Birthing mother abused for refusing male nurse 2

[sakura184]

I was actually quite glad the thread reached 1k as I'm not really enjoying it at all, but I've started this on me just in case there is anything else to add.

It ended on the note of talking about the subject of baby centered care.

I think negligence, forced intervention and poor treatment in hospitals can be just as responsible for a damaged baby as a woman who decides to go it completely alone.

One thing I will say, is that we can't have it both ways. We can't insist women are listened to and then blame the hospital when/if it all goes wrong.

But it seems that some women are being overriden by doctors, mainly by arrogance , but perhaps also a fear that they may be sued or something, I don't know. the doctor knows best model still seems to be the norm in hospitals. Women need to be listened to and catered to a lot more

Sorry Sakura, I meant homebirth isn't strange because it was historically the norm.

Old hospital practices really are shocking, but things have changed and hospital midwives and doctors are not dragons trying to ruin your life. They just want to make sure you get to continue your life with a healthy baby.

I mean, if you're refusing medical care or going against medical advice or seeking out a dangerous healthcare provider (one of those "confident" midwives you mentioned earlier) because it's the only way to get your birth the way you want it then sorry but you are prioritising the experience over the baby.

I don't think seeking out a midwife is dangerous at all If you die or the baby dies it's on her head, she knows this, and she wouldn't take you on as a patient if she thought you or the baby were going to die. And if one of you did she'd be struck off, she knows this too as I'm sure the standards midwives are held to are far higher than doctors when it comes to maternal or infant death

RTB you can be reckless and educated (anti-vaccine advocates are all about their education). Even pro-homebirth studies (Birthplace Study) showed increased risk for first-births at home compared to other places.

If the information you are being given is wrong then you are going to form an opinion that is not fully informed.

Perhaps they did know this, but if so then they chose a riskier option despite knowing it was riskier. It's fine for them to decide that, but I do struggle to understand the motivations for voluntarily putting yourself and your baby at increased risk.

Sakura, if they are regulated sure. In the UK they have to follow guidelines and are not allowed to work outside their scope of practice (which is normal pregnancy and birth).

In the USA there are two types of midwives, CNMs who are regulated and have standards of education and training and practice, and CPMs who do not. Many CPMs do not have insurance and are not licensed to carry medications. They are the ones taking on the high-risk women who have been turned away by other HCPs due to their birth plans being unsafe or unworkable. Ina-May Gaskin and the midwives at The Farm are CPMs, they might be very good but they are contributing to a system that is very very bad.

If you die or the baby dies it's on her head, she knows this, and she wouldn't take you on as a patient if she thought you or the baby were going to die.

Thats not technically how it works in the UK though.

A midwife can't refuse to attend a woman in Labour - whether it's planned or unplanned as they have a duty of care to the woman.

So a high risk woman, can effectively (in theory at least) demand a midwife attend at home.

www.birthrights.org.uk/2018/03/07/home-birth-what-are-a-trusts-responsibilities-towards-midwives-and-women/

So this does leave midwives somewhat exposed on a professional level if you have someone hell bent on a homebirth against all medical advice and with a particular known risk to her life or the life of her child.

RTB that's absolutely true, and not a thing in the US which is why women can be 'fired' by their doctors and left without a care-provider which is morally reprehensible IMO and feeds the problem of the CPM taking really risky cases.

It used to be that a midwifery supervisor would also attend the birth along with a second midwife who would take the notes at the birth, to safeguard the professionals and also care for the woman. Not sure how it works now without the SOM role but would imagine it's just a senior practitioner.

Women should always be able to be cared for even if they're making an unwise decision.

I think if a home birth midwife lost a mother or a baby she'd be absolutely vilified. It'd be a total witchhunt. That's why I'm confident these women know what the fuck they're doing

*A midwife can't refuse to attend a woman in Labour - whether it's planned or unplanned as they have a duty of care to the woman.

So a high risk woman, can effectively (in theory at least) demand a midwife attend at home.
*
<a class="break-all" href="http://go.mumsnet.com/?xs=1&id=470X1554755&url=www.birthrights.org.uk/2018/03/07/home-birth-what-are-a-trusts-responsibilities-towards-midwives-and-women/" target="_blank">https://www.birthrights.org.uk/2018/03/07/home-birth-what-are-a-trusts-responsibilities-towards-midwives-and-women//**

So this does leave midwives somewhat exposed on a professional level if you have someone hell bent on a homebirth against all medical advice and with a particular known risk to her life or the life of her child.*

See I don't agree with this. I think it should be at the midwive's discretion as it's their neck on the line. The respect has to go both ways. In Japan it's completely up to the midwife whether she'll take you on or not, which is how it should be.

That's why rather than advocating for high risk women to have homebirths, I advocate for hospital culture itself to be changed so that women can feel more comfortable there

It's also why I think certain high risk births are fine as homebirths, like twins , breech as. VBAC, because again, it should be at the midwife's discretion.

I think it's totally disrespectful of a midwife to insist that she assist you In a birth she's not happy with

That is fascinating about the different midwives, Loops. This article in the NY Times is interesting .

Many CPMs do not have insurance and are not licensed to carry medications. They are the ones taking on the high-risk women who have been turned away by other HCPs due to their birth plans being unsafe or unworkable. Ina-May Gaskin and the midwives at The Farm are CPMs, they might be very good but they are contributing to a system that is very very bad.

Why don't they have the insurance and license? Is it a class thing? Are these women just trying to make a living somehow, and can't afford the necessary qualifications? I don't get it.
Also, yes Ina May is very very good and skilled . Surely we judge a midwife's competence by her maternal and infant survival rate. It should be very easy to do . The fact they're taking on high risk cases so that women won't resort to unassisted births in desperation is amazing.

Like I say , if hospitals weren't hotbeds of misogyny women wouldn't be having high risk homebirths

The Journal of Perinatology found that home births attended by nurse midwives had double the neonatal mortality rate of hospital births attended by nurse midwives, while home births attended by C.P.M.s and other midwives had nearly four times that rate. from the article I linked to.

Is it a class thing? Are these women just trying to make a living somehow, and can't afford the necessary qualifications?

Cost of insurance and whether insurers will provide cover due to the risk. Given they provide care for high risk patients and the US culture of litigation insurers simply don't want to touch them with a barge pole or have premiums which are so ridiculously high as to render it impossible for a midwife to afford it.

No Sakura,

It is not a class thing, it is a medical training thing. They don't have it.

Homebirth with a midwife in Oregon in 2012 was 7 times more deadly for babies than hospital birth. This was the year they started mandating that birth and death certificates for babies listed where the birth took place and who attended it.

Records show that homebirth with a CNM is twice as dangerous as hospital birth with a CNM, homebirth with a CPM is four times as dangerous.

So you can believe that CPMs know what they are doing but the evidence does not support that claim.

Homebirth CAN be safe but only if there are stringent risk-out criteria, the midwife is adequately trained, and there are procedures in place to transfer and to manage emergencies.

There needs to be medication on hand to cope with PPH, equipment to resuscitate a baby (and mother), oxygen, adequate monitoring of the baby and the mother's vitals, and ideally two midwives (one for mum and one for baby).

Women are not having high-risk births at home due to hospitals being a hotbed of misogyny. They are doing it because of the pervasive idea that birth is natural, problems are caused by doctors, bodies know how to give birth, everything is a "variation of normal" and they are the experts in their own births.

It is not male doctors who are spreading and encouraging that message.

Hazeyjane,
It just doesn't tally with the stats I read about the maternal and infant mortality rate of low risk homebirths worldwide. If I hadn't read a lot of evidence from different sources that homebirths were safer for a healthy pregnancy , I swear on my kids lives I wouldn't have opted for a homebirth.

I'm not sure if I can find those stats now but just to let you know if I'd been confident from the evidence that hospital births were safer I'd have gone for one .

It is not male doctors who are spreading and encouraging that message*

Well no because they make money out of hospital births

*No Sakura,

It is not a class thing, it is a medical training thing. They don't have it.*

I still don't get it. If they want to be midwives why not just get the training? That's why I asked if it was a class thing. It's probably because they can't afford it. Otherwise you'd just do it wouldn't you?

Many years ago in my area antenatal care was sickening. At every single visit you were told to take everything off and put on a hospital gown. You would then wait in a small room where eventually a doctor would come in (no chaperone). He would do a full vaginal examination and breast examination often without even introducing himself.This would happen every single time along with several smear tests.

As a young woman I found this sickening, wrong and very traumatic. When I had my second child I did not go for any antenatal care whatsoever and insisted a midwife come to my home for the delivery.

I can't get upset about how or where other women choose to have their babies.

and midwives make money from homebirth, it is in their best interests to NOT transfer patients and not risk-out women during pregnancy, and accept the twin pregnancies and breech presentations, and VBAC/VBA2C.

It helps them if women "trust birth" (trust them) and not trust the mean old doctors with their unnecessary interventions and lack of care and understanding of the transformative power of birth.

The fact is Sakura, that until very recently very few statistics existed about the mortality and morbidity rates for women/babies in the US who were cared for by CPMs. These stats are gathered at the State level (not federal) and some just don't keep those records. CPMs rarely have good notes of past clients and they have no regulatory body to answer to. Also in many states this type of midwife is illegal so they are practicing outside of the law. They have no insurance so clients have little if any recourse for compensation if a birth goes wrong and often the women get blamed for "choosing this" even if the information provided to them by the midwife was incorrect or incomplete.

It just doesn't tally with the stats I read about the maternal and infant mortality rate of low risk homebirths worldwide

It doesn't mean its wrong either though. Just that Homebirth in the US is significantly more dangerous than other places in the world.

I see what you mean, I mean I would yeh? But it's an undergraduate degree then a postgraduate nursing qualification with a specialism in midwifery, and then they have to practice within regulations and boundaries and can't do the lovely home births that they really want to.

Also, they'd have to get IN to the training, so get into college and then meet the grade requirements for postgraduate training. They'd need science and maths at the very least. Why do that when you can just do the easy route?

Also The Netherlands is also cited as country which gets a very good press because of how common homebirth is, but its got a higher rate of infant mortality than most other western European countries.

I believe theway that infant deaths during childbirth are recorded is slightly different to other countries, so it has the effect of masking the rate.

(its a long time since I looked at this, but I'm pretty confident there was a questionable methodology going on that differs from the way others did it so it makes it harder to compare stats).

*sprouts21
*
Many years ago in my area antenatal care was sickening. At every single visit you were told to take everything off and put on a hospital gown. You would then wait in a small room where eventually a doctor would come in (no chaperone). He would do a full vaginal examination and breast examination often without even introducing himself.This would happen every single time along with several smear tests.

It's Gross what they put you through. My midwife never did a single internal exam throughout my ante natal care. Neither did my second midwife with my second child. They mustn't have deemed it a necessary part of the care.

It doesn't mean its wrong either though. Just that Homebirth in the US is significantly more dangerous than other places in the world.

America is just a mess overall with regard to birth

RTB it may be similar to the US where infant mortality is deaths of babies up to 1 and perinatal mortality is deaths of babies in the last weeks of pregnancy, during birth or in the week following birth (I think anyway). So their infant mortality stats are always shocking but that also includes older babies who were ill, or were in accidents, SIDS, various things unrelated to birth safety.

You have to make sure you are comparing like-to-like, including things like risking out criteria and transfer rates/outcomes.