Howdy, folks. There were a couple of responses to my post early last month about midwifery, and I thought that I would devote a post to a reply to objections raised to my proposal that midwives be, well, not in any way encouraged by the state. I am going to draw on some previous posts from my website so that I do not repeat myself. They will be new here, however.
Midwives have extensive education and training, WAY beyond what someone could find on the internet.
Not a ringing endorsement. I commented that a midwife does not provide a service that any friend with an internet connection could not provide. I will stand by this, but let me clarify what lies behind my assertion.
The type of “education” that a midwife is an apprenticeship. The apprenticeship model of education is a valuable model, but the sheer volume of training that an OB/GYN undergoes in a year is literally likely to exceed what a midwife encounters in her entire career. I am going to refer to some horrid articles that appeared in the Post in January. For instance, the Post reported:
Midwives in Missouri and Illinois get their clients through referrals from a trusted source. They typically handle two births a month and get paid $1,500 for their time. Secrecy is essential, which is why the midwives have asked that they not be identified.
2 births a month???? There are physicians who routinely do twice that many in a day. That means that they will have, let’s see 3 babies a day on average over the course of a month, that’s 90 babies. Yep. 45 times as much experience per month as a midwife, can perform emergency surgery, and has a decade of formal medical training to boot. Midwived home births are ALWAYS CLEARLY a horrid choice.
This reminds me of something that a practicing OB/GYN once told me: “If you haven’t had a bad baby, you haven’t done enough deliveries.”
Many evidence-based national and international studies show higher birth rates among births attended by midwives and births with fewer interventions.
I ask you to produce these studies, especially the ones that report on homebirths of the type that are encouraged by this weird new-agey movement. I direct you to a comment made by an EMT who did work in a NICU:
I’m a retired EMT-P and did a lot of NICU/PICU work. Civilians don’t often see what, ‘Go Wrong’, looks like because either it’s a closed casket funeral or the mortician works their magic. One placenta previa with all that blood running everywhere will change their minds about hospitals and babies.
Yep. EMTs agree with me.
People who are making decisions to have children are definitely taking the child’s best interest in mind, especially when they choose to use a midwife. They know that they will get patient- centered care (rather than profit-centered care) and always have the option of obstetrician care at any point in the process.
I’m certain that people who decide to have a home birth with a midwife think that they are doing the baby a favor. I mean, whenever you take 1) monitoring, and 2) the possible of immediate surgical intervention out of the picture, you are putting the baby at additional risk.
The characterization of OBs as “money-grubbing” is ridiculous, and if you had any idea of what it took to just keep your private practice open in the day of insurance company-managed care you would realize that it is impossible to eek out unnecessary charges. The insurance company, if the services you provide cost more than your competitors, will simply drop you from their plan and take its customers to go play somewhere else. There really is not room for “unnecessary” charges.
Obstetrician’s specialize in ILLNESS related to childbearing and in surgery.
Here’s a fact that you will need to deal with. A perfectly, perfectly healthy woman can have a delivery go south real quick. It’s a cord accident. Nobody, not even trained physicians, can predict which woman will have a cord accident. Because of this, medical monitoring is essential, and because there is only a short short period of time between the second the oxygen flow to the rug-rat is cut off to the onset of irreversible brain damage is about 10 minutes, a little under. If you are not monitoring, the clock will start ticking an you won’t know about it. Please explain to me how that is not ALWAYS bad. No advocate of midwifery has ever clarified that point for me.
SavorySweet and BG right on (0.00 / 0)
While untrained and uncertified midwivery activity can be a problem, Certified Nurse Midwives can make a postiive contribution to medical care particularly in rural areas.
Yes, some training is better than none. Nurse practitioners, who are legal and many of whom are a sparrowfart away from medical degrees, can pick up some of the slack. But this is not what we are talking about. We are talking about otherwise rational urban people deciding that they want to give birth in their dining room.
If you haven’t noticed lately, since the stamping out of Medicaid in many states, rural hospitals are going out of business right and left. Many rural women face difficulty in accessing good pre natal care when they must travel long distances to receive it. It is costly and time consuming from many aspects.
If you aren’t willing to drive to town to get comprehensive medical care for your pregnancy, what in the wide wide world of sports are you doing having kids? If you can’t take 4 hours out of your day to get to a check-up…There is something deeply wrong with that argument.
The primary precaution for safe childbirth is good prenatal care.
Which is why you should go see a physician.
The same goes for the actual delivery. A long ride to the hospital may result in a birth enroute. That could be consdered dangerous.
Let’s pretend that it’s dangerous to take a car ride. (In my estimation, having a baby drop out during a car ride is just as dangerous as having a baby drop out at home, except that there is a doctor waiting at the other end of the car ride, just in case.) It’s not as if you’re not going to know that you are going to have a baby and can’t take steps ahead of time to ensure that you are in easy reach of a hospital. That’s just crummy planning. (Some would call it being ridiculously irresponsible.) Now, if a baby is coming early and unexpectedly, if you were making your damned trips to the OB you might have a chance of knowing that you were at risk of delivering early and planning accordingly.
Certified Nurse Midwives are Masters level nurses, work with a physician, provide good prenatal care, and generally cover all the bases necessary for safe home delivery.
Impossible. They can’t do surgery. Most births, a doctor just catches the baby. Really–at the point of delivery, they are as superfluous as a midwife because the mother and baby do all the work. But sometimes you need a surgeon. You need them immediately. And not even Super Nurse can tell when that is going to happen. If that happens, you have made certain that it is harder to get to a hospital.
Any indications that the birth could be problematic will ensure a hospital delivery.
I can turn this one down real easily. I will use the Post articles about Loudon’s misguided crusade.
Even in the two short articles that ran in the Post, you can find what would have been clear cases of malpractice that would could cost a legitimate physician his or her license. Of course, midwives are not accountable, so who gives a tit? Take for example:
“The Illinois midwife has delivered about 425 babies, including 10 sets of twins and 15 breech babies – her specialty, she says.”
The obstetrician said that neurological outcomes for breech births delivered vaginally are not as good as those delivered by C-section. If a physician does this and the baby has neurological damage (for any reason) they are vulnerable to a lawsuit.
In another part of the Post report, the writer highlighted a clinic where there is a legal midwife (actually, it’s still a felony if there is not a doctor in the room, so they have a family practitioner monitoring–not a specialist).
The birth center is a low-tech independent facility for women with low-risk pregnancies, the only one in Missouri and Illinois.
[…]
James enters the room to meet with her; Alleman trails behind.
“I’m ready for this baby to come,” says Oliger, tired and uncomfortable.
Her blood pressure is a bit high. James tells her to slow down and stop working at her yarn shop. She encourages Oliger to be patient and gets her to smile by joking about her baby possibly arriving on Labor Day.
This woman is, as a hypertensive 40 year-old, NOT A LOW RISK PREGNANCY. But at least the midwife made the chick smile while not telling her she was high-risk OB. Medically, smiling’s important. I have a peer-reviewed study from up my ass that says smiling mothers’ babies don’t need as much oxygen. Midwives should be rounded up and put in camps not only for that Labor Day pun, but for putting a woman in a high-risk situation in more peril than she already was.
Physicians have never liked independent Nurse Midwives or other Advanced Practice Nurses. But it is primarily a bottom line issue.
by: tonva
Horse manure. Seriously, did you see the clear deficiencies in the only two cases the Post cited? It’s not a bottom line issue. If it were a bottom line issue, certainly insurance companies would wholeheartedly embrace, fuck, mandate home births. This of course is not the case.
As a closer, I would like to highlight what happens when a midwife has power over an actual physician. This sad tale comes from our military, where a doctor was outranked by a midwife:
Family wins $24 million over delivery that left child disabled
By Nicholas J.C. Pistor
ST. LOUIS POST-DISPATCH
06/02/2007EAST ST. LOUIS – A federal judge called a botched baby delivery an “unhappy story” and ordered the federal government to pay a former Scott Air Force Base military family $24.5 million.
Chief U.S. District Judge Patrick Murphy issued the order Thursday, writing that Toby Tremain, a child born to Steve and Evelyne Tremain in 2003, is profoundly impaired by reason of cerebral palsy resulting from sub-standard medical care provided by the Air Force.
“She got a midwife instead of a doctor,” said Bruce Cook, a veteran Metro East-area lawyer representing Tremain. “Now, the child is tragically injured.”
Court documents say Lt. Col. Shari Stone-Ulrich, who was stationed at Scott, was practicing midwifery at St. Elizabeth’s Hospital in Belleville for the Air Force during Evelyne Tremain’s delivery. Stone-Ulrich, according to the judge’s order, failed to call in an obstetrician when the pregnancy “went downhill.”
Murphy wrote that the Air Force medical providers confused military rank with what was best for the patient. Stone-Ulrich was a superior officer to Tremain’s obstetrician, Dr. John Smith. She was a major at the time; he was a captain. Throughout the delivery, the judge ruled, Stone-Ulrich was treated as if she were a physician.
Scott AFB has an agreement with St. Elizabeth’s Hospital, where Air Force doctors are allowed to use the hospital’s facilities. The practice of midwifery at St. Elizabeth’s must be supervised by a physician and is limited to uncomplicated deliveries.
Tremain was 37 years old and had had a cesarean section during another pregnancy. She was warned by Smith that a “midwife delivery was not appropriate.” She got a midwife delivery anyway, the judge ruled.
During the night of the delivery, the judge found, there were signs that the baby’s heart rate was worrisome. But the midwife kept calling the shots.
Finally, Smith was called in. He performed surgery and found the baby half extruded from his mother’s uterus into her abdominal cavity. The baby – reported to be listless and blue – was transferred to St. Louis Children’s Hospital. He survived and is now 4 years old.
Murphy ruled that the child, Toby, will never live a normal life and ordered the multi-million dollar verdict for his future care.
The Tremain family now lives in New Jersey. It is unclear whether the federal government will appeal the ruling.
HJ