Someone is going to get hurt - Lay Midwives

[countressrascal]

I am OB/GYN call this weekend-I wanted to add something to all this talk about non professional midwives. In the community that I live in we have two of them, one who works with our clinic all the time communicate about her patients because if she gets in the weeds we will help her out. Count is OB/GYN Family Practice and I am Nurse Midwife. The other will not communicate with us at all because she has a calling to deliver babies and special gift of knowing and healing her patients-quote from her. The two do not get along at all. A couple months ago the second midwife was caring for a patient that needed a higher level of care, she has multiple medical issues along with her pregancy. I called her and told her that I thought that she was over her head and she needed to release the patient to us for care. Of course she would not because she has this special gift of healing. Since she was also seeing us for other medical issues, I tracked her pregancy and made sure that I was in town around her due date because I knew backup would be needed and even air evac, which midwife can not order. Guess what complications did happen, to the point that both the mom and fetus almost died, due to the fact that midwife did not call for help fast enough, then when she did instead of calling the clinic she called 911. Small community know who to call when they get that type of call, we got the call and transported the patient to the clinic/hospital and called the AirEvac and saved both of them. Midwife was pissed because we airlifted her out and she had to have a C-section which now prevent her from having a homebirth. Hopefully this is her last with her medical history she does not need to get pregant again, next time she might die and I have told her that.

Here is my issue with lay midwives is that they do not have the equipment nor the medical knowledge to handle complex medical issues that could come up during labor, plus they don't do a very good job in prenatal care, since majority is done in the patients home. Example we are required to urine samples on every visit and blood work on a regular bases, they don't do any of that. Plus they reply on nonstandard medical methods to spend along labor. I read Zsu posting about her seeing a chiropathor and having a massage within 2 weeks of her due date that is very risky it could cause the fetus to have a bowel movement which would cause an infection now and at birth. I know that Count and I are ebil medical professional however we do care about the safety and well being of both lives.

As I said before I have a gut feeling that something is going to go wrong with Zsu delivery and her newest special snowflake, I hope I am wrong.

[Swamptribe]

the whole midwife thing worries the hell out of me. Years ago, a relative insisted on having a home birth with a midwife. The pregnancy supposedly went fine, when she finally delivered, the baby was born with no breastbone, and intestines on the outside. The midwife ran screaming from the house. Luckily the husband was a cop and knew how to handle an emergency.

Way to many things can go wrong even in a seemingly routine pregnancy and delivery. If you live in a developed nation, and you are to friggin cheap to pay for a hospital delivery, then you probably shouldn't be having children. If you are more worried about money than the health of mother and child, being a parent is not for you.

PS, my deliveries were monitored by a nurse/midwife, in the hospital.

[Deleted03]

the whole midwife thing worries the hell out of me. Years ago, a relative insisted on having a home birth with a midwife. The pregnancy supposedly went fine, when she finally delivered, the baby was born with no breastbone, and intestines on the outside. The midwife ran screaming from the house. Luckily the husband was a cop and knew how to handle an emergency.

Way to many things can go wrong even in a seemingly routine pregnancy and delivery. If you live in a developed nation, and you are to friggin cheap to pay for a hospital delivery, then you probably shouldn't be having children. If you are more worried about money than the health of mother and child, being a parent is not for you.

PS, my deliveries were monitored by a nurse/midwife, in the hospital.

If you live in a developed nation, the STATE should pay for deliveries. Enough poor people bashing. Having babies is a wealth for countries and particularly developed countries. Plus it often costs more money to have a homebirth than a hospital birth, so really wrong argument here.

Countress, I hear you. But I also know that in Canada - Québec and Ontario, the midwives training is very exclusive and very good. Most of them though are in birthcenters (which I personally prefer to hospitals and homebirths). So there are so midwives that are trained for these kind of things.

I think the answer is to have properly trained midwives that are answering to someone, rather than just have very few on the side, where sleazy women or men can pretend to know anything about what they are doing.

[emmiedahl]

Generally in the US, the government will pay for a hospital birth for low income women but not a homebirth. So women who do it at home are not doing it for financial reasons, unless they have some ideological issue with medicaid.

The pregnancy and birth affect the baby as much or more than anyone else. A helpless infant should not be punished because someone else disagrees with their parents' financial choices.

[duplessis3]

One of my best friends is a midwife and she does the urine every time (not bloodwork though amd in my pregnancies i never had anyone want blood every single time) she refuses high risk pregnancies too. There was a midwife in town who was one of those jerky spiritual ones who wouldntgo with moms she transported. Seeing as my community has a 35+% c section rate with one doc clocking in at a 65% rate, a hospital that requires a 3 hour post birth seperation from mom and baby and women giving birth in corridors...you choose your poison i guess but a helluva lot more can go into gome birth choice. (I had a doc doing prenatal care for me but hada homebirth. Why? Because when we went on the hospital tour, there was blood on the warmer. Among other things, including a sexual abuse triggering delivery at a hospital with my first.)

[emmiedahl]

Out of curiosity, why were you bothered by having blood on the warmer? I have a history of postpartum hemorrhage so they always make sure they have some O- ready to go.

[Witsec7]

This is a oft reviewed subject at FJ. Suffice it to say medical personnel need medical training. How hard is that to understand?

[valsa]

This is a oft reviewed subject at FJ. Suffice it to say medical personnel need medical training. How hard is that to understand?

Pretty hard for people who think education and professional training come from straight the devil and personal "callings" and the ability to "heal" come from God.

[Witsec7]

Pretty hard for people who think education and professional training come from straight the devil and personal "callings" and the ability to "heal" come from God.

I always miss the fine print :D

[Lala29]

How is having chiropractic work and a massage dangerous to the fetus? I think you are overexaggerating a bit.

And your last statement contradicts what you said. One of the direct entry midwives keeps in contact with you guys, transfers people out if they risk out, etc. The other one is a crap direct entry midwife. My first OB in my first pregnancy would routinely forget I was pregnant before I came in for my appointments (aka didn't read my chart). Thank God I switched OBs, because the second one saw a spike in my BP at 36.5 weeks, ordered 24hr urine and found out I had mild pre-e. Had I had the first, I'm sure it would have gone unchecked, since my BP was not super high (140/90, regularly 120/80).

All that to say, yes, there needs to be more training, similar to Canada and Europe, but banning homebirth (Europe does a lot of those and it turns out just fine for low-risk pregnancies) and saying massage is dangerous is being overly dramatic.

[emmiedahl]

There is increased statistical risk of certain complications with massage in pregnancy, some people care about that. The risk is mitigated if you choose a massage therapist who has been specifically trained in prenatal massage.

Zsuzsu does not give a fuck about risk; she is eating organic and trusting in God so nothing bad could possibly happen as long as she avoids the perverts in traditional medicine.

[pixydust]

There is increased statistical risk of certain complications with massage in pregnancy, some people care about that. The risk is mitigated if you choose a massage therapist who has been specifically trained in prenatal massage.

Zsuzsu does not give a fuck about risk; she is eating organic and trusting in God so nothing bad could possibly happen as long as she avoids the perverts in traditional medicine.

Why aren't message therapists perverts? They put their hands all over your naked body. Sounds pretty pervy to me!

[emmiedahl]

Why aren't message therapists perverts? They put their hands all over your naked body. Sounds pretty pervy to me!

But if someone wants to touch you and they don't have an education, no perversion there. It is only the trained and educated who can be defrauded. :D Or something like that.

[Deleted03]

How is having chiropractic work and a massage dangerous to the fetus? I think you are overexaggerating a bit.

And your last statement contradicts what you said. One of the direct entry midwives keeps in contact with you guys, transfers people out if they risk out, etc. The other one is a crap direct entry midwife. My first OB in my first pregnancy would routinely forget I was pregnant before I came in for my appointments (aka didn't read my chart). Thank God I switched OBs, because the second one saw a spike in my BP at 36.5 weeks, ordered 24hr urine and found out I had mild pre-e. Had I had the first, I'm sure it would have gone unchecked, since my BP was not super high (140/90, regularly 120/80).

All that to say, yes, there needs to be more training, similar to Canada and Europe, but banning homebirth (Europe does a lot of those and it turns out just fine for low-risk pregnancies) and saying massage is dangerous is being overly dramatic.

I just want to say that homebirths are extermely rare in France. But when you go to the maternity ward midwives are the only "nursing" staff there. it's a separate discipline and teachings.

[Witsec7]

I had a teaching CNM attend me after I transported. She stayed with me for the full 9 hours. (Baby girls 27th is on Monday :D )

[Glass Cowcatcher]

I get the feeling that the site is somewhat controversial around the internet, and it is at times inflammatory, but [link=http://skepticalob.blogspot.com/]The Skeptical OB[/link] posts a lot of cases where people do, indeed, get hurt by homebirths.

[Arete]

I just want to say that homebirths are extermely rare in France. But when you go to the maternity ward midwives are the only "nursing" staff there. it's a separate discipline and teachings.

Lala, nurse midwife training in the US is just as good as nurse midwife training in Canada and Europe. There is no "improvement to get to their standards" required. What is a total joke is these fundy women or hippy dippies that call themselves "midwives" when they clearly are not. I also call bullshit on this "lay midwife" training some states have. You either go through the rigorous training and education to be a nurse midwife, or you have about as much business delivering babies as I do. Home birth doesn't need to be banned but these baby catchers need to be cracked down on.

[Muriel]

I just want to say that homebirths are extermely rare in France. But when you go to the maternity ward midwives are the only "nursing" staff there. it's a separate discipline and teachings.

I was about to say the same, I'm often surprised to see that Americans view us Europeans as one country "Europeans say that" "Europeans do that", but in most case, it's not true at all... It would be the same saying Canada and USA are the same country :roll:

Sorry but it's a pet peeve of mine :oops: :D

[Lala29]

Yes, people do get hurt in homebirths. They also get hurt in hospitals.

I am all for making sure midwives are medically trained professionals, with all the vigor that entails, 100%. That, I believe, would make the risk a lot lower. Homebirth is also not for anyone who is not low risk, either. In certain parts of Europe (Netherlands, for example) homebirths are attended by TRAINED professionals.

As for Dr. Amy, I hate her with a fiery passion. She fear mongers a lot, and I just can't get behind someone like that. Especially someone who views any blip as a reason for c/s.

And if it helps, I've had one 'natural' birth (before viability, but whatever) and 2 c-sections, for different reasons. I am not against hospital births at all, in fact, it's where I feel most comfortable. But I won't rail against low risk mothers choosing to homebirth with trained professionals who will transfer when problems arise either.

Lala, nurse midwife training in the US is just as good as nurse midwife training in Canada and Europe. There is no "improvement to get to their standards" required. What is a total joke is these fundy women or hippy dippies that call themselves "midwives" when they clearly are not. I also call bullshit on this "lay midwife" training some states have. You either go through the rigorous training and education to be a nurse midwife, or you have about as much business delivering babies as I do. Home birth doesn't need to be banned but these baby catchers need to be cracked down on.

I agree CNM training is really good here in the States. However, the majority of CNMs can not do homebirths. I wish there were ways to get certified to do homebirths like other countries are able to do.

As for lay midwives, they terrify me. Some are really, really good, like Countressrascal mentioned, who keep in contact with OBs and make sure to transfer when problems come up. The majority though, are like Jill Duggar, who use prayer as a major component of their 'care'.

[Witsec7]

I need some help with this. AR permits these midwives to serve poor women with low risk pregnancies. Doesn't poverty, at times, put a woman's pregnancy at risk?

[Arete]

I need some help with this. AR permits these midwives to serve poor women with low risk pregnancies. Doesn't poverty, at times, put a woman's pregnancy at risk?

Just another example of a southern state setting the bar lower for its poor or minority populations. Nothing to see here, move along. ;)

[emmiedahl]

I think a lot of times, it is the higher risk moms who go with the lay midwives precisely because a CNM will not take them on. Maybe I have just been reading too much at mothering.com, but it seems like many women get into this lifestyle by going to an OB who does not support risky choices. They get freaked out by the idea of a birth that is not completely under their (completely uninformed) control, and then shop for a midwife who will do the birth their way. Often the CNM's are not any more interested in trying a home birth for a high risk pregnancy so they are left with the untrained midwives.

There is no easy solution to this issue. Many women are mistrustful of modern medicine and will not take into account the very real risks. We have seen people we follow on FJ have terrible outcomes or very close calls that most of us would see as a wakeup call (like Zsuzsu). No one wants to talk about the tragedies in homebirth, but they are there. The statistics collecting is poor and inadequate, like if you are transported to a hospital and die there it is recorded as a HOSPITAL death and not a homebirthing one. Modern medicine is not out to get anyone.

[icecreamycakeycake]

There is increased statistical risk of certain complications with massage in pregnancy, some people care about that. The risk is mitigated if you choose a massage therapist who has been specifically trained in prenatal massage.

Zsuzsu does not give a fuck about risk; she is eating organic and trusting in God so nothing bad could possibly happen as long as she avoids the perverts in traditional medicine.

I was in a car accident early into my PG and suffered a back and neck injury. Not being able to properly DX because I was PG, and unable to take medication, my only relief was PT. I had threaputic massage, US and (oddly enough) inversion therapy. My PT and DR both advised discontinuing PT after about the 6 month mark just to avoid any additional risks.

[lilwriter85]

Just another example of a southern state setting the bar lower for its poor or minority populations. Nothing to see here, move along. ;)

This. I also kind of worry about Jill Duggar being sued if something goes wrong in a delivery or she does something wrong. I don't like Jill that much as a person, but I would hate to see end up in a lawsuit or something.

[Deleted03]

I was in a car accident early into my PG and suffered a back and neck injury. Not being able to properly DX because I was PG, and unable to take medication, my only relief was PT. I had threaputic massage, US and (oddly enough) inversion therapy. My PT and DR both advised discontinuing PT after about the 6 month mark just to avoid any additional risks.

Can you explain more why it is not recommended? Just curious about the process :)