Lie to your patient and other homebirth midwifery wisdom

Want to know what homebirth midwives really think?

Read From Calling to Courtroom, A Survival Guide for Midwives. I should warn you in advance, though, that it may turn your stomach.

It may surprise you to find that midwives are every bit as concerned about legal action as the obstetricians they deride. They’re not worried about malpractice since by refusing to carry insurance they have rendered themselves judgment proof. No, homebirth midwives are worried about legal prosecution for practicing in violation of state laws. The book is a compendendium of strategies designed to prevent prosecution, or deal with it once it has occurred. It can be summed up very briefly: to protect yourself, a homebirth midwife should do anything, say anything (true or not), betray anyone and (most important) hire a licensed lawyer.

1. In order to prevent prosecution, homebirth midwives should lie to their patients.

Apparently informed consent, which homebirth midwives harp on endlessly in their criticism of obstetricians, is only for doctors, not for midwives. According to midwife Elizabeth Camp:

In the future my motto is, “No witnesses”. If I ever have to cut an episiotomy to save a baby’s life, I would ask everyone to turn their backs and turn off all video cameras. I would say to the mother, “I’m sorry, I had to TEAR you to deliver your baby quickly” (ok, so you tore her with scissors). I do not carry Pitocin anymore. For those midwives who do carry Pitocin, I would advise them to never admit it to anyone who has the ability to testify (that is, anyone except your husband). If a midwife ever feels the need to inject Pitocin or administer any kind of drug, such as Methergine, she should refer to such substances as “minerals.”

Be careful how you talk to your apprentices. You may think, “Not her, she would never betray me.” In my experience, there were only a few out of hundreds of midwives in my state who stood by me and defended me.

Be careful how you talk to your clients. Always use terms such as “If I were you, I would…” instead of diagnosing and recommending. Always have them initial on their charts when they refuse to get lab work or choose not to see a doctor.

Be careful where you keep your medical supplies. A search warrant can be issued without warning to you at any time. Do not chart emergency medical procedures. Use a “made up” code that only YOU understand. Don’t ever think it can’t happen to you. I believe I was careful BEFORE I was prosecuted. I am even more careful now.

In other words, lie to your patients, lie to your assistants, lie in your charting. Be sure to set things up so that if anything goes wrong the patient will be blamed.

2. Hire a licensed lawyer.

No self-proclaimed lay lawyers for these women. Evidently no concept of irony, either.

Want another reason that a midwife needs a lawyer? Look at the previous section of this book, describing the legal system. Lawyers go to school for at least seven years, take a grueling bar exam (which not everybody passes), then go out into the “real world” to learn how to research, argue without ticking off a judge, and apply classroom knowledge to courtroom situations. This book helps the midwife understand the system and not be shocked the first time she gets a search warrant or cease and desist order. It will not leave the midwife knowledgeable enough to represent herself. A midwife should feel no more comfortable representing herself than a lawyer would feel doing a midwife’s job (besides, most of them hate the sight of blood). The rule of thumb is this: if they have a lawyer, so should you. After all, it’s your freedom and your professional life that is at stake.

3. Don’t worry about dead babies; some babies just die.

This horrific passage comes from Geradine Simkins, former President of the Midwives Alliance of North America (MANA):

In the mid-1990′s, a well-known midwife was involved with a couple of baby deaths in out-of-hospital settings in Michigan. During one of the investigations the story became a media circus—as many of the midwife and homebirth stories do. The American public loves drama, and live-versions of drama are relished even more than fiction… This is the kind of situation that should not be made into a mini-drama. You know, babies die; it’s part of life. And only those entrenched in the bio-technical model think that that it doesn’t, or shouldn’t happen. I have traveled extensively in other countries, mostly developing nations, and people understand this reality elsewhere. I once arrived at the house of a midwife in another country the morning a baby had died in a homebirth. I found that the family had embraced the midwife and was so grateful to her—because the mother did not die. They were understandably sad about the baby, but families expect that a baby might die. A mother dying is considered beyond tragic. It’s a matter of perspective.

I’ve never seen a clearer expression of homebirth midwives’ the bone chilling lack of concern for dead babies.

When you tell women that they should accept their babies deaths and just be grateful that they didn’t die, too, you’ve forfeited any claim to being considered a professional of any kind.

When you insist that women should just get over the death of their baby because African women have it worse, you have demonstrated utter contempt both for women (generally women of color) around the world who suffer repeated heartbreak, and contempt for the emotional pain of your own patients.

There’s more, much more, along these lines in From Calling to Courtroom. I suggest this document be invoked at any legislative hearing on licensing homebirth midwives or expanding their scope of practice. Nothing can more clearly illustrate the fact that homebirth midwives are not professionals, and are unworthy of licensing, than their own words.

  • NOTAGREEINGINANYWAYSHAPEORFORM

    I think some of you are also missing this simple fact; not that i agree with the things that this midwife said or agree with using any kind of midwife. There are two kinds of midwives, the first is the licensed and legal kind that can work in a home, in a hospital or really anywhere because they basically have the qualifications of a RN, and the second is the completely unlicensed and natural. Regardless of what kind this woman was, this is one of the most disgusting articles I’ve ever read and its a shame.

  • RivkahChaya

    Oh surely there’s something about diluting a regular homosexual 100,000 times….

  • LawGeekNYC

    Only if the mother is a minor. Otherwise, I don’t know any law that prevents folks from making home-made porn if they feel like it.

  • LawGeekNYC

    Well, to be fair, I don’t think I would have passed the evidence portion of the NY bar without my Law & Order addiction . . . So you’re probably already closer to being a lawyer than they will ever be to being a doctor.

  • LawGeekNYC

    Well, lawyers have to take CLE credits to stay licensed, too. But, yeah, law school is so much easier than med school, and we’re called (and paid as) lawyers during the firm training that substitutes for residency.

  • Kate B

    Just out of interested, during my third birth – which was failing to progress following induction for PROM (premature spontaneous rupture of membranes).
    My registrar (a registrar is a doctor of lower rank than a consultant ob-gyn) attempted to speed things up by manually dilating my cervix. It hurt like a bitch and didn’t do anything – I ended up with a section.
    Is manual dilation of the cervix ever an evidence-based intervention? Is it common medical practice?
    I’d never heard of it before my registrar attempted doing it to me, and I’ve never heard of anyone having it done since!

    • toni

      I’ve heard of doctors doing that but only in Britain (and I assume that’s where this happened since you used the word registrar). They did it to my mother about 20 years ago when she had my sister. She said it was torture and worst part of the whole birth but it did work on her and she delivered vaginally a little while afterwards. Oh and the doc didn’t even warn her he was going to do it. Horrible. Sorry that was done to you and didnt even work! When I had my baby in June (in Florida) I freaked out when the ob went to break my waters i said please don’t pull my cervix open and he looked a bit surprised and said we don’t do that here. Not sure if he meant that hospital or all of USA. I reckon some nhs staff are just reluctant to do caesereans and they’ll try almost anything to avoid them.

      • Dr Kitty

        Well it’s definitely not taught as a good thing, or, frankly even as an idea to be entertained, in the part of the UK I work in.

        • toni

          Well this is the first I’ve heard of it since my mother told me about her experience but I just looked it up and there are accounts of it on mumsnet so I guess rare but not unheard of? I did say Britian not UK though :P NI is different in a lot of ways.. you still have a selective school system I think (?) my dad’s cousin lives in Newry and recently had her fourth baby and got an epidural without anyone trying to dissuade her at all. She couldn’t believe it. Her other babies were born in north wales and she’d never been allowed one. It was always too early and then suddenly too late.

      • Kate B

        I think you are right – in a socialized healthcare setting, there’s always going to be a focus on reducing expense and c-sections are definitely expensive. (Which is also why I find the claims of NCB advocates in the UK that Ob-Gyns have no interest in ‘natural’ birth to be bizzare – Natural birth is cheaper if nothing else, so of course they do!)
        During my first birth, the Registrar (a different one) went to great lengths to avoid a c-section. He attempted ventouse at least 7 times and forceps three times. It worked, I avoided a section – but my son came out with no skin on the top of his head and was on painkillers for a week after the birth. I’ve also had pelvic floor issues including a prolapse.
        Thanks for your comment x

        • toni

          That’s shocking, you poor thing :[ I thought they were only supposed to make three attempts with ventouse OR forceps and never use both on the same baby. Hard to believe they really think what you’ve described (injured mother and child) is a better outcome than a c section but they probably do! I had a friend who left sixth form to have a baby and ended up with forceps delivery (no pain relief!) She tore into her bottom and her daughter had a bloodshot eye and looked a real mess. The midwives told her it was still better than a section because with those you can’t lift the baby etc

  • Ducky

    i’ve been reading your blog for a year now and this material is shocking, to say the least.

  • Anonymous

    Because administering drugs, any drugs, in the wrong quantity can be lethal.

  • Anonymous

    Maybe if the case starts to go south they can call a lawyer who’s only a few minutes away. After all, guilty is just a variation of not guilty.

  • Anonymous

    Saddest quote from that literary blat:

    “When one midwife gets arrested often other midwives in the same state want to believe it was her fault. Not the fault of the state legal system or the medical establishments but that she, the midwife, must have done something to deserve this.”

    You mean that the legal system doing it’s job? It’s kind of rare that someone gets arrested for doing nothing at all.

  • amazonmom

    AH yes. Those two. They got caught eh?

    • Bombshellrisa

      Yes, along with Amanda Feldman. Since its a matter of public record now because its on the WA health website, I can say that all three never accompanied their patients during transfers and there were deaths that resulted from their poor care. I had the unfortunate chance of meeting one of them, they are very into rescuing and helping animals and frequent the same off leash dog parks we do. When someone is trumpeting about being “so glad their job doesn’t involve life and death decisions anymore” I tend to listen in, and that is how I came to realize I was talking to a killer “midwife”.

  • SadNation

    How did we ever make it thousands of years….and to call ourselves a mammal…why the monkeys and raccoon should start hiring Drs to pee, I mean birth. How pathetic that people think they need a Dr when they aren’t sick!

    • Amy Tuteur, MD

      How? The same way we made it here with a 20% miscarriage rate.

      You scare me. Someone as ignorant as you are should not be caring for women and babies.

  • SadNation

    Interesting how you turn these quotes around to discredit. Wonder if you also posted anywhere that there is a 20% death rate due to hospital neglect, sickness, and other trama to mother and baby either during or right after birth. There is less than a 1.7 death rate per capita at home births. Also did you mention that the care of the OBGYN is to lie to mothers continually to get them to have major surgery instead of a natural birth…You can’t tell me there is a problem with 60% of births in some US hospitals warranting a c-section and 40% US wide!!! Emergencey? I think not,
    …I am both a doula and a midwife. I have seen OB’s “up the pit to see how low the heart rate will drop so we can just do a C-sect” or for a first baby “your too small to deliver so we will have to schedule a CS” or “I am going on vacation so it is better to get this done now” Or the newest fad…”You have a bad uterus or not enough fluid.” We do care about death…we also know that some babies that are born in a hospital or at home are going to die…so do moms. It is tragic. And I never lie to my moms, dads, or whomever….most of us don’t.

    • Amy Tuteur, MD

      A 20% death rate? One in every 5 babies born in the hospital dies?

      Do you even think before you write? Do you have any idea how foolish that makes you look?

      Thank you for dropping in and demonstrating, yet again, that homebirth midwives are uneducated, incompetent fools.

    • An Actual Attorney

      Wait, 20% death rate??? 1 out of 5 hospital-born babies die?

      1.7 death rate PER CAPITA?? Shit, no way I’d sign up for that. But impressive? Do you shoot 7 out of 10 dads at the births?

      The only thing I can do in the face of this stupidity is to laugh.

      • auntbea

        OMG! I peed!

        • Bombshellrisa

          Me too, especially about the “I never lie” part.

          • Young CC Prof

            Scary part is, maybe SadNation actually believes what he or she is saying. Despite the fact that 20% is easily shown to be laughable with a brief nonscientific neighborhood count.

          • auntbea

            It is mathematically impossible to believe in a death rate larger than one death per capita.

          • Young CC Prof

            Mathematically impossible to happen. In 13 years of teaching, I’ve learned nothing is impossible to believe in.

    • Bombshellrisa

      Wow, thank you for reminding me how dumb I used to sound. And especially how uninformed I was after doula training and formal education and apprenticing as a midwife.

      • Squillo

        I have a hard time believing you ever sounded that dumb, even if you held similar beliefs.

        • Bombshellrisa

          Dr Amy’s latest post sort of sums up why I sounded like that, however I was a rather vocal (and ignorant) buddy.

    • Dr Kitty

      Wow.
      When you come back, bring grammar, Maths, statistics, common sense, logic and some sort of coherent argument….oh yes, and some knowledge of obstetrics would be nice.

      In case you haven’t worked out why we’re laughing at you:
      20% death rate implies 1/5 of babies dies.
      1.7 death rate per capita implies that for every home birth 1.7 people die.
      You also appear to believe that CPD, uterine atony and oligohydramnios don’t exist ( they do, and they aren’t to be messed with).

      You may not be knowingly lying to your clients, but if that is what you’re telling them, it isn’t the truth either.

  • Ithinkyoumissedthepointhere

    Did you miss the part where the MANA website specifically states, “Currently, MANA has two part-time staff members: executive director and conference coordinator” above Geraldine’s profile? It’s a pretty safe bet that she has less of a leadership role helping part-time now, while Jill Breen is the full-time President. The point, though, wasn’t to devalue her role, as you are implying is being done here, but it seems to me that Dr. Tuteur is acknowledging Ms. Simkins’ prior full leadership in that organization, which would not have otherwise been obvious.

  • Ithinkyoumissedthepointhere

    I think you meant to write appalling, which is exactly my reaction to “From Calling to Courtroom” teaching midwives to have an utter lack of compassion and respect for life. A mother whose baby just died, because you failed to deliver that child alive to her, really wants to hear your loving reassurance to “quit being a mini-drama queen because some babies die.” As for “justifying strongly-held beliefs,” you haven’t provided any facts in rebuttal to the hard facts that Dr. Tuteur has cited and sourced. This midwife “legal” guide is blatently promoting, among other things, 1) lying to the mother about procedures (or telling her “babies die” when hers does), 2) practicing medicine illegally, and 3) advocating hiding evidence of illegal activity. Perhaps that advice is why unlicensed midwife Tina Bailey is facing life imprisonment for 1) accidentally killing a child (and practicing illegally), 2) obtaining property by false pretense, and 3) obstructing justice.
    (“Unlicensed Midwife Charged in Baby Death” http://www.my40.tv/shared/news/features/top-stories/stories/wlos_baby-death-investigation-11038.shtml)

  • Anna

    http://www.ncbi.nlm.nih.gov/pubmed/17105644

    CONCLUSION:

    Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model. (Just one example, of many).

    • Susan

      That’s just an abstract about CNM being good care for the right women. Have you read the study? It doesn’t appear to be about home birth or DEMs. What is your point?

  • Anna

    Not every baby lives. That is the truth, no matter whether you are following the medical model or the midwifery model of care. However, the midwifery model of care has better outcomes at a national and international level, because it is person-centered, woman-driven, more cost-effective, and provides more personal attention to pregnant and delivering women.

    • Susan

      Not every baby lives. That is the truth, no matter whether you are following the car seat model of driving or the mom’s lap model. However, the mom’s lap has better outcomes at a national and international level, because it is baby warmth centered, more cost-effective, and provides a more personal car ride for both mom and baby.

    • Amy Tuteur, MD

      No, it doesn’t have better outcomes. For example, in The Netherlands the perinatal death rate for low risk midwife patients is HIGHER than for high risk obstetrician patients.

    • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

      However, the midwifery model of care has better outcomes

      So long as you dismiss the babies who don’t live….

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