that you have a voice for this issue !
Love to you and your family
Absolutely, Gabriel. More women are choosing homebirth (including those who are of high risk, AMA, VBACs) - more homebirths = more risk -taking = more deaths and/or birth injuries. My fr., Hillary, chose to homebirth her 1st child (frank breech position). This child is now 11 yrs. old - in and out of skilled nursing facilities for pulmonary issues. He has a colostomy and a tracheostomy. The child has cerebral palsy due to a cord compression injury. He cannot walk, talk - total care. All because this woman insisted on a natural birth - against the MD's advice.
I wold like to clarify that Florida does require malpractice insurance, but also allows CPMs and direct entry through what is basically a supervised probation period intended for people who are licensed in other states, presumably.
Well, my issue is so personal.
In our state-Idaho, midwifery was unregulated until recently. You could birth with whomever you chose. Now, however, you must be a licensed midwife. So, my midwife went through testing on the info she already knew to prove she knew it, and went from a CPM to a licensed midwife.
The only thing that has happened for ME as a result, is that she can no longer be my provider.
See, with that, ridiculous things happened like outlawing home birth or birth center births in our state if you've had more than 1 c-section. I had 2 vag births, a c-section for a transverse lie, a forced unecessary repeat due to a VBAC ban, and then 2 successful vag births again-the last being an illegal homebirth.
Now, I'm forced to break the law, as is my midwife.
I get why many want or like legislation..now my midwife has to charge more for the insurance she carries as a licensed midwife, and the birth center births of friends i know are just like hospital births...
ugh..it's a difficult one. Even though I've successfully vag birthed 4 babies (and the last homebirth was 10 lbs 9 oz, no problem) I will have to go to the hospital for a section or break the law to birth..
Sorry, the last comment was from me..my husband was signed in on his Google acct! My bad, sorry!
@RightThinker-Andrea
Well, I certainly don't think it should ever be against the law for a mother to give birth at home, I do think that it is up to the state of Idaho whether to allow midwives to do high risk home births, and a VBAC or especially a VBA2C is statistically a high risk birth.
I agree with the Idaho law, because the services of a midwife just aren't for women in high-risk situations, and for women in low-risk situations, informed consent ought to mean having a conversation that goes, "Are you comfortable with tripling your odds of this baby not surviving delivery? Ok, sign here."
I am sorry that you feel backed into a corner on this, though. Labor is not something to go into feeling out of control. That really sounds like a hard situation to be in.
Thanks, Gabriel.
Yeah, it's a junky situation.
I would stand on the side of VBAC's are safer than repeat sections for otherwise healthy mom's...
Everything I've been able to gather puts the risks of a 3rd c-section a LOT higher than a rupture risk..particularly since I had a "proven pelvis" prior to my first section, and have been a successful VBA2C twice now...
Ugh!
Right-thinker does have a point about potential laws excluding women who want a chance at the birth they want. But, Gabriel made a good point that perhaps there needs to be a law with parameters, and that women who want to go beyond those parameters would have to sign an informed consent. That way the parameters would allow other women to realize that homebirth does have its risks.
As for malpractice insurance-of course it makes sense, but the price of midwifery would go up and many families can not afford that out of pocket expense. So, then insurance companies would have to cover homebirth and of course that is a long shot at this point in our nation.
I applaud your hard work and research on this subject, Liz. Just your blog alone has opened up many eyes to the reform that needs to take place.
Overall I agree with you.
I do have some reservations, but not about making homebirth as safe as possible.
About 5 years ago, I lost a job with a local doctor's office (an internist) because her malpractice insurance was so high she had to make cuts somewhere. She wasn't the only one. Many OB/GYNs have quit delivering and very few family practice docs deliver babies any more. Malpractice insurance is fine, but you have to have some sort of tort reform to keep the costs affordable.
Also, to get CNMs on board, you have to get the medical community on board. In the long run, that really is what is going to make the homebirth option as safe as possible.
Right-Thinker-Andrea,
I have ten children one not yet born. I too have successfully vag. birthed 2 very large babies, with no issues. They were 9lbs11oz and 9lbs9oz. I used to day that I had a proven pelvis and it was not a problem, I even had the nerve to think/say that a bigger baby was easier to birth... :(
That is until I had my little 7lb11oz-er, my 8th, who was so terribly stuck, and we really had no idea until it became an emergency. Had I been birthing at home he would surely have died, and I likely could have died with him. (No I was not labouring on my back, no I didn't have an epidural, yes I was able to stand, walk and sit and was)
The truth is size does matter, but something even more, and that is positioning of the child itself. And frankly, one thing I do know is you can't control the positioning of that child, despite hopeful exercises to encourage proper positioning, despite spinningbabies.com. It's a terrible gamble to stay home.
I wouldn't stake my child's life on my wish not to have a ceasarean... I read recently women writing and saying that a c-section was their worst nightmare. My worst fear approaching birth from my first child was what if I lost him? Unthinkable. You do have a choice, we always have choices.
~Rebecca
Rebecca,
So sorry to hear of your difficult time with your 8th!
I realize that things go wrong with birth. I credit Liz, partly for that through sharing her story.
I do not come with my birth story from a haughty or prideful/boastful position.
I just come to it saying that a repeat scheduled c-section is unecessary for me, being that I can birth vaginally until a need arises necessitating a c-section.
Telling a woman that she can either have an un-necessary repeat section or an illegal homebirth is not a choice, IMO.
I'm familiar with fetal positioning problems, as that was the cause of my first section-a transverse lie cannot be birthed vaginally, and I accepted that need, and would again if needed. However, a VBAC ban at hospitals is not an appropriate reason for a major surgery.
I pray many blessings for you on the arrival of your 11th! How wonderful!
Andrea,
Not debating that the hospital's policy is not unfair. I am asking you to reconsider the fact you are stating you have no choice, and must break the law and stay home. No, you are not being forced, you are making a choice.
Another Mom-to-many reminded me when I agonized over my birth choices, that God is in the hospital too. He is, my 8th child is alive as a result. I did not have a c-section. I have never had a c-section, I had 8 births in hospital and one at home.
My child was not in a transverse lie, I did read that. There are many other ways that babies can get in trouble at home, and those are glossed over by homebirth Midwives. They just assure you over and over that everything will be fine, and that if there does present a problem, we'll have time to see it and transfer... My Midwife in Ontario used the analogy of a train coming down a long tunnel, we'd have enough time to respond...
No I am sorry, in my case my child turned occipital posterior during a reasonably fast labour. Which meant some serious decels, but his forehead also became completely wedged into my pubic bone, and I began to hemorrhage because my placenta was ready to come already. The OB-on-call gave me one serious episiotomy and delivered my child with forceps. He was born dripping blood with a huge bruise covering his whole forehead. But he is fine and undamaged, and a wonderful boy. The Father was there, and that OB worried over me, and sat in a stool at the foot of my bed waiting and assessing. Until it became readily apparent that things weren't right, he listened to me and then he acted. Just like we needed him to.
Rebecca,
Thank you so very much for sharing your story with me..I do value it-truly!
To be very clear, I don't put on that it's a "righteous" thing to do to have homebirth. I really don't. God is with me everywhere, and has saved my life in previous medical situations, as well as my soul.
I'm not anti-hospital, as I've had 5 out of 6 children at the hospital. In this post, I described how the medical community nearly killed me in and after my first pregnancy: http://andreamomm.blogspot.com/2011/02/to-carry-scars-most-of-us-bear-some.html
I then began taking responsibility for my own health care decisions and it's a long road I'm still on.
While it's easy for someone to say that it would be best for me to simply choose un-necessary c-sections, it's a little harder for me to do. My second section, 4th child, was completely due to a VBAC ban. She was a healthy 8 lbs when they took her out at 38 weeks..she was head down, and in optimal position. They took her because they wouldn't allow me to birth. There was no choice for me.
While a c-section isn't the worst outcome-a dead baby is, I suffered from an incredibly severe post surgical infection, and nearly lost my uterus, and ability to make children..my Henry and my Oliver wouldn't be here now..because of surgery that shouldn't have happened.
I know we are sort of discussing apples and oranges-you saying home birth is unsafe, dangerous and irresponsible, and that it's also unfair to not have the right to VBAC at a hospital...yet that I have to make the choice.
Yes I do, and I'm not sure what I will choose. My 5th was a drive well over an hour to be induced because I was postdates, and then birth in the lithotomy position in a hospital with their rules-oh in another state. It was a none of my kids there thing since it was so far away, and we didn't know the time table of the induction. It was a pay out of pocket for a large part because it was in a different state from where my insurance has coverage.
His birth was smooth, and would have been smooth at home. Of course, hind sight is 20/20, and I fully grasp as a home birth mom, the gravity of what I would face if my own choice led to a death. I cannot imagine carrying that burden.
Life is fragile, and we all make the best choices we can. I am praying about this choice and I'm not pregnant yet.
I appreciate prayers for direction, as I don't claim to have all the answers, or all the wisdom. I value all takes, and I trust God will lead me if I listen to where He leads..if that's the hospital, I'll go..if that's a homebirth with my midwife who is attentive, and helped to manipulate Ollie's big shoulders-with a chest of 15 1/2", I'll put my faith there again.
Again, thanks so much for your caring enough to share your story...I certainly come from a place of diverse enough experience to not view birth through rose colored safety goggles!
God Bless!
I like you, Asplendidtime.
Liz, keep fighting - we are all with you.
I wish there wasn't a civil war between birthing mothers.
The reason Andrea had to have a forced C-section instead of a VBAC was a fear of law suits! ACOG made recommendations that were close to impossible to meat for VBACs and so many hospitals took away the VBAC option. As a result mothers underwent thousands of unnecessary major abdominal surgical procedures!
Yes, Asplendidtime, the loss of a child is the worst case scenario - right up there with loss of the mother. But the answer isn't to ban homebirth but to make it safer. You haven't had a C-section. I've had 3. It's not something to be cavalier about. Each one of those procedures changed me profoundly. Yes, I love my children and yes I'm glad they're here. I would die for them. But to brush off C-section as if it's not a big deal is also doing a disservice to women.
I wish we could get along. I wish we could make homebirth safe. But to do that we have to really look at the root of the problem. And it's not that the crunchy mamas want to give birth in a field with rainbows and butterflies! That's the wrong opponant!
Follow the money trail. Your answer lies there.
It is unfortunate that doctors/hospitals have their hands tied because of possible lawsuits. I have an OB and a lay midwife. One of my homebirths with the midwife was a transfer to hospital during labor. After I had the baby(and all was well), my OB and another dr. were talking very candidly to each other discussing homebirth and the procedures that I was opting out of by signing informed consent. Both drs. had worked as missionary drs in third world countries and they were talking about how they knew that one could have a baby without most of the procedures and tests that they do, because they did it on their missionary trips. But, they also said that they knew that they had to do these procedures because of following protocol. It was so strange to hear them talking!
But, they also said that these protocols were in place because they have seen where they have saved lives. Unfortunately one big broad stroke for everyone is what they have to do, and I think that is why some women opt for midwifery and homebirth.
I do not have the answers--I wish I did. I am a homebirther, but I am not against medical procedures. There can be balance between the two.
Elena,
Here we go again - I don't think that homebirth should be banned - because - some women are going to proceed with it - regardless and there needs to be safeguards for this subset of women and - especially - their babies. But - honestly - I do not agree with it and I will never agree w/ it. Just the way that I feel.
Elena,
Again, I am not in any way saying that the Acog (I'm Canadian) recommendation is good/right, etc... Neither was I minimizing a C-section and it's potential impact... I tried to make very, very clear, that I am arguing for the idea that she said she had no choice. I pointed out that she was making one by staying home.
I only asked her to please consider the potential issues. I am a young-ish Mom to 10, and I nearly bled to death at my one homebirth. So no, for me I would never, ever consider it again. Her risk of PPH is higher, because of her grand-multip. status. It's real. I have experienced it, I know others who have too. Also her having had a 10lb6oz baby means it's pretty likely she'll have other big babies, and frankly, just because you could birth one safely, doesn't guarantee a safe delivery next time.
Like I said, a small baby can get into trouble, a small baby can get "stuck", and any Mom can have a placenta detach earlier than expected. But the gamble goes up higher, the more factors you add which count up the risk. None of these can be handled at home, despite Ina May Gaskin's books, which I read enthusiastically when I was preparing for my child's homebirth.
I think her situation is frankly tragic. I think her not being listened to is frankly unacceptable, and I think it's a travesty her choices have been limited. I am not arguing that, what I am saying is that the cost, should something go wrong, at home, is much, much too high. :( I hope you understand.
Andrea, I am going to pray for you, please pray for me. You sound like someone I would love to know better and a sister in Christ.
~Rebecca
FWIW, I am not about a "civil-war", and I don't get where that comment comes from? I recounted my experiences, hoping to help someone else understand that some of the things she is counting on: history of good outcomes, history of large baby, etc.... May not be things she should really be counting on to have a homebirth be safe. Why did I share? Because I do care, I don't know Liz, but if I could have done something for her, if I could have helped I wish I could have.
I read this blog because I don't want to forget about Aquila. I would like to see this never happen again. It's senseless. And I also realise how this could have been me, and I am grateful, and I want others to know that.... No civil-war here.
Liz, I say that the Father was with me when things went horribly wrong for us, with three of our births. I don't like how that might sound.... Because in our cases things worked out, and my children are with me, and I feel so blessed. I know that my situation was different because I had medical care to help, medicine to stop hemorrhage, and competent help, people were there with the tools to help some "unforeseen" issues, and as a result we had good outcomes. It's not magic from God, I know that. I just felt that the Lord was with me, just as when things have been bad outcomes in my life, where His presence made all the difference then also.
FWIW, it took months and months for me to recover from my episiotomy, it was huge, I had never seen a bruise that was actually black before. When the home health nurse came she looked at it because I was in such pain, and she said she'd never seen anything like it. I was a hairs breadth away from a C-section, but I hadn't had an epidural, so it didn't work that way. Not minimizing a C-section, but please don't suggest I have no idea about pain and trauma from birth.
What a previous poster said made me wonder have you thought about a book idea? Not necessarily only Aquila's story, though certainly that, but perhaps a collection or a collaborative effort?
Keep up the hard work Liz, your story is making a difference.
"I am not about a "civil-war", and I don't get where that comment comes from?"
From my vantage point, I'm seeing women ripping each other about their birth choices when we should be working together to make birth as safe as possible at home, in the birthing centers and in the hospital.
I listened to the MP3s that Liz provided of the hearing and it is clear that Faith was more than a little inept in the way she handled Aquilla's birth. That needs to change. There are skilled midwives out there but events like this casts a shadow on all of them.
But at the same time we're allowing thousands of women to undergo unnecessary surgical procedures and take away their reasonable birth choices under the guise that it's for the best? The best for who? and it's Not always the best for the baby, the woman or the family. Seems to work out well for the hospital and the lawyers though.
But as long as moms want to fight each other over who is safer, smarter, more compassionate, or who has suffered the most the real problem stays the same.
@JSR: You may indeed be in a position where no midwife can legally attend your homebirth--which is unfortunate. However, NO WOMAN has to accept a planned repeat c-section for lack of VBAC policy at their hospital. A doctor cannot legally perform a medical procedure on you against your will. You always have the right to refuse. "I do not consent" and "I refuse" are powerful phrases to remember. Your offical refusal releases your provider of liability. Make it clear to your provider ahead of time that you will not consent to a planned repeat c-section. Then, when in labor, you arrive at your birthplace--make your clear statement of refusal so they can document it in your chart. You should then be "allowed" to labor and birth with only normal monitoring and measures (baring, of course, the emergence of an actual "medical issue") Best of luck to you!
Have you ever done that in labor Erica? How did it work out?
I refused forceps with my first, but then after an hour more of pushing I consented because she was then showing distress.
I also refused a c-section with my second daughter because there was no indication that I needed one both me and my baby were fine no warning signs for anything. I remember thinking they were out of their minds when they came in to prep me, I wasn't even fully dilated yet!
It is very, very hard but it can be done.
Wow Elena, you've successfully silenced me. When just sharing your story means that you are "ripping" on others... Well I guess I have nothing to say or share then. When you have info because of your life experiences, where you learned new things you believed to have been false previously.... You are likely right having my tenth baby really hasn't helped me to be able to help others at all.
Is it possible that you have projected your own feelings into my posts?
:( So sorry for sticking my neck out. I won't make that mistake again. :(
asplendidtime-
please don't go away!
And I was not ever cavalier about c-sections, but you have really proved I don't know anything.... :(
That being said, I think I get to be the person who really does get to interpret what I meant when I was speaking. I certainly wasn't speaking about the C-section problem at all, I am not even aware of ACOG's recommendation. But considering what was the reality of her situation, I can't do anything about that. I am not even in the same country! But considering this is reality, for her. Once again, I made my comments based on her comments of why she really was safer at home, my experiences tell me different. I was concerned for her, not trying to "rip on her".
You said I was being cavalier about C-sections, I was not. I didn't even address that, until I went out on a limb and said I hadn't had one, and said I didn't understand, and then you said I was cavalier and didn't understand. :(
Bowing out now....
I think we have to be careful when we offer help. We have to remember that many, many women come from places of pain, loss and victimization. That has to be validated and acknowledged carefully and with delicate precision before we can be in any place of offering help.
We're women. We feel pain more deeply, almost to the soul sometimes. We have to negotiate those same scars in others when we want to help.
And if you guys don't do it, then you're just as bad as the crunchy homebirthers that say everything will be lovely and fine!
And I acknowledge that sometimes I suck at that too; it's a work in progress. But can we get over ourselves and look at the solutions? I think what Liz presented is workable and needs to include the malpractice and tort reform to make it all practical.
Asplendid,
Thanks so much for reaching out and being kind! You seem like a nice lady, and I always have a heart for other mama's of many! God Bless!
Erica,
I am a member of ICAN, and am aware of showing up in labor, etc. It's not for me. I knew that when I was a VBA1C, and unaware that I could even have a home birth with a midwife..so that resulted in me agreeing to a RCS that ended up dangerous for me for 5 weeks pp. I birth quickly, (usually very quick from realizing the difference between false/real labor-I am notoriously faked on prodromal as a VBA2C) and would end up with a car birth (probably not attended) which hardly seems more prepared than a homebirth attended by a skilled midwife.
I had an illegal homebirth in September. My midwife risked everything for me. Some may say this means she's a crappy midwife, I say she is great.
I certainly don't think that it is respectful of Liz's intent of this post, for me to discuss on this blog why I did that, or why I may do it again if blessed with another pregnancy.
For me, birth choices come down to understanding options (or lack thereof), understanding risks, being informed, trusting a provider, knowing that birth is scary and can be catastrophic even in usually easy birth situations, having faith that we and our provider can affect outcome-but only so much at home and even sometimes in the hospital, and then being secure in that choice.
There are always going to be women who feel safter at the hospital, and those who feel safer at home. Liz's post is about making that choice to stay home safer, and I understand that.
My initial comment was that some legislation says it's not safe at all for sme women to birth at home, and since those writing the legislation in this state are OB's with the ACOG-(the same who look at a less than 1% chance of rupture with a VBAC, and a much higher incidence of trouble with repeat sections and deem VBAC's an unsafe choice to appease malpractice lawyers writing insurance policy) it isn't unusual that VBAC's are outlawed for homebirth/birth center birth.
http://www.proliberty.com/observer/20100216.html
VBAC's are not allowed under certain circumstances and VBA2C or more are completely illegal-no matter how much safer than a RCS it may be. This means that no matter how many credentials and licenses a MW has in our state, you are SOL. That's a different discussion entirely than what Liz is talking about here, yet it's one in the same, because you cannot have legislation, and ensure freedom.
*delurking*
I soo agree with Rightthinker-Andrea. As a VBAC mama in the Seattle are, it is very hard to find a VBAC supportive OB that will not meddle with the natural process of birth. Most will not let you go past 40weeks. While HBAC his legal here, it is HUGELY frowned upon and not very many midwives will take on a VBAC due to the politics. There are a few that do though because they do not view a VBAC as being "high risk" and they believe in a womans choice of birth. I'm sorry, but I can not support more regulations that will take away more options to woman. Funny, you drive 4 hours south of here into Portland and VBAC is very normal down there. Go figure. A woman should have the freedom to birth where she feels safe. For some, that is home and for others, in the hospital. I think it comes down to a mother taking responsibility for herself, her health and in finding a competent caregiver. I agree, that something should change in that midwives should carry malpractice insurance. But it also shouldn't be so expensive that it puts her out of business.
I am all for freedom and liberty and having the ability to make educated decisions. I shouldn't have to feel backed into a corner in that a re-peat C-section or highly managed pregnancy/labor are my only options. No thanks. I am also not against the medical community. Thank the Lord it is there for when its needed and for high risk pregnancies and birth.
I am sorry Liz for the loss of your sweet, sweet baby girl. Something no mother should have to go through. I pray God's tender peace over you and your family and I am angered by your midwife's incompetence. If anything I have learned in being a mother, nothing is stronger than your intuition and Faith did a diservice to you by not hearing your voice when you knew it was time to transfer. Blessings.
I will add that what Liz is proposing here is COMPLETELY reasonable and we should be aiming for these standards in midwifery. However, freedom of choice needs to be protected as well.
Would you ladies please pray for my friend J? She's 38wks, and her baby is in frank breech presentation with an anterior placenta. So no version. She is planning a homebirth.
She has been told she has a very large pelvis and her midwife is very sure that everything will be okay.
Please pray.
~Rebecca
Prayers are going up for your dear friend.
I can relate to the worry over that..my last guy, the first to start out with an anterior placenta, ALSO chose to be breech and then sort of a modified transverse, until about 38 weeks. I was planning on going to the hospital though if I went into labor, as we knew he was probably close to 10 lbs at that point.
I was thankful for rounds of pulsatilla, the birth ball, my pool, and the chiropractor (Webster), as he flipped with a few days of diligent work.
Perhaps suggest pulsatilla to your friend, as well as birth ball, spinning babies, and Webster technique..also, if she can get any pool time at the Y or something...REALLY helped me. (A good midwife would be suggesting this already, as they shouldn't be jumping for joy over a breech! Mine wasn't!)
He got engaged and went to 0 station right away...
Anyway, Sabbath blessings to her and to you.
Liz, you links to the perinatal death studies aren't working. I'm very interested in reading them. TIA!
Sorry @6VeganKids, I fixed the link.
There will always be "bad midwives", just as there will always be "bad doctors" or "bad nurses". Licensing and regulating midwifery won't weed out midwives who practice unsafely any more than it does doctors or nurses. It will only restricts the rights of a birthing woman.
Just because you don't think homebirth is safe for women who are carrying twins, or breech or VBAC, it doesn't mean they should lose their right to do it.
In the states where legislation like you are suggesting has passed. women are no longer allowed to legally have a homebirth with a midwife for twins, breech, VBAC or advanced maternal age. For some of these women, their only legal option for a vaginal birth is to go it alone, and to me that is not acceptable.
I want the right to birth my baby at home with the birth attendant I choose.
What I would like to see happen is to leave the direct entry midwives alone, but allow CNM's to also attend homebirths. That way people who share your opinion that birth is medical can have your homebirth and have your insurance pay for it. And people like me who don't think birth is medical, and want our midwives acting on our behalf, not the behalf of their insurance company and licensing board can have our births without the intrusions that made us not choose a hospital birth in the first place.
Erin,
That was a spectacularly wonderful comment!
I believe the same thing..unfortunately, I'm still not good at standing up for my homebirth choices..thank you for verbalizing what I feel so strongly about, yet am too intimidated by past experiences to really stand up for myself..(another reason why facing MD's in a hospital setting usually goes their way and not mine)
God Bless!
Erin
"What I would like to see happen is to leave the direct entry midwives alone, but allow CNM's to also attend homebirths. That way people who share your opinion that birth is medical can have your homebirth and have your insurance pay for it. And people like me who don't think birth is medical, and want our midwives acting on our behalf, not the behalf of their insurance company and licensing board can have our births without the intrusions that made us not choose a hospital birth in the first place."
what are you talking about?? cnm's ARE allowed to attend homebirths. there are 5 in my area alone. most don't WaNT to because they have better training and know the risks.
maybe like sky diving , there could be true informed consent- something along the lines of - you are allowed to birth with CPms at home, VBACS twins, ect, but you must be informed of the true risks- higher death rate an higher brain damage rate than the hospital...
then if you want to do it you can, but people like me would know better. i wish i had been informed of the true risk rate....
Liz, CNMs aren't allowed to do homebirths everywhere. Where I live in Ohio there is not a single one!
And don't be so sure that it is just the risk that is keeping CNMs out of practice. It's probably insurance malpractice rates that have a lot to do with it too.
Elena-
just because there are not any in your area does not prove they are not "allowed" to practice. please provide any links that show that CNMs are not "allowed' to practice (homebirths) anywhere in the us--and it is not a case of malpractice insurance either- as ONLY florida has mandatory malpractice insurance for ANY kind of midwife. if you read "baby catcher" you will see a CNM who did homebirths , carried insurance , then after being dropped chose to continue practicing "bare". CNMs CAN do homebirths and as long as it is legal to do homebirths without insurance, they will.
I double checked and you are correct. CNMs are not barred from attending homebirths by statute or administrative law. But there are only a handful attending homebirths in the entire state - which certainly still limits access for women.
"which certainly still limits access for women. "
this is certainly not a reason to flood the market with unskilled, poorly regulated midwives (CPMs)
agreed. I never argued for poorly trained midwives!
My comment goes back to the original post and I extend my heart to you and your family, for your loss and hopefully the healing that you've experienced since 2009.
As a Certified Professional Midwife, who attended a 3-year, MEAC accredited midwifery program, attending over 100 births and over 2000 clinical hours to graduate, as well as having to write a thesis, I do believe that there are waves of CPM's out there who are as trained as CNM's. Who are trained extensively in diagnosing and managing pregnancy complications, western and herbal pharmacology, as well as encouraged to review and base protocols from ACOG, BJOG, and JMWH in their out-of-hospital practices.
I think you're right to say we have to review the current midwifery system and make it better for the women of the US. Using and encouraging a title (and the education) of a Registered Midwife (see midwives in Canada, UK, Netherlands and NZ) really means that there is a unified force and one that works in collaboration with ACOG and AMA. These midwives are able to assist in ceasarean births, as well as do waterbirths in hospitals, and even home births. They work in teams with physicians, nurses and sister-midwives. Dedicating a title such as CNM in the US would ignite massive fires, at this point. It would ostracize a large part of the midwifery population. Blending into a more collaborative model would be a more more sustainable approach. Also, it would provide all midwives to be covered by insurance companies therefore clients would be reimbursed like they are with a hospital or birth center birth. With around 5 percent of births in the US being attended by midwives, in some states 3 percent and some up to 10 percent, again it would be best to base off models where 70 percent of births are being attended by midwives. Education is the missing link on midwifery in the US.
Compassionately remember that loss occurs wherever birth occurs. I agree that some candidates of every license probably shouldn't get the letters behind their names, YET they do and they practice. Malpractice happens everywhere, as well. Therefore, I appreciate your take on integrating the system. Please take into account the work many CPM's these days are putting into licensure. Be grateful for the states that don't arrest midwives (CPM and CNM) for attending women who want a homebirth and state makes it illegal for them to CHOOSE such births. Let's do what you say and try to integrate the midwife in the US, and empower her so she can empower her clients to make informed decisions, intelligent choices, and birth her baby into a healthy landscape. Because at the end of the day all OB's, Midwives and Nurses want the same thing: healthy moms and healthy babies, healthy outcomes.
Again, I am so sorry for your loss and Aquila will always have a place and voice on this planet and her work will make an impact. May love guide you.
Again, I am so sorry for your loss. I have worked as a Registered Nurse in a high risk L&D unit in the state of FL for ten yrs. I gave birth to my first two daughters in a hospital attended by CNMs (Nurse Midwives). My last was born at HOME attended by a CPM with 20+ yrs of experience. I clearly know the risks. I have to disagree with you about midwifery training needing to be that of CNMs. I am currently looking into enrolling into a CPM program. Just because they are nurses DON'T make them better - coming from a NURSE!
Just watched your spoken word video, linked from Angie's blog--the first time being here. I am so sorry you lost your precious little girl.
I've cruised around and read your story and as a homebirth mom, got a very bad taste in my mouth, as babies die everywhere, and they die at the hands of capable and skilled obstetricians just feet away from operating rooms and Level III NICU's.
However, this post is very important and I absolutely agree 100% with you. I am in Washington and have been appalled at some of the stories I hear from friends in other states regarding their midwifery care.
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