| April 3, 2006
Midwives are being prosecuted for supervising home births.
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Paradoxically, as a board-certified Ob/Gyn who practiced in a rural setting for 14 years, I don’t object to lay-midwifery and home births.
What I do desire is for all practitioners, whether cardiothoracic surgeon, naturopath, Ob, or midwife to take responsibility for their actions.
If you’re going to offer health or disease management be responsibile enough to offer the complete package, or take responsibility for the incomplete package you offer.
Two examples in my own experience come to mind.
A lay midwife brings a primip at term into L&D after 3 1/2 hours of pushing at 8-9 cm. Exam reveals complete breech. Midwife’s comment: “I wondered if that was so.” The patient went complete and prior to the arrival of the OR team (rural hospital and) the patient delivered a healthy boy, but not until after I reduced a nuchal arm.
A naturopath called me up one day to announce she had a method for reversing cervical dysplasia. The naturopath wanted to be able to refer patients for pre and post treatment colposcopy. I sent her literature regarding where she could take a colposcopy course.
We should get rid of all the midwives, as well as all the OB-GYNS. The lawyers can deliver their clients babies. Women in this country don’t deserve sterile deliveries.
To Anon 4:25 PM
You’re displaying your ignorance.
There’s no such thing as a sterile vaginal delivery.
I’ve done a bunch of deliveries. What goes on in hospitals is more sterile then what goes on in the hood when one of my 13 year old patients delivers at home. Not that anyone cares what happens in the hood.
Since the late 1900s, medicine has been waging a war (born of greed, professional vanity, sexism, and male fear) against midwifery.
Yet, study after study has shown that midwifery is a BETTER alternative for low risk women.
Ahh . . . but medicine is not about evidence, it’s about power and profits. You doctors would rather lacerate and wound woman and get yr Lexus, then really help women.
We must be a pretty stupid bunch. Pick a specialty where lawyers can’t keep their fingers out of our Butts, do 5 years of the worst residency hour-wise their is (pregnant women don’t seem to pick bankers hours to have their babies) and even when residency is over, having to come to the hosptal at ungodly hours, just to have some sodomite get rich when you’re the one on call when a baby with CP is born, then have morons like the geezer above say you’re out there only to lacerate uteruses. By the way, I drive a 1998 that needs $2000 worth of repairs I can’t afford.
“The news article also related that the charged midwife needed to perform CPR on the newborn immediately after delivery. Was she certified in NALS (Neonatal Advanced Life Support)? How many intubations had she performed in the past year? Does she know to choose the right endotracheal tube?”Most OB-GYNS don’t know how to do cpr/NALS either on an infant, that’s done by pediatricians.
“By the way, I drive a 1998 that needs $2000 worth of repairs I can’t afford.”
I can’t imagine why you don’t get paid enough to get a better car.
In response to Dr. Rack:
Well, how available was pediatric support? Same premise.
The premise of midwifery is: “If nothing goes wrong I’m your best friend, but if something goes wrong, you’re on your own.” $1500 please.
This from the toxic vitriol of anonymous 6:01. “Ahh . . . but medicine is not about evidence, it’s about power and profits. You doctors would rather lacerate and wound woman and get yr Lexus, then really help women.”
If one reads the article, it is clear that this midwife did perform an episiotomy. This is the “lacerate and wound woman” to which anonymous refers to as a brutal medical practice.
“Alternatives” to mainstream allopathic medicine should be licenced. Licensure is necessary to ensure that practitioners of any trade are adequately trained to the standards of their trade’s general standards, maintain proficiencies, and maintain liability insurance to compensate potential victims.
An informed populace could then choose from among differing schools of practice upon the basis of quality, practice style, and cost effectiveness (i.e. not just the cheapest, but the best value for the buck).
Ever try logic? It would be a new experience. Yes, doctors wound and lacerate on a FAR GREATER scale than midwives. Just look at the cites. And, they do so for no reason. Consider episeotomies. Standard practice for decades (helps forceps delivery_, yet recent studies show that it is of no use generally–but doctors still do it routinely. Evidence-based medicine . . . please
As for licensure… what a bunch of nonsense. All license do is raise barriers to entry and allow practitioners to make more money. As Milton Friedman argued decades ago, let the market take care of matters–it will flush out the quacks.
“Consider episeotomies. Standard practice for decades (helps forceps delivery_, yet recent studies show that it is of no use generally–but doctors still do it routinely.”
YOU’RE A MORON!! AT least in the U.S., doctors are doing much fewer episiotimies….because they have to do so many more C-Sections to avoid the John Edwards crowd.
Do you really think physicians get some kind of Bizaare pleasure by doing a vaginal incision? DOn’t you think at 4 am a physician would much prefer a NVD, no complications, takes 10 minutes, then they can go back to sleep? But why assume you understand anything, since you are a complete and utter moron.
As the below article discusses, there never really was any evidence-based rationale for episiotemies. Yet, the practices continues–and was standard until only recently.
Why is that? I thought medicine was supposed to be an empirical science? If it is not (which it isn’t in this instance), perhaps we should examine doctors’ need to control, express their anger as reasons for brutal procedures they so routinely perform.
To Anon 9:35 PM
“As for licensure …. what a bunch of nonsense.”
Interesting. Sounds good. The “pilots” who took over the planes on 9/11 didn’t have licenses. Maybe my 13 y.o. should be allowed to drive cross-country this summer. I’ve never given general anesthesia, but I’d like to try it. While were at it, lets get rid of all building codes. There’ll never be another earthquake in California. My drunk neighbor should be allowed to prescribe narcotics. He thinks clearly between 11 am and 4 pm. Makes sense.
“perhaps we should examine doctors’ need to control, express their anger as reasons for brutal procedures”
Moron: SInce most OB-GYn’s these days are female, and females do not express their anger in violent outbursts, maybe you should stop blogging and call the Samaritans and discuss YOUR anger before you do something dangerous to yourself or others. What happened in your life that makes you so angry about this procedure?
you do realize that the MIDWIFE did the episiotomy in this case, not a doctor. Why arent you raging on her?
Episiotomy usage is dropping… its not gone yet and there are still some doctors who do it routinely. You are talking about a profession of tens of thousands of people here. Yeah we’re still purging it out of the profession, nobody said we were perfect.
Medical professionals get scrutinized more than any other group. Lawyers dont have to worry about their procedures being “validated” by outside science. Accountants dont have to worry about it either. Doctors are one of the few professions which are judged against science. Thats a much higher burden than lawyers, CEOs, accountants, bankers, or most others have to deal with.
I have read through most of these posts and I must say, respectfully, that everyone seems to be missing the point. This is about the right to choose for a set of expecting parents. There is a place for the medical community but that place is for the truly sick. In most cases, it can be determined early on if there are going to be complications. I have 3 children who have all been born very successfully at home. Each time, there was a team of 3 midwives who all had college level training in midwifery. They treated my wife as a healthy athlete training for a marathon. They educated us on proper nutrition, exercise and trained us both on what to expect in delivery. Yes, things can go wrong, but we had a plan for that as well. I would challenge anyone to compare the death rates around the country between homebirths and hospital births. Even worse, I’m certain, are the after birth complications due to all of the intervention that is done in the hospital. There are probably doctors in our country who are wonderful at delivering babies but the experience of having a child enter the world at home is unbelievable. I have told my expecting friends that if they truly research the benefits of homebirth and still choose a hospital birth, then I will stand with them 100%. It is their right to choose and we don’t need the government stepping in to make that choice for us. Don’t forget, if you put some sort of government regulators out there watching midwives in action, you are invading MY privacy and coming into MY home and that is something I will not tolerate. The midwife is there to assist the mother in delivery. Not the other way around. I have no problem with requiring midwifery licensing and periodic certification exams (I believe they do this in Florida where my first was born). Just keep out of my home. Besides, if you take away the rights of parents to use a midwife, you will increase the number of parents who still give birth at home without any assistance and that will be dangerous.
I have a problem with the same old Doctor’s worn out statements…”Women in this country don’t deserve serile deliveries.”
Why don’t we? Show me some evidence that backs up your claim. Who in the heck are you to make such off the cuff remarks? What is it that any patient at all deserves from you?
Does your wife, and baby, deserve a sterile delivery? Obviously not, as you stated ALL women! Also, why is it not possible for you to speak without name calling? Are you 12?
Do you tell the nurses in your ER that they don’t deserve sterile deliveries? Can the nurses even stand you? Do you talk like you type?
It’s to shock you, to make you angry at the lawyers, to make people understand they are the real problem. I obviously don’t mean it, I don’t practice what I preach. It’s such a helpless feeling to sit at work, and tell a patient, who I generally like (alot) that I have to do tests on them I know they don’t need. It seems that nobody os listening, we are in the hospital 24/7, and all we get is stabeed in the bad for bad patient outcomes which are not our fault. There’s another doc on here who generally believes his anger against patients, I am actually another person when I am around patients. I just hate the lawyers that are profiting from natural human causes and making it seem like we are deliberately hurting the patients we care for. F You CJD and other lawyers with your un-informed Know-it all answers, but this is the absolute truth.
I knew there had to be more to you than your hate filled ramblings. You are in one of the best professions in the world. You are allowing it to make you far too bitter.
I’m sorry there are some people who run right too an Attorney when one little thing happens to them. Most people don’t, we understand Drs are human. There isn’t one person any where who hasn’t made a mistake at work.
Dr. Pho’s BLOG has enlightened me about this problem. I knew it existed but not to the extreme that it seems too. But, what can we do? It’s the folks not coming here, (they are taking cruises on your money) that are abusing everything. Their the ones that make us blame you for defensive medicine, and are making you guys hate patients. Those people couldn’t care less.
There has to be a solution but what is it?
In response to Michal Racks question, “Was she certified in NALS (Neonatal Advanced Life Support)? How many intubations had she performed in the past year? Does she know to choose the right endotracheal tube?”
I can answer that. The answer is yes she is certified. As is my wife who studied with the particular midwife. As is ANYONE who EARNS the C.P.M license. You can’t take the C.P.M. test without first being certified.
I would like to also emphasize that this is about the right to choose your birth experience. This isn’t about what you think is right, or who you think is a nut freak or hippie. It’s about the freedom to make informed decisions. It’s about the government staying the hell out of my business and out of my home. Pregnancy is NOT a fucking illness.
“Pregnancy is NOT a fucking illness.”
Then how else do you get it?
To Anon 5:28By immaculate conception,which is an extremely rare occurrence, and has been reported only once this past 2005 years.
really? I run across immaculate conception a couple times a month in my ER.
“tell a patient, who I generally like (alot)”
You are a fool to actually like your patients…if you made a mistake or missed a cancer they will come back and sue you…see how much you like them then…just stick to the other part of your post and do defensive testing…that’s the ticket…
i can also attest that as a homebirth midwifery student, it is absolutely necessary that we have our Neonatal Resuscitation Certification before graduating or sitting for our NARM exam.
Midwifery is about providing women with a choice given all the information that is available. It is about allowing the woman to reclaim her body and her freedom over her body.
All of the discussions about defensive medicine is what influenced my sister’s decision to go with a midwife.
“There has to be a solution but what is it?”
I know this isn’t the end all, but personally, when I’m sitting in the ER deciding what test to order, I think to myself “I wouldn’t order that test if there were malpractice caps”. If I was 100% guaranteed not to pay out of my own pocket if sued I wouldn’t be so defensive. And no, it’s not currently gueranteed.
I remember a case when my collegue’s refusal from a defensive test actually saved the doctor from possible malpractice suit.The doctor listened to her complaints of abdominal discomfort and nausea and wanted to do a uterine biopsy. When she asked was reluctant, he told – “what if I were to tell you that it is almost certainly cancer….”. She didn’t like the answer, refused and decided to look for another doctor. Some days later she miscarried – she had been pregnant. The first doctor didn’t even bother with a pregnancy test. Maybe he thought she was too old – she was in her 40s, but her 1st child was only 4 year old then, and while she and her husband weren’t trying for another child, she would have been happy if it “just happened”. Granted she herself thought she can no longer have children, but still… .
The new doctor did a D/C after miscarriage, when she asked while she had had felt discomfort, he answered “I guess this is how your body reacts to pregnancy”.
Now imagine she had agreed to the biopsy and then had the miscarriage. She would’ve most certainly blamed the first doctor – it is hardly standard of care to do uterine biopsies on pregnant women. Given that she was upset when she miscarried, I imagine she would’ve been really mad if she thought there was somebody to blame. I think she was pretty litigious too, from what I remember.
“I know this isn’t the end all, but personally, when I’m sitting in the ER deciding what test to order, I think to myself “I wouldn’t order that test if there were malpractice caps”. If I was 100% guaranteed not to pay out of my own pocket if sued I wouldn’t be so defensive. And no, it’s not currently gueranteed.”
So let’s get this straight. If there were caps on noneconomic damages you would do your job? In other words, money is all that motivates you? I think we’ve found one of your problems. If money is the only reason you do your job, you’ll never be happy, as you illustrate daily.
Your other problem is your complete inability to reach a conclusion that is based on the evidence. Non-economic caps won’t change the fact that a devastating injury which renders someone unable to work is probably a case far in excess of $1 million anyway. The majority of most med mal verdicts are for economic damages. This isn’t a windfall for the plaintiff – it’s for their future and past medical care. Their insurer, if they have one, gets paid back for past medical bills they’ve paid, and their future medical bills go right back to the health care industry.
The other economics is money they would have earned anyway through working. But they can’t work now because your negligence robbed them of that ability.
” I think she was pretty litigious too, from what I remember.”
Just because someone threatens a lawsuit doesn’t mean they will actually be able to find a lawyer to file one. If you’ve ever talked to a med mal lawyer, which I’m sure none of you have, they’d tell you they turn away 10x as many cases as they accept.
The funny thing is, you guys could cut your chances of patients going to even see a lawyer in 1/2 if not more if you actually talk to them and treat them like humans. Novel concept, I know.
“The funny thing is, you guys could cut your chances of patients going to even see a lawyer in 1/2 if not more if you actually talk to them and treat them like humans. Novel concept, I know.”
Wow you actually know how doctors practice in real life from reading a stupid blog of what people write (if they even are doctors)??
Actually, I know from reading studies by physicians about the issue. As well as talking to the patients and lawyers who they go talk to.
But here, so you have it from a physician, see Dr. Hickson’s findings:
WHo needs 4 years of med school and 5 years of residency if you can read about medicine from patient depoisitions and lawyer statements of “I remember a case when I was younger”. I should go to the state capital and hang out in the Lawyer’s toilets so I can pick up some of this first hand “between the stall” information. That’s gotta make these lawyers more knowledgeable then any of us who practice medicine every day.
” knew there had to be more to you than your hate filled ramblings. You are in one of the best professions in the world. You are allowing it to make you far too bitter.
I’m sorry there are some people who run right too an Attorney when one little thing happens to them. Most people don’t, we understand Drs are human. There isn’t one person any where who hasn’t made a mistake at work. “
lOOK AT ANON 1105 AM’S RESPONSE TO OUR COMMENTS. THIS LAWYER RESPONSE IN ITSELF JUSTIFIES WHY WE PRACTICE DEFENSIVE MEDICINE. THERE ARE OVER 1 MILLION LAWYER PARASITES OUT THERE.
” THIS LAWYER RESPONSE IN ITSELF JUSTIFIES WHY WE PRACTICE DEFENSIVE MEDICINE.”
Because you’re a coward? We already knew that.
“WHo needs 4 years of med school and 5 years of residency if you can read about medicine from patient depoisitions and lawyer statements of “I remember a case when I was younger”.”
Or you could read the studies by other physicians. But you should let your nonsense opinions be corrupted by facts – that’s no way to learn!
Why are you guys trying to justify defensive medicine or explain why you do it…just do it…these idiots will keep suffering the consequences of unnecessary copays and side effects…and they’ll eat it up!
“I notice that the lay midwife in the subject news report charges approx. $1500 for pre-natal care and delivery. My average remuneration for the same, being boarded in OB, is approx. $1200. And that needs to cover office overhead and malpractice premiums. How much do you think that midwife pays for overhead and insurance. I hope the midwife enjoys her Lexus. She should have no trouble paying for it.”
That’s funny because I still owe well over $2000 from the prenatal care I received during my pregnancy with my son.
That did not include the over $15,000 hospital charges and delivery charges and all the “standard procedures” they did and the poor and out-dated breastfeeding info I was give. It did not include the charges incured when my son became a separate patient and as a result received other medical bills for him.
The $1500 is prenatal care by someone CERTIFIED who also provides personable care, the homebirth, staying with me and my daughter for several hours after, cleaning up, making sure the breastfeeding is off to a good start, making a housecall 2-3 days later to check on us as a mom and baby as well as checking on the breastfeeding, and another visit with her for the 6 week post-partum.
Does your $1200 cover all of that? Do you do housecalls of your breastfeeding moms to make sure they are off to a healthy start? Do you stay with all of your moms for 4 hours or more after the birth and make sure that both mom and baby are well?
I would imagine not. I know the OB who delivered my son only showed up to “catch” him and when it was not time (on his schedule) he told the nurse to up the pitocin so he could be home in time for dinner. When it was time to push, he got mad at me for peeing. (What do you expect when I’m being forced to have numerous IV fluids.) He left right after the birth and I never saw him again. He never listened to me. He never respected me as a woman, as a mother, as an individual.
My midwife genuinly cares about all the moms. She answered any questions I had no matter how strange they may have been. She never belittled me. She treated me with dignity and respect. SHe let me know I can trust my body to do what it was designed to do. Give birth without having to go by someone else’s timetable, and breastfeed.
The British Medical Journal validated through exhaustive, detailed research the same conclusions I instinctively came to when I learned about homebirth.
It is just as safe if not safer than hospital birth for low-risk women.
I recently found out that my husband and I are expecting again. I am having another midwife attended homebirth. I have an OB back-up just as I did with my daughter. (Different OB than what I had with my son.) My OB knows that I am a homebirth mom. He fully supports my decision.
For every “homebirth horror story” shared here, there are just as many if not more “hospital horror stories” to go around.
The last comment was very well written and the lady was not well served by the OB at her first delivery and obviously well served by her midwife at her second.
That said, I would like to point out what I think is a mistake in thinking on the part of both the OB community and midwifes.
I think the nut of it all is that OB’s are trained as high-risk physicians and surgeons and lay-midwifes are not trained to any significant degree in management of complications of pregnancy and obviously not as surgeons. Neither profession is bad, but, to use the old phrase, it’s like comparing apples and oranges.
Because pregnancy is not a disease, and in most instances progresses to a normal, natural conclusion without abnormal sequelae, it didn’t matter, for the majority of my patients, if they came to me, an OB, or stayed at home, and delivered with or without a lay-midwife. Occasionally, if asked, I would state that 70% of my OB patients didn’t need me and would do just as well staying home with a good, experienced, old-fashioned grandmother.
Doctors, whether physicians or surgeon, in my opinion, are not health care professionals, they are disease managers. In fact, that’s the point. OB’s are there, and are virtually exclusively trained, and for practical purposes, only interested in, management of complications of pregnancy. That’s not to say we want anyone to have a complication, but we know complications happen.
The mistake patients make, and this is my opinion only, is that some go to an OB, and perhaps not articulated or consciously, expect lay-midwife care and some go to lay-midwifes expecting an ability regarding disease recognition and management approaching that of an OB, but get a good grandmother. Nothing wrong with a good grandmother.
A final point. I wasn’t familiar with what a “C.P.M.” was so I googled it.
Seems that it means “Certified Professional Midwife,” So I was curious. What would it take for me to become a “CPM.”
Seems, among other criteria, that you need to participate in 20 births and be primarily responsible for 20 more. That’s it! 40 births.
I don’t know, maybe the students we let into medical school are retarded, and the CPM students are brillant, but that’s about the amount of deliveries we expect a third year medical student to attend and manage. To become an OB you have to do at least one additional clerkship in medical school plus four additional years of training.
But I’m probably guilty of comparing apples with oranges. If there’s nothing going on, all you need is a good grandmother. They’re available for $1500.
“Seems that it means “Certified Professional Midwife,” So I was curious. What would it take for me to become a “CPM.”
Seems, among other criteria, that you need to participate in 20 births and be primarily responsible for 20 more. That’s it! 40 births.”
Before you get too excited, you should know the average community supporting direct-entry midwives (yet another google for you) isn’t teeming with women ready to offer up the chance for a student to participate and/or manage her care. Unlike med students, we can’t just show up in a room with gloves and catch a baby. It takes time and finesse to build a community relationship of trust to be invited into that position. So it is often tens more than 40 births the student will have attended, participated, managed, and been the primary midwife for by the time she is ready to sit for the credentialing exam.
Whether or not medical students are morons is debatable For one, we get specialized midwifery/obstetrical, and well-woman/gynecological edcucation. We don’t spend (valuable, yet useless) time on rounds in the ER, surgery, nephrology, oncology, etc. For another, we are similar in that usually it is a 3rd year midwifery student that starts to hold that caseload you describe, while under supervision.
I would definitely say the situation is rare that a student midwife knocks out 40 births and is a credentialed midwife. In addition to those “small” requirements there are a couple hundred pages of education, skills demonstration or verification, clinical visits to document, and a lengthy exam to complete. Having just completed the process myself I can attest that it wasn’t easy.
In about a week I am due to give birth to my first child and because of a move I switched to a new OB only one week ago. This doctor wants to force me to have a C-section because of my child being rather large (over 9 lbs at the ultrasound). However I am healthy, and my family (and his) have a history of large babies being born naturally. His lack of concern for my wishes and treatment of me – trying to scare me into a C-section when I am well aware of research on the subject – make me want to find other alternatives to a hospital birth. Even the docs on this site and other can’t seem to offer many reasons why I shouldn’t home birth. This is especially distressing because I found out that doctors can get court orders to force me to acquiesce to their wishes when there isn’t even research backing them up!
What happens to so many doctors that causes them to treat pregnant women like ignorant irrational fools? I value doctors but they often do not seem to treat patients like human beings. I wonder if it is fear of malpractice suits (which does not, contrary to some opinions on this website, make doctors ‘money-grubbing’), the whole medical school process, dealing with gallingly boorish patients or just seeing sick people at all hours that causes so many MDs to treat good patients like shit.
Don’t know if this is still active…I have a friend who is quite petite (less than 5′ tall and very slender) who was told by her OB at 38 weeks she would need a C/S b/c she was too small to deliver vaginally. She got scared and angry and hired the community’s best midwife, who reviewed her pregnancy and medical history and two weeks later ‘helped’ my friend to deliver her 7.5lb baby girl in the water at home. A safe, normal delivery. No cutting, no painkillers (except warm buoyancy), no interventions or fear.
Defensive medicine is why women leave OB situations.
I cannot beleive the range of opinion, and ignorance…
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