Anna is 41 wks and Mel is 37 wks, new blog.

[ilovetchotchkes]

Well, how high ARE they, you know? OBs are highly paid (don't know specifics there, but they are one of the highest paid doc types). So is it that their insurance rates are as high as their income? And do midwives have to carry liability insurance?

OB rates are obscene. That's why good family friends of ours decided to give up his OB and do fertility medicine instead. Which is a damn shame because if the way he treated me as a patient during infertility issues was any indication, he was an amazing OBGYN.

Midwives DO I believe have to carry the insurance BUT, all hospital midwives that I know of have to have OB back up. So i'm assuming they have less.

[emmiedahl]

OB's seem to be at the median for a physician when you look at hourly wage:

http://en.wikipedia.org/wiki/Specialty_(medicine)#Physician_compensation

For about a decade, malpractice insurance for obstetricians has been rising, to the point where many are leaving the specialty.http://www.usatoday.com/news/health/hea ... actice.htm Hospitals that deal with high risk populations are at risk of having their insurance cut off completely, leaving poor women with nowhere in their area to deliver.http://www.nytimes.com/2011/03/01/nyreg ... pital.html

When you are standing in front of a panel explaining why it is not your fault a baby died or has a catastrophic brain injury, you will have an easier time if you followed protocol, made wise risk analyses, and used every technology at your disposal when it became prudent to do so.

In some states, midwives are required to have insurance, but in many they are not. The midwifery movement is generally against legislating to force them have insurance because it will increase the cost of care and increase the profitability of lawsuits. http://cfmidwifery.blogspot.com/2008/01 ... wives.html This is a blog, but it references and explains an article in Midwifery Today. Of course, the illegal midwives and practical midwives would not obey the legislation either way.

[MamaJunebug]

The sons having to carry heavy backpacks probably is part of the belief that suffering is good for the soul. We're all purified by it, you know.

[BelieveinScience]

OB's seem to be at the median for a physician when you look at hourly wage:

http://en.wikipedia.org/wiki/Specialty_(medicine)#Physician_compensation

For about a decade, malpractice insurance for obstetricians has been rising, to the point where many are leaving the specialty.http://www.usatoday.com/news/health/hea ... actice.htm Hospitals that deal with high risk populations are at risk of having their insurance cut off completely, leaving poor women with nowhere in their area to deliver.http://www.nytimes.com/2011/03/01/nyreg ... pital.html

When you are standing in front of a panel explaining why it is not your fault a baby died or has a catastrophic brain injury, you will have an easier time if you followed protocol, made wise risk analyses, and used every technology at your disposal when it became prudent to do so.

In some states, midwives are required to have insurance, but in many they are not. The midwifery movement is generally against legislating to force them have insurance because it will increase the cost of care and increase the profitability of lawsuits. http://cfmidwifery.blogspot.com/2008/01 ... wives.html This is a blog, but it references and explains an article in Midwifery Today. Of course, the illegal midwives and practical midwives would not obey the legislation either way.

Thanks Emmie and tchotckes. Isn't pennsylvania hurting for OBs right now because of this?

I think a lot of doctors, especially OBs, are in between a rock and a hard place. People think they are infallible but doctors do make mistakes and medicine isn't guaranteed. Things can and do go wrong even when a doctor/nurses follow protocol exactly.

[emmiedahl]

We like to think of childbirth as a natural thing, and it is. But maternal and fetal death are historically as normal as a healthy infant and mom. Modern obstetrics have changed that. We now expect that a pregnancy will end in a healthy infant and mother; it is the default, and something needs to happen in order for that to not be the case. Sometimes shit goes wrong because a doctor made the wrong call (not being psychic and all) and sometimes things go wrong because that is the nature of childbirth. And of course sometimes the doctor is totally in the wrong.

My mother had malpractice attorneys contacting her after my older brother was born with CP. He was a micropreemie in the mid-70's. Some of his disabilities are actually due to treatments that saved his life, and she technically and legally had every right to sue. Because the doctor *did* that, never mind that C would have died if the doctor had not.

The doctors I have encountered are very patient with my printed out second opinions from Dr. Google. Most of the time, they already know and shrug it off. Only one time have I had a doctor say, "Wow, I have never heard of this!" and then explain to me how the course of treatment would be the same either way but Wowzers, what an awesome study! I come in with primary research though. I imagine the reaction might be different if I was quoting Ricki Lake. Where did she go to medical school again?

[Charliemae]

I am currently planning a midwife attended home birth, so I've been reading this with interest. I think something to keep in mind is that the attitudes surrounding birth are largely regional. Living in the Pacific Northwest there are very few barriers to home birth, and insurance companies are required to cover midwifes. I know in some states it's near to impossible. It's seemed to me that even the hospitals here tend to be less slice and dice than in other place

[SeaSaltCaramel]

I was reading the post about Mary Maxwell working overtime to graduate early, :roll: and I realized this post is almost a week old with no labor progression for either Anna or Mel.

This is great for Mel, her baby still has important developing to do. I'm just a tad concerned about Anna hitting the 42 week mark. If she plans to do a no-induction home birth, I hope they are prepared with an intubation set up and suction if that baby aspirates meconium. I pray this doesn't happen.

[skankbiscuit]

They know the realities that a baby can die because of Susannah; hopefully Chris and Anna are sensible and are getting good care and medical advice.

[Elle]

I concur that the drugs they give you for induction (it's just petocin, isn't it -- or oxytocin?) bring that labor on like a train. My first child was born naturally with no meds after 13 hours of labor, 18 minutes of pushing, and a week early. My second, my water broke and when I had some contractions but not steady and when I finally called my OB/GYN about 9 hours later, she acted like it was URGENT that I get to the hospital RIGHT AWAY even though I wasn't having regular contractions. She couldn't hardly wait to get me on something to get that baby out! I finally showed up about 2 hours later and I begged her not to give me the pitocin, but was going to have nothing of that. She agreed to give it for only an hour, which she stuck to, and my contractions did start. But then I went through 4 hours of difficult contractions, nothing like the natural labor I'd experienced before since it was condensed into such a short amount of time. But she got that baby outta there just before 5pm when I'm sure she had to go home. Grrrrr. I didn't know to argue it more, but now I do. Unfortunately, I am done having babies!

If I'm paying a doctor, I expect them to do what's best for ME, and fuck if I care about what's convenient for them. If you don't want to put in the time that's best for me, then another doctor can take my money instead. I can't stand how doctors will do what's not the best for the patient because they want to go home at 5. Doctors need to think about the unpredictable hours before choosing a field. Want a predictable schedule? Go into plastic surgery or something. I have no pity for doctors who want to be home in the evenings. It's their own damned faults for not thinking about that before deciding. Our c-section rates are obscene, and Pitocin increases the chance to over 50%. It forces the contractions, but does nothing to help the body transition, and this increases cervical and perineal tears. And then, when you get an epidural, you can't move. The lithotomy position is the WORST position to routinely put women into, and works against the bodying every way. But who cares as long as the doctors can go home in time for the evening news.

[Elle]

You're so very right.

Prior to my current job, I was a childbirth educator at a suburban hospital, along with about 5 other educators. We taught informed consent and risk/benefit, and tried to ensure that all of our clients understood their options, including medications, inductions, etc. We NEVER taught or even inferred what a patient "should" or "shouldn't" do - just tried to give them facts to make informed choices. The doctors never liked the classes, and they said - and this is an exact quote from a medical staff meeting - "The patients are getting too much information." They hired a new director of L&D with the understanding that she would take over the classes, fire all 5 of us, and run things the way the doctors wanted. And she did. The last I heard, the c-section rate at that hospital was over 50%.

I've heard this. Often. I've very active as an advocate in the birth community, and this is common. Many hospitals are doing away with education classes because it's easier for the doctors to get ignorant mothers to do as they say, and hospitals make more money off of interventions, especially c-sections. They're helping keep their NICUs full, a steady stream of income, at the expense of the mothers' and babies' healths.

[Elle]

Or her malpractice insurance rates are sky high. My friend's dad is an OB and he had to quit because his malpractice insurance was way too high. From what I've been told by a few of my doctors OB have one of the highest malpractice insurance rates. We're family friends with someone who's brother i an OB and his wife actually has to work to be able to keep them floating financially because of his insurance rates.

When something goes wrong in a birth, it's the rare family who doesn't sue, even when there is nothing that could have been done to result in a better outcome. It's just a fact of life that sometimes babies won't make it and sometimes mothers won't. Of course we should try to lower the rate, but sometimes nothing in the world will prevent a death or something else from happening. Sometimes a woman does because she should have had a c-section, but sometimes women die from c-sections when they likely wouldn't have from a vaginal birth. Hemorrhaging to death after a c-section accounts for about a third of maternal deaths (actual percentage varies depending on which reports you go by).

If a woman dies from a c-section, the family isn't likely to be successful. "Everything that can be done was done." Good luck convincing a judge that a c-section shouldn't have happened, and even if it shouldn't have, how do you get around the consent forms including the chance of death? Doctors make more money AND are better covered against a successful malpractice suit.

If a woman dies from a vaginal birth, even if she for some reason could NOT have a c-section, the family is more likely to win in court. Sometimes doing everything mens not doing something that's too dangerous, but the courts don't see it that way. They see it as there was an option that wasn't done, and disregard how that is not a safe option for everyone (I'm one such person, I'm not getting into it, but the chance of death from a c-section is astronomically high for me, but my OB/GYN, before I had a midwife, honestly said that due to liability for her, she could not allow me anything but a c-section).

Medical malpractice laws need to be overhauled in this area. Doctors are protected by acting too much, even though the rate of deaths has increased right along with the rise in interventions.

[Elle]

Or her malpractice insurance rates are sky high. My friend's dad is an OB and he had to quit because his malpractice insurance was way too high. From what I've been told by a few of my doctors OB have one of the highest malpractice insurance rates. We're family friends with someone who's brother i an OB and his wife actually has to work to be able to keep them floating financially because of his insurance rates.

Well, how high ARE they, you know? OBs are highly paid (don't know specifics there, but they are one of the highest paid doc types). So is it that their insurance rates are as high as their income? And do midwives have to carry liability insurance?

[Patsy]

Just to throw my hat into the ring, I think Melanie is having a boy :)