The only degree a homebirth midwife needs is a high school diploma? Seriously?

Seriously flat Xsmall

Midwifery Today posted the following query on its Facebook page:

Midwifery Today 3-6-14

In case you can’t make out the text in the image:

I am looking into becoming a CPM soon so I was just curious if you guys had any recommendations on schooling?! I am a stay at home mom located in Oklahoma so I was looking for mainly online courses!

That’s right. She plans to become a homebirth midwife by correspondence course!

If you think that’s bad, consider this: she doesn’t need any midwifery degree at all. Her high school diploma is the only degree she needs to become certified as a homebirth midwife.

Why are the standards so pathetically inadequate?

Simple, American homebirth midwives (CPMs, LMs, DEMs) aren’t real midwives. Unlike midwives in the Netherlands, the UK, Australia and Canada, who are required to have a minimum of a university degree in midwifery, American homebirth midwives aren’t required to have any formal education in midwifery. That’s very different from real midwives in the US, as well. American certified nurse midwives (CNMs) are the best educated midwives in the world with a master’s degree in midwifery.

American homebirth midwives can’t be bothered (or aren’t qualified) to complete a real midwifery degree, but they are “passionate” about birth and want to earn money from their hobby. They created credentials that are nothing more than public relations ploys, designed to convince unsuspecting women that homebirth midwives have the equivalent education and training as midwives from around the world. Nothing could be farther from the truth.

Why did these fake credentials gain a foothold in the first place?

According to Judith Rooks, CNM, MPH and long time homebirth advocate:

The PEP route to becoming a CPM seemed reasonable when it was started, but I thought it would only be used to provide an opportunity for very experienced OOH birth attendants, and that new educational programs along the lines of the Seattle Midwifery School—a direct-entry professional midwifery school based on the curriculum used in The Netherlands, would be started to provide educational opportunities for young women who wanted to start preparing themselves as midwives from scratch…

To my great disappointment, many young women who want to become midwives seem to think it is too much bother, time or money to complete an actual midwifery curriculum and think it is enough to just apprentice themselves to someone for a minimal number of births, study to pass a few tests, and become a CPM that way… (emphasis in the original)

I thought the CPM would be short-term; we have lived with it now for a long time. The data from Oregon, shows that it’s not working. The CPM credential was a stop-gap measure from the next-to-the last decade of the 20th Century. We are now in the 2nd decade of the 21st Century.

On the CPMs themselves:

…[M]any have inadequate knowledgeable, manual skills and clinical judgment. Some DEMs/CPMs say that it is the responsibility of a pregnant pregnant woman to choose her midwife wisely, but that is very hard to do.

I count on the state to not license inadequately trained health care providers. I can’t assess the skills of every professional I use. I would not hire an electrician to change the wiring in my house without someone knowledgeable exercising due diligence to assure me that the person I hire has achieved some minimal level of relevant education and prior experience (an apprenticeship). Attending lectures or reading some books isn’t enough…

Sara Snyder of Safer Midwifery for Michigan gets to the heart of the matter:

The lingering questions then become why are the minimum standards so low, especially in comparison to counterparts around the world? Why is it acceptable for midwives to aim for the cheapest, quickest route instead of striving to be their best? Why are the “certifying” bodies (ie NARM/MANA) keeping the bar so low…as in only requiring a high school diploma as of 2012 instead of requiring a college level education to deliver our babies?

Why are the minimum standards so low? Because the CPM isn’t designed to ensure competence in midwifery; it’s designed to provide a false sense of security to American women, most of whom have no idea that when they hire a CPM they are hiring someone who isn’t a real midwife.

As Rooks points out, it’s long past the time when the CPM should have been abolished. Better late than never, though. The CPM should be abolished as soon as possible.

Will American women continue to hire poorly educated, poorly trained self-proclaimed “midwives”? Some women probably will, but as long as they understand whom they are hiring, they have every right to do so.

In the meantime, anyone contemplating a homebirth needs to understand that at the moment the only degree an American homebirth midwife needs is a high school diploma.

Seriously.

Edited to correct a misattributed quote. The last quote is from Sara Snyder of Safer Midwifery for Michigan, not from Judith Rooks.

  • NursingRN

    So, this freestanding Birth Center around the corner from where I live- we get their patients when things go wrong. The midwives who work there are a Biology major and a Food and Nutrition Science major, and I think the last one is a Women’s Studies major. I noticed they hire on-call RN’s there. It occurred to me that perhaps they hire RN’s because RN’s with OB experience (which is what they want) know more than they do. Have the RN tell them when things are getting ugly- or even worse- blame the RN, because the RN has accountability. The RN could lose her license. The RN could have allllll sorts of nasty happen to her hard-earned license. Maybe the CPM. LM, are hiding behind the RN’s!

    • Karen in SC

      That is despicable! You should write the agency that sends them, as they may bear some accountability as well.

      • NursingRN

        I just wonder because this last weekend I had a couple who transferred from this place because of “maternal exhaustion”, she wanted an epidural. Her water had been broke for almost 60 hours. It’s a miracle her kid didn’t end up septic. They seemed so…I don’t know…clueless is the word? They had so many questions, and I’m happy to answer them but they seemed like “wow? REALLY?” to everything. Of course they refused every intervention- no eyes/thighs (no eye drops or K- the birth center was going to supply them with K drops…good luck with that, I could hardly get my babies to take their multivitamin drops and Zantac).

        They just seemed so wet behind the ears, everything I was telling them seemed like an amazing revelation to them. Made me wonder just how bad the “midwife” and doula painted the experience to be.

    • auntbea

      Why do the rn’s accept the job?

    • manabanana

      We have some CPM-owned birth centers around here that only hire RNs as birth assistants. One impression I had was that the RNs had more skills. It seemed like CPMs didn’t want to hire other CPMs as birth assistants because they lacked not only the skill set, but also the license to be an effective birth assistant. I also think having RNs on staff lends to the birth center’s legitimacy and creates the illusion that these centers are integrated into the larger health care system.

  • Staceyjw

    Until a year or so ago, you didn’t even need a diploma or GED.
    There were ZERO educational requirements.

    NARM-MANA was being pressured to do something about the low educational standards, so what did they do? Added the requirement of a HS diploma! problem solved, LOL.

    If they thiik this low standard is acceptable, it’s no wonder they believe what they do, and

  • MrG

    All of this brings up the question: Why oh Why does the real “American College of NURSE Midwives” which partners with ACOG http://www.midwife.org/American-Congress-of-Obstetricians-and-Gynecologists continues to associate with DEMs and doesn’t vehemently defend their professional members?

    • Stacy21629

      This is very bothersome. I interviewed my last homebirth CNM before I even got pregnant and talked with her about my concerns over hiring a CPM if I moved out of the area (this is the only homebirth CNM in the state). She kept trying to convince me that the CPMs here are great, she had one deliver her 2 babies at home, yada, yada.
      Her assistant at my birth was a recently licensed CPM and the “plan” was that if I went into labor and my CNM wasn’t available that the CPM would attend me. I didn’t tell her…but no freaking way. I’d call 911 and get an ambulance to the hospital rather than have a newly licensed CPM attend my labor. Thankfully it wasn’t an issue and when I needed to transfer my CNM was fast to diagnose and get us out the door and everything was ok…but yea, the comfort with CPMs is very troubling.

      For my first birth my hospital-only CNM referred me to the OOH CNM that delivered my son. I don’t know her feelings toward CPMs but looking back “out of the woo” I’m glad she referred me to a true medical professional. I very well might have ended up with a CPM instead.

  • manabanana

    These are screencaps from a midwiife’s facebook page today. Both posts within 24 hours of each other: “I have attended 81 births.” “I passed my NARM exam.”

    • Staceyjw

      81 births is a LOT for a HB MW, few ever get so many ever, not even over years. Before getting a CPM? No way.
      I do wonder how many she was a doula for?

      • manabanana

        I’m guessing that these are her doula births and midwifery training births combined.

        Are you saying this person is over qualified as a new CPM?

  • bomb

    I have legit published books on pregnancy that differentiate cpms from cnms as “CNMS often work in hospitals and can prescribe medication. CPMs rarely work in hospitals and cannot prescribe medication s.” Rarely???? How about never??? Everything else in the books is accurate and mainstream. They made me think cpms were just another type of provider, like a nurse practitioner in a doctors office etc.

    • DaisyGrrl

      Well, they’re Certified and Professional! Clearly they know what they’re doing.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      You should point that out to the author as an incredibly inadequate description.

  • Tiff

    This definitely brings me back to almost over a year and a half ago, when I found this site. I was pregnant with my fourth child and wanted to try a VBAC (after two c-sections). So, I began searching and found the world of homebirths and midwives. I didn’t know a CPM from a CNM; to me they were the same. But to make a long story short, after discovering this site and the difference between the two, I quickly found myself a competent OB who was more than willing to let me try for a vbac (though, in the end, because of my baby’s position, we ended up with another c-section). However, I still find myself pissed at the two midwives I met with. I still feel very deceived because they were not at all upfront about their credentials, leading one to believe they were on the same spectrum as a midwife who worked at a hospital or doctors office. I later found out that one of them was actually a high school dropout who got their GED at age 25. Nothing offensive towards dropouts as I once met a doctor who started out as a dropout but still, he paid a lot of dues and this woman had not but yet, delivers babies. Also, one of the midwives admitted to me she had delivered babies “underground” for years and only got “licensed” when the state we live in legalized midwifery. Any way, I wonder about the women who haven’t found this site – women who trust these midwives without question. I also wonder how many lives Dr. Amy has saved? I know she definitely saved my son’s.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    OT – I’ve got another urgent denial of planned cesarean situation in Ontario …and this mom actually has medical reasons for a CS and would like a tubal ligation at the same time (she has 4 prior deliveries, all VB)…she is about 35weeks, baby is breach, she is ineligible for regional anesthesia and up until this week her OB was on board with a planned cesarean under general – doctor wants to do an ECV/instrumental vaginal delivery. She also has the support of her GP and a psychologist for a planned cesarean.

    • AlisonCummins

      I wonder what’s going on here.

      Third-hand anecdote from many years ago: A friend’s friend is a urologist. He gets a quota of the number of orchiectomies per year the provincial government will reimburse him for. (I didn’t know about these quotas. I suspect most people don’t.) This puts him in a delicate position when he’s got twelve men with testicular cancer but can only operate on ten of them. [LMS1959, feel free to rant about how terrible Canada’s single-payer insurance is.]

      I wonder if something similar is going on in Ontario? OBs or hospitals have quotas, so they are avoiding all possibly elective c-sections to make sure they have budget available for the emergent ones?

      • The Computer Ate My Nym

        feel free to rant about how terrible Canada’s single-payer insurance is.

        Because NOTHING like that EVER happens in the glorious free market of the US. (/snark). BTW, did you know that repeal of EMTALA is under discussion? Soon we will again be able to allow the unworthy to die outside our ERs. Also, Harper is a twit.

        • AlisonCummins

          Yeah. Resources aren’t infinite so there are always hard choices. At least here in Canada the consequences are pretty much spread around so we all feel the effects, not just the people least likely to vote. I feel crappy for the doctors though if they end up being the ones who have to decide who gets what. One doesn’t get the impression that rationing is a gut-wrenching decision when it’s made by an insurance company.

      • Rochester mama

        A c/s doesn’t cost significantly more than an instrument vaginal delivery. I was involved in billing in a hospital. Both have to be done by an OB in a hospital setting. We charged 3k more for the c/s. But our Drs are all salaried staff so they get paid the same no mater how the baby gets out.

        • AlisonCummins

          If you charge more for the c/s then presumably the *payer* cares how the baby gets out.

          If the *payer* will only pay for a predetermined number of c/s per year, then the docs need to figure out who’s going to get them. Not out of selfishness but out of concern for the patients with the most medical need.

          • Rochester mama

            A normal vaginal birth was around 23k (our package bill includes all routine prenatal care including dating and 20 week u/s and is facility and provider and babies hospital bill after birth) and a c/s is about 25k. In a bill that big it seem awfull to put her through that process over such a small financial part of having a baby.

        • LMS1953

          Moreover, the cost differential of a vaginal delivery + postpartum tubal ligation and a C/S (the tubal takes maybe 5 minutes) is negligible. The OR time for a PPS-BTL is around 30 minutes, about 10 minutes less than the average C-section – so the C-section might even be cheaper, especially if the labor is extended. But try telling a CNM Nazi that.

        • sarahh.rosanne@gmail.com

          I’ve had 2 instrumental deliveries in the US. My total billed expenses for each of the deliveries and all associated expenses (including 2 day stay) were approx. $24,000 (2009) and $28,000 (2013). I don’t believe there would have been an appreciable difference in the total cost for a c-section. I know the same math isn’t applicable to all situations.

          • Rochester mama

            The only reason the c/s is more is the use of an OR as opposed to delivery room and some drugs and supplies.

      • LMS1953

        On the advise of my counsel I respectfully exercise my Fifth Amendment right and decline to rant. :-)

      • mishabear

        Holy crap. If this is in fact why the OB is resisting c-section, Mrs. W’s friend should talk to the hospital about what it would cost to pay for the c-section out of pocket (i.e., the difference between an out-of-pocket c-section and the tubal ligation, which is presumably covered and which the hospital can still bill OHIP for). If the hospital has an accommodating billing/finance person, this may be possible…and she might even be able to pursue reimbursement after the birth in a more leisurely manner.

        My out-of-pocket c-section (in BC though, not Ontario) was a little under $6000. It was an emergency (HELLP), but not emergent, and included 5 days in hospital, Mg drip, internal medicine consult, etc. I got the billing rate for returning Canadians (i.e., the 3-month wait before you get picked up by MSP) even though I was technically a visitor who was in the permanent residency application process. Hospital really was flexible that way…and $6000 is considerably cheaper than what it would have cost out-of-pocket in the US. Heck it was cheaper than what I would have paid for COBRA and probably about what some would pay in deductibles for the shittier insurance policies in the US.

        Long time lurker, but this is my first post. 8-)

      • Haelmoon

        The quotas (called caps) were removed in Ontario several years ago. It was an attempt to lower health care costs. Many physicians just kept on working, whether or not they got paid. In obstetrics, there was a maximum amount you could bill per year, but you really couldn’t stop delivering babies. It was not specific to vaginal deliveries or C-sections.

        • AlisonCummins

          Thanks, Haelmoon.

        • LMS1953

          What a great system! Indentured and involuntary servitude is alive and well on our continent. I have often wondered how one human being could enslave another and justify it. The common thread is that a certain class of people is deemed innately capable of providing a service. Said service is integral and vital to preserve the establishment or status quo. Said service is more costly when paid for equitably and fairly than the system feels it can possibly bear, so the system places the indentured class into involuntary servitude. Twelve Years a Slave indeed. Go to college for 4 years, go to medical school for 4 years, do a 100 hr work week residency for 4 years. Emerge from that gauntlet indentured to hundreds of thousands in school loan debt and then have “the system” pay you in dimes on the fair market dollar and call you a greedy bastard if you complain or ask for more.

          • Amy Tuteur, MD

            That is such self pitying bullshit, LMS. Poor, poor you.

            Did anyone force you to go to medical school? Does anyone force you to continue practicing medicine?

            If you think practicing medicine is indentured servitude, I suggest turning off the morons on Fox News who feed your never ending sense of grievance and volunteering to provide medical care to people sold into sex slavery to see what servitude is.

            There are few things less attractive then a wealthy white male nurturing his anger and hate by pretending he is a victim of discimination.

          • Haelmoon

            Even without caps, we can’t bill for everything that we do. That is just something that we accept. In Canada, if a non-resident shows up in labour, we deliver and just accept that we are likely not going to get paid. Why? I didn’t go into medicine to make a lot of money (don’t get me wrong, I am well paid), but I do my job because I love it.

          • fiftyfifty1

            poor thing, you

          • http://thefresstyler.blogspot.com/ Hannah

            Enslaved? Really? This is so offensive that is barely warrants a response.

            Here’s the thing: this system doesn’t work for patients and it seems it is working less and less for doctors.

            I know plenty of wealthy doctors in Australia where there is a combined system and it works perfectly. You can choose to be paid a reasonable wage in the public system or go private for a higher one. Or if you feel extra nice, you can serve both systems. Doctors choose any of the above, all the time, and they all get to drive nice cars and buy big houses like they always have.

            Nobody made you become a doctor. You aren’t a slave.

    • Ash

      I hope she will be able to get a C-section as originally planned. I hope she will be able to petition the chief of OB or rally another physician to help her. I really don’t understand why this request would be denied. I wonder if a pelvic floor specialist would be willing to advocate for her.

    • DaisyGrrl

      What the heck is going on here in Ontario? I know midwives are starting to run L&D units in some hospitals, so there may be pressure from the hospital to minimize c-section numbers. I hope she gets her c-section.

      • DaisyGrrl

        The Markham Stouffville Hospital has a midwife-run birth unit. It appears the pressure to reduce c-sections there is intense: http://www.ontariomidwives.ca/newsletter/page/an-ontario-first-a-midwife-who-runs-a-hospital-birth-unit

        • staceyjw

          MWs really shouldnt run anything. An OB ought to oversee. Its not because MWs arent educated or experienced- its because they are collectively suffering from woo syndrome, too much NCB kool aid. it is fatal to moms and babies.

        • AmyP

          Midwife-led labor and delivery in places where it has previously been OB-led seems like something to fight at all costs. (Remember that famous mumsnet thread on British midwives delaying and preventing epidurals?)

          Unfortunately, in the current environment in the US, the cost-cutting benefits of going to a midwife-led model is going to be very attractive to a lot of people.

    • LMS1953

      A patient needs to give informed consent for an external cephalic version. It is NOT an innocuous procedure – there are risk of abruption and cord accidents. A couple of years ago, Dr. Amy presented a case – I think it was in her residency or very early in her career. Each time she did the version, the baby would flip back. This happened at a couple of visits. She asked an older OB his opinion. He said the patient would eventually present in labor and the baby would probably be vertex. He was exactly correct, only the baby was an intrauterine fetal demise.
      This kinda sounds like “crowdsourcing”, but I don’t think you’ll get many recommendations for stevia or evening primrose or moxibustion. Anyway, I think it would be reasonable for her to decline the ECV due to known risk. The baby may well flip on her/his own. If not, proceed with C-section for breech with the BTL.

      • CognitiveDissonaceHurts

        My midwife did an ECV on my third baby who was breech, which would have ruled me out of a homebirth in her books. I had never heard of the option of turning a baby that way. My midwife was British trained. That night, I felt a tremendous amount of kicking and elbows and sure enough, by morning, baby had flipped back to breech. She’s still a bit contrary, 22 years later, lol. But at full-term, she was vertex and delivered safely at home.

    • LMS1953

      Does Canada require a woman who wants a planned home birth to get a note from her psychologist/psychiatrist?

      • RebeccainCanada

        Oh! Awesome! Great point thank you!

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        No it doesn’t this situation is nuts.

        • LMS1953

          I think there are a lot more nutso’s in the cohort who want a planned home birth than in the cohort who requests a planned (elective) C-section – no birth is “elective”, but the cohort who wants to preserve perineal strength and function while avoiding the pain of labor and the risk of labor on the baby should have their autonomy acknowledged. Women who want to home birth their first baby, a breech baby, a VBAC should have their heads examined.

          • http://Www.awaitingjuno.blogspot.com/ Mrs. W

            I don’t like the term “nutso” – and think there are very solid psychological reasons to take into consideration…mental health doesn’t deserve to be ignored for any mother.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      I think she should call a lawyer, and then possibly the media. That doctor is not acting responsibly.

      • DaisyGrrl

        Most of the media in Ontario is having a big love-fest with natural childbirth. A woman being refused an elective c-section will not generate much sympathy from that front.

        • The Computer Ate My Nym

          It might help change the conversation.

          • DaisyGrrl

            It could, but any woman willing to take that on will need a really thick skin (if the media even goes for it and does a story). You’d think the opening of midwife-only birth centres was the greatest thing that ever happened. The other problem is that with single-payer, people are quick to jump all over options they perceive as more expensive (unless it’s for themselves).

          • Elizabeth A

            Maybe someone wants to stir up a little controversy?

            You know what’s really expensive? A failed ECV/instrumental delivery that progresses to emergent section. Those cost a bomb.

            Plus – she’s ineligible for regional anesthesia? And they’re planning an ECV and instrumental delivery? Is that some kind of human rights violation?

          • DaisyGrrl

            I agree, it blows my mind that the doctor is even pushing this option. I hope that she’s able to take LMS1953′s advice and refuse the ECV. It’s nuts in every single way, and will almost certainly end up costing more money.

            But, at 35 weeks, the mother might not have the energy and inclination to seek out the publicity when the culture is so pro-NCB. That’s really all I was trying to get at. Going against popular opinion is difficult enough at the best of times.

          • LMS1953

            And what is REALLY expensive is a brain-damaged baby needing lifelong care which substantiates a multi-million dollar malpractice liability settlement.

          • Haelmoon

            We don’t usually use anesthetic for and ECV. If it is easy, it generally isn’t too uncomfortable. If it is hard, it is uncomfortable, but likely not going to be successful. Just because someone can’t have an epidural does not mean they can’t have a regional block. I will use pudendal blocks for forceps and vacuums and it can be quite appropriate and not overly uncomfortable for the patient. Also, there is very little pushing (pulling) needed for a fourth baby, if she shows up in labour (vertex). I would not deliver a breech vaginally with an indication for an assisted second stage.

          • Mer

            I thought that one of the reasons for an epidural during ECV was in case it cause something to happen that requires an immediate c-section?

          • Haelmoon

            There were some studies suggesting a higher success rate with spinal analgesia for ECV. However, 1-5% of babies will have a transient bradycardia that last less than 10 minutes. We only attempt ECVs on babies that are thought to be healthy. Therefore, if there is a complication, we have a slightly larger window to safely deliver the baby (as opposed to the chronic stress of labour with additonal acute distress). The risk of abruption needing emergency C-section is like >1/1,000. That is a lot of nursing and anesthesia resources for that risk, with no clear benefit. In my centre, all women have fasted for 8hr and have an IV in place to lower the risk. The only time I have the patient have a spinal first is if I have previously failed and it is the day of their booked c-section. I will try once more if they request. My success is only 1 of 18 at this time (immediately pre-c-section). Most patient’s don’t want me to try again once I have failed.

          • Mer

            Ok, that makes sense. Thanks for explaining!

          • sarahh.rosanne@gmail.com

            Could a pudendal block be sufficient for anything beyond an outlet assist (ie. rotation etc.?) I don’t have a medical background. The original post said she was not a candidate for regional anesthesia so does that leave any effective option? Again, that wouldn’t be a justification for this, I am just wondering if there is any silver lining to what I’m imagining. I can’t understand that level of disregard for the mother’s comfort or well being. My epidural had to be removed before my first rotational forceps delivery and even with dulled sensation the pain was hideous. I am appalled by this.

          • sarahh.rosanne@gmail.com

            How could he justify a planned instrumental delivery without a possibility for regional anesthetic? Could a pudendal block be sufficient? Not that it would make the situation any better. the whole proposal sounds reckless and sadistic.

          • LMS1953

            Precisely! It is not long before “single-payer” becomes “single-option”. Autonomy be damned. It’s all utilitarian ethics after that.

          • rh1985

            And this is another reason why I don’t want single payer in the US. A system like Australia has (with the option of private insurance and private hospitals) would be okay.

          • http://thefresstyler.blogspot.com/ Hannah

            Australia’s system works pretty well except that cost-cutting measures mean that labor and delivery is being infected with midwife-led woo.

            It works a shitload better than the US system, in that if there is an emergency, you can be treated in the public system to a pretty great standard for the most part, or you can choose your own medical path if you wish. In some cases, the hospital will admit you as a public patient because it just works better for that case.

            Basically it is the best of both worlds and the new government is insistent that the US and trickle-down is the model to aspire to (as an economics major and someone who sees the US economy for the clusterfuck that it is, it enrages me). Maybe I will renounce my citizenship for US citizenship, after all. *cries*

          • Staceyjw

            For some of us, this is still better than no option at all, and “single option” doesn’t have to be inevitable.
            BUT
            I wouldn’t want a system where the US government was in control like the NHS, or even a federal government single payer option. This gives too much power and control to a group notorious for ignoring the needs of the population, and catering to far right religious fanatics.

            If we had these systems here, I could see the far right taking over and screwing up care for women, like they do anywhere they can. They also stick their noses into family planning, and end of life care. Catholic hospitals already ban things they don’t like, even if they are the only place in town. I would hate to see this writ large, and that is exactly what the wing nuts would fight for (parallel to destroying the whole thing, naturally).

          • The Computer Ate My Nym

            Too true, about needing a thick skin.

            As far as single payer causing limited options, here in the great free market of the US, we’ve got a problem with a particular disease. This disease is present at birth and people with it live, on average, 40 years (a little longer for women, a little shorter for men.) They suffer numerous complications, including severe pain and failure of multiple organs, including being at high risk of stroke from birth on. They have a high risk of dying in infancy. The hospital where I work has a new initiative for this patient group. To do what, you might ask. Perhaps to improve their life expectancy? Or quality of life? Or reduce organ failure? No. The hospital’s primary goal is to reduce the number of times they get admitted to the hospital. Without respect to whether they aren’t admitted because they feel better or because they’re being sent home with severe pain.

            Oh, and before you say, “That’s one evil hospital you work at. Why don’t you quit and go to work for some place a little less evil like maybe the NSA?”, let me just say that this hospital is unusual in our region in that it actually does accept patients with this condition. Most of the hospitals in the region, especially the private ones, just try to dump them here.

            The problem isn’t the system. At least, all systems have problems. The underlying problem is that we, as a society, are willing to accept substandard care in return for lower apparent costs.

          • DaisyGrrl

            Agreed. There’s good and bad in both systems. All in all, I prefer single-payer because at least everyone has access to a certain level of care without consideration for their financial circumstances. The problem arises when you have the taxpayers trying to inject their fiscal priorities into the discussion. And you’d better believe it happens all the time.

            But, when the limited options fail to take into account the needs of the patient, it can go too far. And it also makes it more difficult to go doctor-shopping at 35 weeks pregnant when the only way to see an OB is through a referral from your GP (which can take weeks to go through – weeks that Mrs. W’s friend unfortunately doesn’t have).

          • The Computer Ate My Nym

            I never will understand people’s priorities. Even if the average taxpayer doesn’t want to provide care for the “undeserving”, does s/he think that s/he’ll never be sick? Or pregnant? Or, heck, have a desire for cosmetic surgery? Being cheap with your medical care system strikes me as about as stupid a fiscal decision as can be made.

            I can’t defend the Canadian system much, having no experience with it. I kind of like the German system: multiple insurers but everyone is covered by some form of insurance, public or private, with multiple public as well as private options. I’m not crazy about how hard it is to go from private back to public, but it’s better than having 20% of the population not covered at all.

          • SkepticalGuest

            Got me curious. What is the disease?

          • Jessica S.

            I agree, I’m curious too!!

          • Beth

            sickle cell anemia?

          • The Computer Ate My Nym

            Bingo! Sickle cell it is.

          • auntbea

            I feel like there are some ugly overtones to cutting care for this disease in particular. ..

        • Elizabeth A

          C/s for breech may be elective in hospital scheduling parlance, but is strongly medically indicated, and not at all elective in that way.

          • DaisyGrrl

            True, but that’s not how it will get spun if she goes to the media. Even if the story is sympathetic to her, I would predict howls of outrage from letter writers and online commenters.

          • Elizabeth A

            Then the people selling the story in the first place have to be prepared with the spin. A c-section is not “elective” just because you can find a provider willing to try a vaginal delivery. The term breech trial showed that c-section is saver then vaginal delivery for breech babies, and ECV and instrumental delivery both carry risks. This mother is not asking for a c/s on some kind of whim, she is pressing the medical professionals to take what the available evidence indicates is the safest route for her baby.

            No matter what goes up on line, the comments section will contain plenty of idiots who think they know best. If anything goes wrong with this birth, the province is going to be on the hook for that baby’s lifelong care. That needs to be ground into the province’s face.

          • http://Www.awaitingjuno.blogspot.com/ Mrs. W

            There’s a few other big fat red flags in this particular case. It seems like a disaster waiting to happen.

        • http://Www.awaitingjuno.blogspot.com/ Mrs. W

          I wish they’d have a love-fest with quality care and what matters to mothers.

    • RebeccainCanada

      What about changing her Dr? Surely she can find someone who realizes this us madness?

      My sister is a nurse in Detroit, they call their patients “care partners”!

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        She needs a high risk OB who could see her ASAP – as she’s already 35/36 weeks…that would need a referral and is likely to take weeks, she could show up in emerg and request a consult with the oncall OB…. I believe she is willing to travel (so if there’s a Canadian high risk OB willing to see her, please contact me so I can pass your info along that she can ask to be referred)… I am at a loss. I should also note that the instrumental delivery (she has a condition that will not allow pushing) would be without regional anesthetic. The situation has blown my mind. Accessing care in the US is likely out of budget.

        • DaisyGrrl

          That’s mind-boggling. Is she in a region that has reasonable access to more than one hospital? Could her OB be caught between a woo-filled birth unit and reason?

          Maybe she could contact the ethics department or patient advocacy department in the hospital she is going to. Maybe a lawyer’s letter? It’s just awful.

          • http://Www.awaitingjuno.blogspot.com/ Mrs. W

            I think there’s probably only one hospital in that area that takes on high-risk obstetric cases.

          • Haelmoon

            There are multiple hospitals there, but the perinatologists are at one hospital in specific. It is always ok to ask for a second opinion.

        • Ash

          I bet this poor woman has tried to talk to the OB multiple times…but if she hasn’t tried already, what would happen if she discussed with the OB the results of the term breech trial and asked the OB to document their discussion? As in, asking the OB to document that they discussed the results of the term breech trial in the medical record? Might be hard for a MD to accept that they are recommending a higher risk of neonatal death if they have to document it in writing.

        • LMS1953

          I can’t think of very many conditions that would contraindicate a spinal/epidural and pushing in the second stage. Back injury/head injury might be one. Or maybe an arterio-venous malformation.
          Also, if a regional anesthetic is contraindicated for the delivery, it probably is also for the PPS-BTL. That means getting general anesthesia on post-partum day one, which is to be avoided due to hemodynamic flux. If she has all these complications, then a tubal sterilization is a good idea. The more that comes out about this case, the less advisable a vaginal delivery seems to be.

        • Medwife

          Surely she can refuse the ECV? If baby stays breech they’ll have to schedule a c/s.

    • Dr Kitty

      Refuse the ECV.
      Ask for a second opinion.
      Ask for a conference with her OB and the head of obstetrics at her hospital because she is unhappy with the care plan that has been proposed.
      Make a formal complaint to the hospital about her care.
      Request transfer of care to another OB.

      Lots of options.
      But she needs to do it NOW.

    • thepragmatist

      Hey Mrs. W! Thanks for catching her. She’s very very grateful. Good work.

  • Alexandra

    More STUPID from Jan Tritten Facebook page:

    “Beth Bailey Barbeau: Absolutely it’s most valuable to leave the cord attached until long after placenta is born, and until we’ve asked the baby as well as the mom if they are ready to be separated from the placenta. And yes, we’ve had babies immediately WAIL and Squawk loudly when asked, leading even those in the room who were rolling their eyes at seriously including the baby in the process to comment, “Well, I guess that’s a NO then!” (The same babies when asked a half hour later contentedly blinked and made mouth motions.)”

    Yup, according to this midwife, you should ask the baby when to cut the cord.

    They are so remarkably stupid. It would be funny if it wasn’t so damned irresponsible. And deadly.

    Can we do a whole series of screengrabs of the stupid things we’ve seen midwives say on the web? I think it might be valuable if we gathered all the stupid on one spot. Then maybe they would be less likely to post this garbage in the first place if they knew we were capturing and mocking them.

    • Jocelyn

      That’s a good idea. It would illustrate the craziness of lay “midwives” better than we can just explain.

    • Zornorph

      I just asked my baby if he was ready to be separated from his dirty diaper and he immediately wailed. So I guess that’s a ‘no’, then!

      • prolifefeminist

        I just asked my baby if I should pour myself a cocktail or read him a book. He started drinking his bottle, so I grabbed mine. Thanks, baby!

        • ngozi

          You win the Internet!!!

      • realitycheque

        At 12am last night, after my 2y.o woke up and refused to return to sleep for multiple hours despite considerable effort on my part, I asked if he was FINALLY ready to go to sleep, and got a very definite “NO!”, followed by exhausted wailing.

        I guess I should have caved to his requests and let him stay up all night eating chocolate biscuits and watching Cars for the 10,000th time! Toddler knows best!

    • Trixie

      I just asked my baby whether I should mop the floor and she started wailing. Sweet!

    • ngozi

      You can find many things that midwives supposedly say on the website “My OB Said What?” That is a site that is usually full of woo, and is supposed to be a nose thumb at OBs, but I would say that at least half the complaints are about midwives and nurses.

      • yugaya

        “My Midwife Said What?” blog is definitely needed.

        • Coraline

          Seriously, can someone please start this blog?!?!

          • RebeccainCanada

            Hey, someone has, look in the links above! :)

          • The Bofa on the Sofa

            Yes – Blogroll to the right —–> and up ^

          • Jocelyn

            Doesn’t look like it’s been updated in a long time though…

    • ngozi

      Those babies are probably wailing and squawking because they don’t like stupid people

      • realitycheque

        Probably screaming, “Why are you asking me such stupid questions, woman?!”

      • rh1985

        They are probably thinking what the heck is going on, I want back inside, these people are insane.

    • yugaya

      I can’t, I can’t be reading any more of that. When I see something like that first I want to reply in a reasonable manner thinking that my appealing to common sense and reason may help someone, then I read down the thread and find something even more cringe-worthy… aaand then when I read a few more quacks I just end up with this sudden urge to chuck the laptop outta window and punch people in the face.

      How do you people do it?

    • Comrade X

      LEAVE THE FUCKING BABY ALONE!! HE IS TEN MINUTES OLD. IT IS NOT HIS RESPONSIBILITY TO MAKE MEDICAL DECISIONS!! STOP TRYING TO SHIFT RESPONSIBILITY FOR YOUR JOB ONTO SOMEONE WHO IS TEN SODDING MINUTES OLD!! GAHH!

      • Amazed

        Err, Comrade… they won’t leave the babies who are not born YET alone and you’re pleading the cause of ten minutes olds. Not gonna work, I’m telling you.

        Sometimes babies just make the decision that they are not to be born alive. Happens more often at homebirths. And they are not even a MOMENT old.

    • Elizabeth A

      Hey look guys! Dunning-Kreuger in action!

    • rh1985

      I am going to go ask my two week old if that midwife is an idiot.

    • anion

      I was on the MT FB page yesterday and noticed a comment that made me LOL. The question was about GBS testing, and one of the responders was very, very definite when she informed the OP that no one should EVER be putting ANYTHING in her vagina.

      Of course, if the OP had followed that advice to begin with…

      (I know it’s really not an uberdumb thing to say, it just seriously made me giggle like a dork, so I thought I’d share it.)

      • ihateslugs

        Unless it is a clove of garlic inserted to “take care” of the GBS. That’s ok per midwives… Oh wait, and a ball of yarn for knitting your little placenta bag for your lotus birth. That is also ok.

    • Beth

      what?? they don’t ask the placenta? Monsters.

  • namaste863

    Dr. Amy, maybe this is off topic, but another common thread on this blog is the anti vacc movement. I pride myself on being an empiricist, and since this is at least partially a discussion about woo, I’d love to hear your thoughts on germ denialism.

    • Stacy21629

      Just look around on the blog – she’s post about vaccines many many times.

  • Ra
  • Zornorph

    The thing I don’t understand is why CNMs don’t do more to complain about this and point out the differences. Seems to be that they risked getting damage to their profession by these jokers. It is all rah-rah-sisterhood or am I missing something?

    • Comrade X

      I’m wondering that too, Z. If I were a midwife, very little would piss me off more than complete charlatan idiots pretending they were midwives too.

    • The Bofa on the Sofa

      Nope, not missing a thing.

      Notice that it’s not only damage to the profession, it’s actually unqualified competitors!

      If nothing else, having CPMs mean that fewer people will be CNMs.

      As a professional organization, that in itself should be abhorrent.

      I know that my profession takes a very strong stand against people who are less qualified trying to take positions away.

      And don’t get me started on mail-order “PhD”s (or people trying to pass off “honorary” PhDs as being equivalent to legitimately earned ones)

      • Zornorph

        I tried to hire Julius Erving to deliver my son, but he claimed he wasn’t qualified. I think he just didn’t want to do it, the lazy bastard.

        • The Bofa on the Sofa

          From Scrubs…

          Cox: “Are you are real doctor, or are you a doctor like Dr. J is a doctor?”

      • ngozi

        All of these preacher/pastors who buy a doctorate in religion make me sick. That’s not an easy course (well, I guess by the time you are studying for a doctorate, no subject is easy) Many of them can’t read and understand the Bible as well as my second-grader. But boy don’t those dummies flaunt their “Dr.” title!!!

        • The Bofa on the Sofa

          Worth noting, Dr Martin Luther King had an absolutely legitimate PhD from Boston Univ in 1955. His thesis was ”
          A COMPARISON OF THE CONCEPTIONS OF GOD IN THE THINKING OF PAUL TILLICH AND HENRY NELSON WIEMAN”

          His thesis is signed by L. Harold DeWolf and S. Paul Schlling.

      • anion

        or people who throw their unedited word-vomit manuscripts up on Amazon Kindle and run around calling themselves “Published Authors.”

    • student nurse midwife

      Not really rah rah sisterhood, but kindof. Midwives in general are a “re-emerging” and currently growing profession. I’ve already had to explain to enough people about what the scope of a CNM is, how I’m not going to catch babies at home, how I don’t live in a barn, and I haven’t worn tie dye since I was 6. Also, we know many people don’t know the differences between the different types of midwives – so, by hating publicly on CPMs, it has the potential to ruin CNMs…

      • The Bofa on the Sofa

        lso, we know many people don’t know the differences between the different types of midwives – so, by hating publicly on CPMs, it has the potential to ruin CNMs…

        Because the CNMs don’t do enough to make the distinction, of course.

        That would be the first step, for sure. “CPMs are NOT CNMs”

        • student nurse midwife

          Oh trust me, I definitely point it out when I have the chance to. If someone is talking about seeing a MW, I let them know to be sure it’s a CNM. And I take time to explain the difference when someone asks me what a MW is.

          I guess what I was saying before is that CNMs’ recent “popularity” (or w/e you want to call it) is largely due in part to Ina May and the Farm. Even though we don’t practice the same way, we still hold a lot of the same core values – we just interpret them differently. We do have a lot to lose by publicly hating on CPMs – both are trying to advance midwifery as a profession. ACNM does state that they only approve of the MEAC pathway, and the reason they’re not all about CPMs is because there is lack of federal guidelines for certification.

          For some lolz about the drama btwn ACNM & NARM:

          http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000310/CPM_FAQs_07_31_09.pdf

          and

          http://narm.org/pdffiles/OpenLetterToACNM-080409.pdf

      • prolifefeminist

        CPMs are ruining the reputation of CNMs just fine all on their own. Recommending stevia for a postdates baby with zero fluid and asking babies if it’s ok to cut their umbilical cords kinda does paint midwives in bad light. CNMs would be wise to distance themselves from wanna-be midwives!

    • Are you nuts

      A friend of mine is a CNM. She has not only a bachelors degree in nursing, but a masters as well. I would be super pissed if I had spent several hundred thousand dollars and 6+ years of my life learning my profession, and then these jokers with online certificates act like they are the same thing.

  • anon

    I don’t understand why anyone would even want to become a CPM. I would be terrified to be responsible for the life of a laboring woman and her child unless I had extensive training and support from other people with extensive training. I would be constantly crushed with fear and anxiety that I would kill someone. No thanks.

    • Comrade X

      I think most normal people feel like that, anon.

      • Julia

        So in addition to being inadequately trained, CPMs tend to be people who have problems with risk assessment and can’t properly judge their own limitations.

        • The Bofa on the Sofa

          IOW, “how can you trust someone who thinks that birth is safe?”?

          That might be a little harsh, but I do think that “how can you trust someone who doesn’t treat birth as a potentially life-threatening situation” is absolutely fair.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      bc you are convinced that birth is safe. duh.

    • Dr Kitty

      You have described exactly why I don’t attend births.
      And I’m a Dr.

      CPMs should be in the dictionary beside the word “hubris”.

      • Haelmoon

        I do deliver babies and some days I wonder why I do it. There are some many things that can go wrong, and I end up seeing most of them in my region (one of two perinatologists for a large region). I don’t trust pregnancy, the placenta or the baby at all. It can e really depressing sometimes. The whole trust birth issue makes me mad, particularly on behalf of my patients. So its their fault they had a trisomy bay? as severe IUGR? a preterm delivery? Its not under your control. If you can have a homebirth (in Canada) you are lucky to have had such an uncomplicated pregnancy. It was lucky, not something your midwife or you made happen.

        • akm

          I don’t trust the birth process either. I do anesthesia and quit hospital practice because I always felt like disaster was just a moment away on OB. I’ve slept better and my migraines have ceased since I stopped participating in OB

        • Arwen

          I’m relatively new so I don’t know if this has been covered a lot, but I think it’s insulting to the point where I want to shred faces when people suggest a “good” birth is because the mom did something to deserve it, and a “bad” birth, including conditions like you’ve described, are because of the sins of the mother. I think as a society, we should be beyond the “suffering is due to your sin” bullshit. It’s immature and unethical to suggest that.

          The things that high-risk moms do to keep their babies, and secondarily themselves (that’s usually how this works out) alive, and as healthy as possible, are staggering. And they do all this, only to be told they’re uneducated, weak-willed, worthless, evil failures of womanhood who don’t deserve to have children. They’re told their children are worthless trash that should have been weeded out of the gene pool.

          I can’t even go on. I literally get so angry I feel like a rabid cat. I want to grab my precious children and scream till I’m hoarse at the people who think I’m worthless because of what I went through, how I fed them, how I transport them, where they sleep, and so on. And then I want to cry.

  • Mel

    Second thought: In my experience, science by correspondence course is a very sketchy idea. When I teach a blended online-traditional class, students still need to do labs. In a lab with glassware, chemicals and gas lines. Virtual labs work in a pinch when you have no other options, but they don’t help you get the manual skills needed to be a good chemist or biologist. In training a new herdsman, reading books on cattle behavior, birthing process and illnesses has an important place in training along with hands-on experience. Without the hands on experience under a trained instructor, you know nothing.

    In short: I don’t want anyone who doing mostly online classes to do any medical procedures on me or anyone else.

    • Young CC Prof

      College I work at offers a bunch of online courses. I’ve even taught a few. They want to offer a fully online Associate’s degree, but that’s the sticking point, lab sciences. The science faculty are uniformly and strongly opposed to a science class with no in-person lab component, and I have to agree.

      (Of course, for a liberal arts degree where you only need one science class, there are ways to make it less onerous, like you only have to come to campus once a week, or you can even do it in a short summer session, but you have to do it.)

      • Medwife

        My undergrad genetics class, which was for science majors, didn’t have a lab. That was sad.

  • Trixie

    Cats and dogs never get PPH!

    • DaisyGrrl

      ugh. A rescue I volunteer with had a surprise litter a couple of weeks ago (like, two vets examined and x-rayed the dog and said she’s not pregnant). Puppy number six got stuck (didn’t make it).

      Another time I was online when someone was asking what to do with their cat who had given birth and seemed unwell (vet, now!). He did us the courtesy of coming back and saying it turned out to be a retained placenta.

      And if you want some really really gruesome reading on what can go wrong when dogs breed, I can point you to a website but it’s not pretty.

    • Mel

      The stupid….it burns.

      I don’t know much about how cats and dogs give birth, but I do know that cows can have uncontrolled postpartum bleeding.

      I’m trying to imagine standing up at a dairy/rancher conference on managing two common but dangerous problems in postpartum cattle – milk fever (very low blood calcium) and L/RDA (a twisted stomach) and saying “I don’t know why we bother about this so much. I mean EVERYONE knows humans don’t have these problems. Neither do cats or dogs! Obviously, the cows don’t trust birth enough.”

    • AlisonCummins

      One of my fantasies is to breed chihuahua terrier crosses when I retire. (I had one and she was perfect. Everyone else should have one too.) There are lots of different ethical and practical reasons I won’t, but one is the risks inherent in breeding. If I love my breeding stock I won’t want to subject them to the dangers of pregnancy and birth!

      • The Bofa on the Sofa

        We used to have a neighbor with an intact chihuahua who used to roam the neighborhood. When another neighbor’s husky got pregnant, I was wondering if the pups were to be huskihuahuas.

        • AlisonCummins

          Even better!

          Chihuahuas are lively, playful, attached and small. Mix that with any breed of dog and you get a better pet.

          (Chihuahuas are also stupid, irritable and their teeth fall out, so mixing them with another breed is a good idea.)

          • The Bofa on the Sofa

            I just like saying huskihuahua

            Although the mechanics of the male chihuahua with the female husky are a little challenging

          • AlisonCummins

            Funny story about mechanics:

            When I got my chi-terrier from the SPCA I was supposed to take her back to be spayed. I didn’t because I didn’t think it was necessary — dogs only go into heat twice a year and such a small dog is easily controlled. But then I learned about pyometra and realized I needed to, and I picked up a stray chihuahua off the street who pissed on clothes and furniture and needed to be relieved of his balls immediately. Off they went together to the vet, but my chi-terrier was going into heat and surgery would be too risky for her that week. Ok, so she comes home intact and in heat and that night the chihuahua commes back altered.

            The next morning… Action! They were going at it like teenagers in love. I called the vet and asked if there was still sperm in his tubes and they said no, they didn’t think so, but I should realize that he’d just had surgery and should keep them separated. I thought about that for about thirty seconds: “Ok Poupoune, you stay here in the tv room and watch Skippy the Bush Kangaroo. Pepe, you come into the kitchen with me and I’ll get out your colouring book and crayons and you can work quietly.”

            Nah. So the way it worked was that he grabbed her around the waist and hung on for dear life, hind legs kicking in the air. They liked my bed best because it had better traction.

          • Stacy21629

            You’re really lucky if she didn’t get pregnant. How long ago was this? He absolutely could have gotten her pregnant immediately after a neuter. There is definitely sperm still in the tubules and such.

          • AlisonCummins

            1998?

            She didn’t get pregnant. Whew!

          • Stacy21629

            Haha, that’s great! :-P

            I did my very first C-section ever on a chihuahua. 10 months old…so essentially a teenage mother. Got the first 3 pups out…4th was stuck. I guess she only trusted birth 75%.

          • AlisonCummins

            Meaning she delivered three vaginally and needed the section for the fourth? Or you got three out during the section but had to leave the fourth one there?
            Poor thing! The terrible thing about animals is that you can’t explain anything to them.

          • Stacy21629

            First 3 vaginally, 4th was stuck…and dead by the time they brought her in.

            If they’d done the prepartum and intrapartum interventions I’d recommended just a week prior when they brought her for her FIRST ever visit (namely, pre-whelping rads to know how many pups there were), we could have sectioned her 24 hours prior and saved the pup. Nothing wrong with it, they just waited too long and it suffocated to death with it’s poor head shoved against her pelvis until it was completely deformed. Oh yea and mom was trying to go septic.

            Trust birth!

          • AlisonCummins

            Awww, poor little thing!

          • Stacy21629

            I spayed her at the same time too – they didn’t get any choice about that. If I was doing the surgery, she was getting spayed. They could leave and take her to the ER for more $$$$ if they didn’t like it. If you’ve been this irresponsible so far, no way are you walking out with an intact bitch.

          • deafgimp

            That’s what these local idiots did. They had a small terrier mix female, intact, and a rough collie puppy male, intact. The puppy was very young, like 4 months old, and they created another puppy. They thought the puppy was too young so they didn’t bother keeping them apart when she went into heat. The terrier was maybe 8 or 10 pounds and had one enormous baby inside her, which of course died during birth. They took her to the ER and refused to allow a spay. As soon as she healed, they spayed her. I don’t know why, but hey, they were idiots.

          • Mel

            It’s amazing how many times “Trust Birth” is short for “Septic Shock Time!”

          • Laura

            “Huskihuahua” I had to say that a couple of times, too! Hliarious!

          • Mel

            We had a young, short bull successfully breed an mature, Brown Swiss cross cow. None of his feet were touching the ground, but she ended up pregnant!

          • FormerPhysicist
    • Coraline

      Yes, the stupid — it BURNS. I worked in a veterinary clinic as a simple receptionist for two years when I was in high school. Not any kind of medical professional, mind you. And yes, Jan Tritten, I can tell you even from my LIMITED experience working in a vet office as a receptionist: cats and dogs CAN and DO die of postpartum hemorrhage. What a stupid, misinformed thing for her to say. But then again, she’s a CPM, right?, so I guess that just comes with the territory …

    • Stacy21629

      Not only hemorrhage, but cephalopelvic disproportion (chihuahuas, bulldogs, bostons, pugs, etc), they absolutely will grow a puppy “too big to birth” (especially singleton litters), hypocalcemia, uterine inertia, malpresentation, hydrocephalus, and on and on the list goes.

      And then, especially in primips…they eat the pups.

      Yea, let’s be just like dogs.

      And to top it all off…when they have dystocia, owners bring the bitch to me – a vet with 9 years of post-high school education.

      I will admit the comparison to CPMs works though for most “breeders” I meet – most think they know everything there is to know about breeding and really have not a clue in the world.

      • Siri

        Homebirth Husbands: If your wife has a dystocia, don’t bring the bitch to an amateur – choose a professional!

      • Mel

        I hadn’t thought about the infanticide angle, but very, very rarely a first calf heifer will attack the calf after the calf is born. (It’s happened twice in 50 years on our farm.) We’re not really sure why, but our best guess is that either the maternal aggression switch gets set way too high OR that the heifer treats the new calf as she would a new cow in the herd and tries to fight it for dominance. The attacking cow is never safe around a calf either; she’ll try to attack any calf she sees.

        Nowadays, we don’t breed her back and sell her for beef when the lactation is finished. Back when the farm was smaller and couldn’t absorb that loss, the cow spent most of her late dry period in a pen next to the other dry cows so she could still be with other cows but couldn’t get to their babies. They also watched the cow 24-7 to deliver, then remove her calf ASAP. Needless to day, I’m glad it’s not the old days.

    • Amy Tuteur, MD

      Jan Tritten, extending the frontier of homebirth midwifery stupidity each and every day!

      • Trixie

        That’s actually an old one. They had to delete all the recent ones because of people calling them out on their stupidity. So the stupidity from the last couple years has gotten bumped up.

        • Stacy21629

          Keep it up. Immortalize their stupidity of the ages through screen caps.

      • Trixie
    • Ash

      With lay midwives, their interventions always work and never have adverse consequences. Funny how they criticize the “cascade of interventions” at hospitals. Baby with no amniotic fluid? Intervene with stevia. Hell, I could make a facebook profile and say I stopped PPH with a post-it that had “mama intuition” written on it in menstrual blood and it would get “likes”

      The “cascade of interventions” trope is pissing me off. CNMs and MDs make decisions, aka interventions. So do lay midwives, it’s just that their decisions are often full of BS.

      • anion

        Right, the difference is that their interventions don’t actually DO anything. Perhaps the lack of “Don’t smell lavender in early labor! It’ll send things zooming out of control!” is a sort of tacit admission of that fact? No need to warn about the rollercoaster chain of events that cup of herbal tea will send careening into motion, because we all know if anything actually happens it’s sheer coincidence/luck/placebo effect.

        • Medwife

          The only upside to homeopathy.

    • http://kumquatwriter.wordpress.com/ Kumquatwriter

      “I have a single secondhand anecdote that says something we like!”

      “Hooray! Now we have really good PROOF!”

      In a thread about bleeding to death.

      I feel safe.

    • Trixie

      Here, someone encourages a mother to go ahead and attempt a transverse breech birth.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        Tara’s reply is Killen me.

      • Ash

        Where is this screenshot/link?

        • Trixie

          If you can’t see it, try refreshing?

          • Ash

            Sorry, I don’t understand since the screenshot does not mention transverse breech? Is there another link?

          • Guestll

            It’s not a breech, it’s a transverse lie, at 37 weeks.

            The replies on that thread…oh God.

          • Reb, former LM

            There’s a photo in old, old copies of William’s Obstetrics that haunts me. Grossly swollen arm after fetal demise due to obstructed labor from a transverse lie.

          • Ash

            Oops, got it, thanks!

      • Mel

        Plus, if I read the first one post right, it’s a VBAC twin breech delivery.

        That sounds fatal.

        • rh1985

          not quite that bad. her first pregnancy and the c-section were breech twins. it would be a breech vbac singleton. ugh…

      • Guestll

        Jennifer J Erwin: Vaginal breech birth is not more risky with a provider who is experienced with breech, check out my woo links yadda there won’t be any data confirming the opposite of what I’m saying here!

    • RebeccainCanada

      That’s funny my PPH happened in midwife assisted homebirth, where there was no pulling, I wasn’t laying down like Michel Odent likes to say causes it and nobody had augmented anything nor were there “interventions”. When I try to tell this to women believing the woo, they figure I did something wrong then, didn’t eat enuff kale or maybe it was because my midwife was a CNM, and she didn’t have enough woo training! Actually my midwife had taken in too much woo, but not enough that she didn’t immediately give me a shot in my hip and my bleeding abruptly stopped. I had read Ina May and Odent’s books so felt I had all my ducks in a row and nothing could go wrong, but it did and it does! Thanks for the screen cap, it makes me want to cry that they get away with this! :(

    • realitycheque

      A double-blind study on hemorrhaging women?

      • Trixie

        Sure, why not? What could be wrong with that?

      • mollyb

        That blew my mind as well. Who would allow that? How could that even happen? It’s like they know a scientific phrase but not how to apply it or even a middle school understanding of how it works. But I guess they think it makes them sound scientifically legit.

        • An Actual Attorney

          Yes, that large # of docs who can’t tell whether a woman is hemorrhaging or not. Dear FSM almighty.

          • Stacy21629

            I forget where I read it recently, but I saw a story/news article about a CPM missing a retained placenta for 2 days and not recommending the mother transfer. Her “defense” was that it could have been missed in the hospital too. Bull.

  • yugaya

    From Jan Tritten’s fb page:

    “The UK government have announced they will not
    help independent midwives remain legal. We never wanted insurance, but
    it will soon be illegal to practice without it.”

    https://www.gov.uk/government/news/independent-midwives-insurance-options-outlined

    EU Cross Border Healthcare Directive 1 – 0 Quack Midwives UK

    • DaisyGrrl

      “we never wanted insurance” – but I’m sure your patients do.

      • Anj Fabian

        The NHS does because they provide lifetime care for any birth damaged children.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    The most glaring omission in The Business of Being Born was lack of information about different types of midwives and their education.

    • http://thefresstyler.blogspot.com/ Hannah

      I am in a private group on FB for July 2014 first babies and the infection of woo in there is insane. They are otherwise delightful, intelligent women but they are drinking the NCB, Ina May, Business of Being Born kool-aid and it scares me. There was a pact not to read ‘traumatic birth stories’. When I asked what the traumas were, they were usually unwanted exams, episiotomies or c-sections and they are all saying that trusting their body is key not, you know, a dead baby.

      The lone voices of reason are myself, a woman who is an anesthesiologist and another woman whose husband is a pediatrician and 1-2 others who are planning hospital births. Everyone else is NCB-obsessed, hoping to birth in midwife-led centres and thinks a bad outcome is a few stitches in their ladygarden. Sorry. No.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    This is a travesty and an injustice to any woman who is becoming a mother and believing she has hired a qualified person to attend her birth – it’s women and children’s health and well-being, and that should never be second rate.

  • Mel

    Rook’s statement on how she had hoped the CPM would be short-term is exactly what happened in Michigan when teachers needed to become Highly Qualified (HQ) under No Child Left Behind. Some teachers who didn’t have the required qualifications like a major or minor in given subject, but DID have years of teaching experience in an area AND a valid teaching licence were allowed to turn in a portfolio of what they knew to get HQ-NCLB status.

    Some huge differences:
    - The portfolio method was NEVER allowed for new teachers. All new teachers had to use the new HQ-NCLB requirements.
    - The portfolio method had an expiration date around 2005. If you didn’t get your portfolio in by then, you didn’t get HQ-NCLB through portfolio.
    - The portfolio method happened within a larger, policing community. Bluntly, if you were a crappy teacher, you weren’t getting the HQ-NCLB status.
    -Teachers still had to be licensed. There’s no way of getting around that in the public schools.
    -Teaching rarely involves life or death decisions. On the two areas where it could – abuse/neglect and self-injury – failure to adhere to mandating reporting guidelines has major legal and financial consequences.

    Why the hell should midwives be held to a much lower standard than teachers when the consequences of an incompetent midwife is as dangerous or more dangerous than an incompetent teacher?

  • Ra

    I’m in the process of saving up money for a house down payment, and I’ve often quipped that if I was an unethical person then I would become a CPM for my second job. It’s the quickest/easiest way I know of to make money legally. If the baby survives despite CPM “care” then you get $2,000-$5,000 for doing little more than offering encouraging words, performing google searches, and missing a few hours of sleep. If the baby dies, you’re not out anything and you frequently still get paid since it’s a cash transaction that occurs prior to delivery. And there’s none of that pesky integrity/emotional trauma because “some babies are meant to die.” If things get really bad, you just hop the border to another state and carry on. If you did two deliveries a month and charged $3,00 a piece, you would be making $72,000 a year. All for a high school diploma and an iPhone with access to Facebook.

    • The Bofa on the Sofa

      Shoot, if it is just a short term influx of cash you need, you could just transfer out every case. As soon as the patient goes into labor, you say, “Whoa, I don’t like the looks of that! Let’s get you to the hospital.”

      Then, you get to keep the $5 grand AND you don’t even have to do a delivery!

      I suspect that the community might figure out by the 10th one or so that you are not a HB friendly MW, but that’s $50K in your pocket without any effort at all.

      Once again, life would be a lot easier without ethics.

      • Young CC Prof

        Heck, if you offered to accompany the mother as a “friend,” and then glared at the doctors while saying, “I’m so sorry, dear, but they’re right, you really do need to let them examine you just to make sure the baby’s OK,” they might actually leave happy with you.

        • The Bofa on the Sofa

          Seriously, I wonder how long you could actually pull off this type of scam.

          I think you’d actually need to do at least one legit deliivery to get your foot in the door, but from there, you could drag it out.

          • Young CC Prof

            This is reminding me of a discussion on I think Science-based medicine? On how to be a semi-ethical quack. Basically, the plan was to tell your cancer patients that they need to get their chemo, but you have something to prevent toxic side effects. And, in addition to your snake oil, which is something inert and harmless like water, you give them lots of woo-ish reasons for eating a generally healthy diet and whatnot.

          • Trixie

            It’s like those homeopathic drops for detoxing your kid after vaccinations. If it convinces them to vaccinate, it could be worse.

          • The Bofa on the Sofa

            Yep. The problem is that if you actually believe that your homeopathic treatments detoxify, then you are an idiot and shouldn’t be in the business.

            Then again, if you know that they aren’t, then what you are doing is unethical.

            Either way, it’s bad.

          • Amazed

            Unless you have Darby Partner’s rotten luck. She screwed her very first solo delivery.

            Oh but it was Margarita and Shahzad with the rotten luck. Darby just shrugged and went her merry way, stopping from time to time to shed a tear at Sisters in Chains site.

            It won’t surprise me if she got paid in advance for killing Shahzad.

      • Trixie

        Plus you would have 10 placentas on the back end. There’s another $2,500.

        • The Bofa on the Sofa

          Shit, you are right.

          I won’t forget to advertise my services in placenta encapsulation. Gotta buy those gel caps and fill them with ground up beef jerky (I was going to say sawdust, but I do have some ethics)

          • Trixie

            Ground up beef jerky is far more ethical than human placenta. At least you won’t give anyone food poisoning.

          • The Bofa on the Sofa

            Yeah, but I’m telling them it is their placenta. That’s the ethical lapse.

          • Young CC Prof

            Calf’s liver! Have some standards!

          • The Bofa on the Sofa

            Granted, I’m sure we have an undesirable beef cut in the freezer. Probably heart, though.

          • anion

            Actually, considering the amount of iron and other nutrients in a good beef heart, you’re probably giving them something healthier than their own denuded body parts.

          • Guestll

            …suddenly, this Five Guys burger seems unappealing.

          • anion

            There is nothing in the world that can make a Five Guys burger truly unappealing.

          • http://thefresstyler.blogspot.com/ Hannah

            Amen.

      • Mel

        Plus, if you accompanied the hospital as a midwife/doula/whatever, the client generally has to pony up another 500-600 dollars. (I don’t really understand why – you’ve already paid for their MW services. I have no idea why you should have to pay more since someone else delivered the baby.)

        • The Bofa on the Sofa

          OK, I will probably need to get my on-line education in MW marketing. Fortunately, it will only take a few hours and is free.

          But then I should advertise my marketing service, too. I could teach new MWs how to make money without having to do any midwifery.

        • http://kumquatwriter.wordpress.com/ Kumquatwriter

          Honesty, ethics and compassion are my only roadblocks to a life of wealth and leisure.

          • The Bofa on the Sofa

            I’ve said it many teams, people are so easy to take advantage of.

      • LMS1953

        .A couple of decades ago I was (on-call). A lay midwife (that is what they called themselves back then) transferred a patient to the hospital. The patient was a TOLAC, 41 weeks, breech, SROM for 18 hrs, arrested at 8 cm for 5hrs. I did a C-section and delivered a healthy 8#10 oz baby. Mom and baby went home in 4 days. I think the fee for a C-section with post-op hospital care and post-partum care for 6 weeks was $1200. To show her gratitude, the patient paid me $5 per month for several years until I relocated. I figured she would have paid off her bill this month after 240 installments. The lay midwife was paid in full prior to delivery.

    • Are you nuts

      I bet they report every last penny of that cash income to the IRS too…….

  • Amy M

    Looks like she was convinced to go for the CNM.

  • lawyer jane

    Would be great to make a 50-state chart showing CPM/CM/DEM licensing requirements (if any), and compare those to say, barbers and plumbers and electricians.

    • LMS1953

      I think if you prowl around MANA.com you will find a map of the US that shows the current status of the licensure of the myriad types of MWs/

    • Squillo

      “You know, Mrs. Buckman, you need a license to buy a dog, to drive a car – hell, you even need a license to catch a fish. But they’ll let any butt-reaming asshole be a father.”

      Applies equally well to midwifery in some states.

      • Zornorph

        Actually, if you are trying to be a father by butt-reaming, you are doing it wrong. Different target needed.

      • UNCDave

        One of Keanu’s finest speeches!

    • An Actual Attorney

      I can’t upvote this twice, but I love it!!!
      I’m willing to help you

  • The Computer Ate My Nym

    Probably dumb question, but how are they getting away with this? Isn’t there any sort of agency in charge of seeing that people who represent themselves as health care providers are reasonably well trained? The professional organization doesn’t count. I wouldn’t trust the AMA to regulate doctors without any government oversight and I certainly wouldn’t trust MANA. Do they get some sort of exemption like the food supplement industry?

    • Young CC Prof

      Apparently it’s a state-level thing. Some states were convinced to recognize the CPM credential. (Others don’t.) CPMs aren’t claiming to be doctors or nurses, so it’s tough to stop them claiming to be what they actually are.

      What is necessary is a law describing which providers are capable of delivering babies (MD, DO or CNM only) and making it illegal for anyone else to take money for delivering a baby.

      • Amy Tuteur, MD

        I’d be willing to bet that the average legislator who voted to license CPMs had no idea that CPMs needed only to have a high school diploma.

      • Comrade X

        “CPMs aren’t claiming to be doctors or nurses, so it’s tough to stop them claiming to be what they actually are.”

        Not sure about that, Professor. I would venture that most lay people in the developed world understand something fairly specific by the word “midwife”. And “clueless chick who can just about use Google” ain’t it.

        • The Bofa on the Sofa

          I know that someone mentioned recently that their MW was sure to emphasize that “I am not a health care provider”

          They are just going to deliver your baby. Health has nothing to do with it, I guess.

      • Comrade X

        From the United Kingdom’s Nursing & Midwifery Council website:

        “It is a criminal offence in the United Kingdom to pose as a nurse or midwife or to provide false or misleading information. If at any point in the application process we discover that your application is fraudulent, we will not continue with your application and you may be liable for prosecution. If, after registration, we discover that any part of your application was fraudulent, we will remove you from the Register. In addition, you will then be liable for prosecution.”

    • The Bofa on the Sofa

      The one organization that probably could have the biggest impact not only does not take a stand against CPMs as incompetent providers, they welcome them in the name of sisterhood.

      I’m talking, of course, about the ACNM.

    • Are you nuts

      It seems to me that as long as the number of women choosing home births is small, then the absolute number of deaths/injuries will be small (though we know not as a % of attempts). So until home birth catches on more broadly, and I think it will, there aren’t enough people to raise a stink with their state legislature to change anything.