Thinking about homebirth? Think again.

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  • MJ

    I am posting this here in part because I am hoping that StudentMidwife will see it and continue to consider her way forward.

    There’s another post I think might be worth highlighting or capping on the Midwifery Today FB page at the moment – but I’m having technological issues and can’t do it myself. I can’t even copy and paste sorry, but it’s essentially crowd sourcing information on how to do your stats e.g. Do you include a woman who begun labour in your care but transferred and had a successful VBAC in the hospital as your own VBAC and the like.

    To me it highlights a few things a) that there is no standard reporting practice laid down for CPMs, b) that it proves CPM reported figures are rubbery at best, and c) it’s another divide in the rigours if CPMs and medically trained birth professionals.

    • Trixie

      Here you go

      • MJ

        Very speedy! Thanks.

      • StudentMidwife

        It looks to me like this midwife is asking for clarification on what is included in certain statistics for personal/business use, rather than for statistics that get reported to a regulating body. Meh. If she were reporting the figures, I would assume that she would have been given specific guidelines. I can see how it could be confusing. If a midwife transports in labor, she gives up all charge of the client so a VBAC wouldn’t count as one of ‘her’ successful VBACs, but if a transport ends in a c-section she does count it in her stats.

  • Dkdj

    Woah this website is basically terrorism for women wanting a homebirth, who are you to dictate how and where a women should birth? America has the worst infant mortality rate in the developed world. I wouldn’t even have a baby in your corrupt disgusting medical system.

    • PrimaryCareDoc

      Terrorism, huh? Do you always choose to work in hyperbole?

      • Anj Fabian

        I dunno. If people are terrified they might unknowingly hire a reckless, incompetent or clueless midwife after reading this website, I wouldn’t be offended in the least.

        Two midwives up on manslaughter charges this year. Definitely something to think about.

    • DaisyGrrl

      I know, right? Why should women have the actual facts about risks to themselves and their babies when they decide where they want to give birth? If I want to give birth in my living room with an untrained quack who lies to me about her qualifications and safety records, then I should totally have that right!

      I mean, it’s not like there’s anything important at stake. Like, say, your child’s life. Oh wait…

      Okay, serious time now. The infant mortality rate is the wrong measure of obstetric care because it looks at all deaths prior to one year. Neonatal mortality is a more accurate measure. Also, I see nothing wrong with informing a woman that her choice carries increased risk. If she decides that the risk is minimal and she is comfortable with it, then that’s her business. But she should still have that information.

      • The Bofa on the Sofa

        If I want to give birth in my living room with an untrained quack who lies to me about her qualifications and safety records, then I should totally have that right!

        Arguably, yes, BUT you have to be aware that she is an untrained quack and is lying to you about her qualifications and safety records.

        Now, there is also an argument against letting you do that, even if you wanted to, and we do that all the time in our society, but at least it’s debatable.

        However, that is premised on the fact that you are actually fully informed. Lacking that information, of course, and all bets are off.

        • StudentMidwife

          You assume that everyone lies about her safety records? You make some very general, blanket statements.

          • The Bofa on the Sofa

            Yes, because I was referring to the comment above.

            The question is, how do you know she isn’t lying? Because she promised you she wasn’t? Did she pinky swear? What?

          • Durango

            There is absolutely no way to check! They can lie, or not, but no one knows and there are no midwives, apparently, who advocate for mandatory outcome reporting.

          • Anj Fabian

            If I had a list of ten CPMs in the same state, how would I check their history, outcomes, professional sanctions?

            If someone told me they had delivered 500 babies, how could I verify even that simple statement?

          • StudentMidwife

            State regulatory records. At least in my state. I’ve mentioned before on this thread that I am horrified that there are states that allow CPMs to practice with no regulation.

            Example: You can access online all disciplinary letters and actions taken against CPMs (or any other licensed professional regulated by the state for that matter). One midwife in my area has just one letter on record from 7 or 8 years ago for giving juice to a client in the hospital before a c-section. Albeit, it is unclear in the letter whether the c-section had been decided on at that point yet.

          • Bombshellrisa

            That is assuming that any and all incidents were reported.

          • StudentMidwife

            Mandatory reporting. And yes, that’s assuming compliance.

          • Karen in SC

            Does your state keep records of homebirth deaths as well? What is the rate of mortality and morbidity for CPMs there?

          • Trixie

            What state are you in?

          • StudentMidwife

            Again, that isn’t something that I post online.

          • AlisonCummins

            A state with no nursing schools and excellent CPM oversight. How many can there be?

          • NoLongerCrunching

            Even if your preceptor is telling the truth as she knows it about her safety records, she is not an accurate judge of whether or not she has good outcomes. Unless she has formal education in obstetrics and pediatrics, she doesn’t know how to properly assign APGARs, estimate maternal blood loss accurately, or evaluate the baby for subtle signs of hypoxia. There is a reason they have a team of highly trained people in the hospital evaluating mom and baby over several days.

            As I have said before, one of the main reasons I wouldn’t have an OOH birth again, even though I loved my experience, is the benefit to my newborn of being monitored for 2 days through several shifts of RNs and pediatricians. I do believe my baby benefited from the birth center experience of constant skin to skin, never being separated from me etc, but those sweet cuddly benefits don’t trump the safety benefits in the hospital. Hopefully someday we can have a more homebirthy experience in the hospital with bedside assessment, delaying baths, etc, but I don’t believe it’s ethical to avoid hospitals until that time comes.

          • Karen in SC

            CPMs absolutely can’t do a full newborn assessment. My friend who was delivered at a birth center (by CNMs) didn’t get one either. She had to take her newborn to the ped’s office the next day. Who wants to do that?

            And she had another extra – driving to our state capital to get a birth certificate. She has other chlidren, they all went and waited in line.

          • Amazed

            You’ve said it all, NoLonger. I could add that there are “damages” that are repairable and “damages” that are not. Not having skin to skin bonding is repairable by a life of love and hugs; hypoxia can be something that isn’t repairable at all. Not worth it, in my opinion.

            I find it downright misleading to cite that there are ups and downs to hospital birth and ups and down to homebirths. They are not comparable. You can as well say that since Donald Trump has a salary and your average Joe has one, their standard of living should be just the same!

          • Bombshellrisa

            “Hopefully someday we can have a more homebirthy experience in the hospital ”
            I totally agree with this, and I think that a lot of places are coming around in this respect. When I had my son seven weeks ago, the experience was as close to a home birth experience as it could be, given the circumstances (baby born at 35w5d, GBS status unknown, non existent labor)-soft lighting, music or tv playing whatever I wanted, quiet, laboring down and self directed pushing. It was reassuring when the nurse told me “everything we need to treat you and the baby is right in the room or right outside. And lets just assume we aren’t going to need it”. That is better by far than “birth is as safe as life gets, but don’t worry, the hospital is only ten minutes away”.

          • Guest

            That was my experience in an Australian hospital with the birth of my third child two years ago – and an example of the benefits of having highly trained professional midwives. I was induced after SROM at 37 weeks and no labour. My hospital-tertiary educated midwife oversaw the induction. My birthing suite had dimming lights, CD player, tub, TV, shower grab rails, fridge for my food and drink AND concealed but accessible resus equipment and full CEFM. My midwife deftly handled a light loop of cord around my little boy’s neck and delivered him straight on to my chest. After delivery I was shifted into a private room with a double bed (for my husband to stay over) and over the next 12 hours my midwife did all the assessments (but also called in the paediatrician when we discovered my little one had fused toes). A true professional who doesn’t get her knickers in a twist about asking someone with more knowledge for advice, and who can take care of the physical and mental needs if my baby and I – all while life saving equipment is close to hand. Best of all worlds. And, of course, universal health care means it’s all free.

          • Mother2midwife

            Nothing is free… where is the money coming from? Yep, those crazy taxes. Oh, but the poorest aren’t paying anything, so we’re all paying double or more. Huh. Not Free. FYI.

          • Captain Obvious

            Huh?

          • Amazed

            Everyone might be lying, or they might not be. It’s the fact that everybody CAN lie if they want to that I have a problem with.

            I am not at all interested in being fair to the CPMs who don’t lie. I mean, it’s all good and nice to be fair and assume innocent until proven guilty but the stakes are too high. I am more interested in having a good outcome for myself and my baby and hiring a provider who can lie to me about their qualifications and outcomes nine times every day and ten on Sunday and I have no way to find out where it’s a complete lie or the God’s truth isn’t it.

    • LibrarianSarah

      Edit [You know what? You are not worth it.]

    • guesting

      America does not have the worst infant mortality rate in the developed world. America tries to save EVERY baby. Other countries just dump stillborns and babies under a certain weight. I find that disgusting.

      Source: WHO. http://en.wikipedia.org/wiki/Infant_mortality#Measuring_IMR

    • guesting

      People give advice based on safety if your goal is a live baby rather than a specific “birth experience”. If you value a specific birth experience over a live baby, then I pray God that you are lucky enough to get both if you plan more for the birth experience.
      Years ago, before my first child (I’m cooking #4), I considered a homebirth. I’ve been in an ambulance for issues that don’t involve lack of oxygen and a 10 minute ride is excruciating in terms of fear. I would not be able to live with myself if my baby was suffocating in an ambulance for 10 minutes because an uneducated midwife didn’t get us transferred quickly enough. I was totally roped in to their BS and I am mad and I hope other women don’t fall for it. I’m glad I never hired a midwife since all 3 births required TRUE medical assistance. I didn’t hire them because every interview with all 5 midwives, the first thing they did was badmouth OBs and I thought that was weird and unprofessional. I have yet to have met an OB who did that, even though I’ve certainly discussed my desires with them and the word “homebirth” and “natural unmedicated birth” were phrases I used. No OB ever did anything but listen to me and never ever took the chance to badmouth the midwives. The VBA2C child I had (thanks to my OBs supporting me!!!), ironically, had the worst Apgars and least skin to skin experience at first and the pain I felt during labor was far more traumatic than the Csections. I want an epidural if I labor this next time, it was terrible and screw the natural birth movement for talking about “waves” and “orgasmic birth” instead of admitting that sometimes birth hurts for women. I failed as a natural birth mother, which I tried to do. Thanks to the “terrorism” of that movement and its uneducated midwives leading the way, it was a hard emotional battle for me. In hindsight, what a ridiculous goal – being the “most natural”. Nature kills. I’m done with that crap. I am loyal to Modern Obstetrics to the end. It makes me furious that I expected a traumatic hospital birth and I was treated with nothing but amazing care, and holistic care. It’s my own fault to not research seriously, but that is that. End rant.

      • guesting

        My emotional and selfish rant in response to a troll is case in point – I’m exactly the kind of person who is most likely to have got taken in by the woo! :)

        • Mer

          I did too, and it pisses me off because I’m not really into woo in general. But I was nervous about my second baby and a CNM recommended some books and they were FILLED with woo because they were written by Ina may and henci goer. I still can’t believe that a trusted care provider recommended those books to me. Then I looked like a moron when I asked questions about shaving and enemas, the OB was like “yeah we don’t do those anymore and haven’t for awhile”.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      first of all you might consider being accurate. Infant mortality is not the relevant statistic,perinatal mortality is, and the US stands quite high in that.

      “Birth”, btw, isn’t a transitive verb, either.

      You might be surprised to know that in other “developed” countries your options could be narrower than you think. The criteria for home birth suitability are stricter and rigidly enforced.

      • Trixie

        Birth is a transitive verb in the US.

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

    This is utah exclusive, but it applies to other states too. Feel free to edit the text or image to be used however anyone needs.

  • Karyn Croushore Hodgins

    Dr Tuteur, you converted me. I am a

    • Amy Tuteur, MD

      Thank you!

  • anion

    One thing that shocks me about the CPM is the insistence that they are “experts,” contrasted with the refusal to seek education. So many of them proclaim their expertise and dedication to helping women deliver safely…but they have all, by the very nature of being CPMs, refused to take the time to study for an actual degree. They’re so dedicated that two – four years of study is just too much work? It wasn’t worth it to them to spend a couple of years learning the actual science of conception and birth (stuff like, “Where does that darn amniotic fluid GO, anyway?”)?

    Perhaps an image with a phrase like, “So dedicated to learning normal birth that I didn’t even go to school for it!”

    • ngozi

      Even my school-hating niece has stuck it out for 9 months to become a nursing assistant. Good grief.

    • StudentMidwife

      The statement that CPMs refuse to study is a little extreme. To be
      certified as a CPM, a woman (or man) must pass the NARM written exam.
      Some people choose to go to a MEAC-accredited school for at least 2-3
      years, while others choose self-study (admittedly, I am unaware of any
      statistics on how many choose formal schooling). Needless to say, there
      is quite a bit of dedication to studying involved in becoming a CPM,
      although I will agree it is not as extensive as medical school because
      CPMs do less (no high-risk births, no diagnosis/treatment of
      reproductive issues, etc.). I am going through the process right now
      doing self-study for the most part, and I plan on continuing to seek
      education and stay up-to-date on evidence-based practices. Before you
      say self-study is a joke, my “self-study” process began with earning a
      4-year Biology degree from one of the top universities in the US. I
      chose to do self-study because I already have a strong foundation.

      TL;DR To obtain CPM certification, there’s a few years of studying involved. To say midwives reject studying and continuing education is just a tad bit dramatic, don’t you think?

      • guest

        Dunning-Krueger. You don’t know what you don’t know. I agree that self-study, perhaps in and of itself isn’t bad. But what is lacking are the other skills that separate professional people from amateurs. Like being able to pass an admissions committee made up of other professionals concerned with making sure anyone they degree is worthy of the credentials. Why do you want a credential that you could get *without* your expensive four year degree? Just go for the CNM at this point. Then you will actually know what you are talking about. And you’ll catch a whole heck of a lot more babies before you are allowed to practice.

        • Squillo

          And you’ll have more options to help more women.

        • StudentMidwife

          Don’t get me wrong, I have the utmost respect for nurses and OBs. I think that modern medical interventions are truly lifesaving advances that are necessary in emergency situations. I would personally rather be involved in home births. To attend home births, I have a choice between being a CPM or CNM. Becoming a CPM was a better fit for me and my family for several reasons.

          How is a CNM candidate passing an admissions committee made up of other CNMs different from obtaining a CPM certification from NARM, a committee

          made up of other CPMs? I don’t think that’s the best analogy to be made here.

          Also, I would love to know how many babies a CNM will catch in the process of obtaining their certification. That isn’t sarcasm, I really don’t know the numbers. I will assist at 80-100+ births over a 4+ year period and am curious to how it compares.

          • Guesteleh

            These blog posts from Safer Midwifery for Michigan cover this issue thoroughly:

            The education of midwives around the world, Part 1

            The education of midwives around the world, Part 2

            The education of midwives around the world, Part 3

            I hope you read it. You sound well-intentioned and like you truly want to provide good care. Read the posts and then think about how your education is preparing to safely care for women and babies.

          • StudentMidwife

            Thank you for these. I’m reading through it right now. Some first impressions:
            Part 1- I will say that a CM program would have been a more suited option for me if it was recognized in more than 5 states, or if I was single lol. My husband can only work in 2 of the 5 states that recognize the CM certification, and he does not get to be that picky about where he is sent for jobs. Also, I agree that there should be clear risk-out criteria, which is why I’m glad I’m starting this process in a state that has a legislation regulating that aspect of midwifery. I think it’s crazy that some states allow CPMs to practice without formal state regulation.
            Part 2 – Most of the instruction outlined on this page that is lacking in the CPM training module is made up for in my college education. Basic pharmacology is the one thing lacking in both my CPM training and college courses that I don’t feel confident pursuing in self-study, which is why I plan on taking a formal class at a local college.
            Part 3 – My current preceptor believes that the minimum number of births required to become a CPM is inadequate to become competent in the skills required to safely practice home births. By the time I am able to sit for the written exam, I will have attended at least twice the required number of births.

            TL;DR – I am a big fan of the CM certification, but unfortunately it’s not a good fit for me right now. Luckily, I have a solid academic background, a preceptor I respect, and the ability and drive to receive formal education in the few places my current training and past experience fall short.

          • Durango

            No no no. Your undergrad is only a small, small component of your ultimate practice and that you identify pharm as the only gap in your training shows that you are not quite the critical thinker you believe you are. Get a real education: CNMs are legal in all fifty states.

          • anion

            I’m reminded of the time I was informed by an LPN that the only difference between her and an RN was that she couldn’t start IVs.

          • StudentMidwife

            I identified pharm as something at the moment that I know I would be much better off studying in a formal class setting. As I get further into my studies, I’m sure there are other classes I will need to take. Someone brought up professional ethics, which is another class I will be taking. There are also IV classes, CPR, and NRP classes that I am required to take as part of my studies. My preceptor has assigned NCLEX Maternal/Newborn study questions that I am currently working through which is helping me identify gaps in my training, although I have to say Varney’s Midwifery and Oxorn-Foote’s Human Labor&Birth have been great starting places. Thank you for your input. As I have just started my training, I have plenty of time to change my mind.

          • Durango

            Yes you will take plenty of classes even as a cpm. Classes, taught well, can give you a good foundation. Seeing what passes for knowledge among CPMs I’m dubious about the quality of the teaching. But leaving that aside, even the best classes are only the starting point. I put in IVs all day long, and I still have misses. You have to place IVs all the time to get better at it, and how are you going to do that? It’s scary and nerve-wracking the first few times, and HB midwives don’t routinely place IVs. What kind of training is that? The same holds true for CPR and neonatal resus. You must practice them all the time and be around experienced people to learn. You will not get that kind of education. We have seen CPMs try to do cpr on a newborn on a bed. They panicked, of course, and forgot everything they learned in the classes. This is what you are signing up for. You can’t be a safe and effective practitioner if you hardly know what to do when things go south. And I can’t even imagine signing up for a gig where I would be the only one to do all the rescuing.

          • StudentMidwife

            Don’t worry, the classes are not taught by CPMs.

          • AlisonCummins

            A single preceptor is a terrible idea. You need to be trained by many people. Navelgazing Midwife talks about this.

            If you cannot get adequate training as a CNM, then get adequate training as something else — dog grooming or something — and do that instead. If you offer midwifery services without adequate training you could kill someone.

          • Trixie

            It’s really not about you and what fun you would have delivering babies and the money you could earn in your state. It’s about the babies you might end up killing in your hubris.

          • StudentMidwife

            This isn’t about fun and money to me. It is a passion of mine and a career path I am pursuing. I have researched my options. While I would have loved to pursued this through a CM program, it simply isn’t something that would have worked for me and my family right now. I have been replying to comments on this thread to get a better idea of what is lacking in CPM training (I NEVER thought it was perfect) so that I can be better equipped to provide a safe homebirth environment.

          • theadequatemother

            What exactly is your “passion?” It’s clearly not providing safe effective care to pregnant and labouring women. Or you would get a REAL education. If it was really important to you, maybe your husband would be persuaded to alter his circumstances a bit. Maybe you would take out student loans for nursing school. Maybe you would move to Canada or the UK or Australia or any other country where midwives are trained and integrated into the medical system and offer both home and hospital birth.
            But no, you are unwittingly confirming one of our major complaints about CPMs – that they are birth junkies in it for the kicks of catchin’ the babies.
            No…you aren’t passionate. Your posts read as selfish and ignorant. Please, reconsider.

          • KarenJJ

            Is it the passion to be well regarded as a “medical professional” and earning a lot of money without all that bother of actually being a professional? Because that’s what it is sounding like. Why go half-arsed about it? What’s wrong with the nursing degree first? What’s the pull of the CPM or even CM? With a nursing degree you have far more options available to you. Especially if you go overseas or especially if you are in a state where CPMs are illegal or become illegal.

          • StudentMidwife

            My passion is for women who choose to have a home birth. I will be the first to admit that in an true emergency situation (where things go from good to bad with no warning, or there is not time to transport to the hospital), women are better off if they are in the hospital. There are plenty of women who choose home birth knowing that risk. Those are the women I want to serve. I want to give them the best birth possible. Like you, I hear too many stories of CPMs doing stupid things in situations they know should have resulted in a transfer of care or transport in labor. I have also run across one woman who, from the sound of it, chooses home birth because she distrusts/despises doctors and the medical community. I would not want to work with someone who could refuse transport if it was necessary.

            As far as my husband’s job is concerned, he is in the military. Moving to another country is not an option. He does not choose where or when we move.

          • KarenJJ

            Why not counsel women who have fears of medicine and hospitals? I was very worried about how I would experience hospital and doctors (and have very good reasons to due to my background), but I didn’t need options like homebirth. I needed to work past fears and develop better ways of talking to doctors and ultimately to work towards getting a correct diagnosis. Why are you so interested in enabling choices that are based in fear and distrust? Why not help that instead of teaching women they are right in their fears and adding to their distrust and concern?

          • StudentMidwife

            Why are you so sure these choices are based on fear and distrust? I only saw one woman who based her decision wholly on that. I would say that half the women I come across choose home birth for financial reasons, and the other half choose home birth because that is the birth experience they desire.

          • KarenJJ

            I have my personal experiences in the way that you have yours. What do you know about the motivation of the women you plan to serve? Financial reasons – a high transfer rate means they pay you as well as a hospital so your are likely to push a large number of families into further financial distress. What about the other motivations? Do these desires disappear when you tell them that a homebirth has a 4x risk of death to their baby? What about when you come across a family that wants a homebirth because they are an abusive family where the abuser doesn’t want to bring attention to the family? Do you support homebirth in that case?

          • StudentMidwife

            Of course I do not support abuse in any way. I am shocked and offended that you would suggest such a thing. I have had to quit a job after reporting child abuse (apparently a big no-no when the director has already said they would look into it after the 4-day weekend). I have also had personal experience with abuse. You crossed a line there.

          • An Actual Attorney

            Well, what do you do when you realize those are the motivations of a woman who has hired you? What do you see as your ethical and legal obligations?

            Professional school helps you be prepared for those situations and cannons of professional ethics help guide you through those situations.

            Because life always throws us those ugly curve balls, in one form or another.

          • StudentMidwife

            Agreed, which is why professional ethics is part of my education.

          • An Actual Attorney

            So, what do you do when you realize a woman has hired you so she can homebirth and keep abuse (hers or kids) away from more watchful eyes? Do you quit? Do you refund her money, or keep it? Do you call the authorities? What if you only strongly suspect,but have no proof? What if she tells you that her husband will kill her if the police come?

          • StudentMidwife

            Those are great questions. Please keep in mind that my response is based solely on personal experience, because I have not yet taken a professional ethics course. I would continue to provide prenatal care for the woman at the visit, and I would contact the authorities. If she tells me that her husband will kill her if the police come, then I would also tell that to the police. They are trained to handle abuse cases, I am not.

          • KarenJJ

            I don’t see how I crossed a line in bringing it up. It is a reason why some families avoid hospitals. Domestic violence is more common then some of the other complications of childbirth and pregnancy is one of the most dangerous times for women in an abusive relationship.

            Like I said, we all have our stories here. It’s not about you but the women and children you plan to care for. Or are you in it just for the baby catching kicks? Separate the womb-bits from the woman and ignore the rest? It’s another reason why I am personally against midwives that are inadequately trained and don’t have a nursing background.

          • Durango

            Nursing school didn’t really work for me, either, but I did it anyway, because that’s how one becomes a nurse. I hardly saw my kids and husband at all, and I missed out on many family outings because I had to prepare for school/clinicals. Work is also inconvenient, frankly, I still don’t see my kids and husband as much as when i was a SAHM. Careers in medicine and having a family is a tough road to follow, but in order to practice safely, you do the right thing.

            The CPM designation is so lacking, you will not be able to practice in any other developed country (not that you are necessarily planning to do so, but remember when you hear about how great the Netherlands is, or Canada, or the UK, that those midwives have far more training than ANY cpm). 80-100 births and then you’re free to practice? The chance of seeing even a super common 1-in-a-100 complication is pretty low with that few births under you belt. Who can possibly be prepared to run a disaster by themselves when they’ve never dealt with it at all previously?

          • KarenJJ

            Mum spent 8 years updating her hospital-based nursing qualification to degree level as well having a young family and working shifts. It was fine. We survived even on Dad’s cooking. We were all really proud of her when she graduated.

            ETA Dad’s cooking was fine and he’s a better cook then mum, just unimaginative (barbeque 5 ways).

          • Durango

            My kids have had a lot of fish tacos. :)

          • Mishimoo

            Chicken Noodle Surprise was my dad’s speciality.
            Leftover roast chicken, 2 minute noodles, and the surprise…sultanas.

          • StudentMidwife

            Nursing school would require me to live away from my family for 2 years. It isn’t about me not being willing to sacrifice doing family outings and such. I’m already doing that being on-call 24/7. If I move to another country, or if my husband changes jobs, I will go back for more schooling and, hopefully, the CM designation will have gained more traction in the US.

          • The Bofa on the Sofa

            So you can’t be bothered to get a legitimate degree, so you are just going to take the short cut.

            Real professional there.

            I’m sorry, I realize that sometimes life gets in the way of what we want to do, but the alternative is NOT to half-ass it and do it anyway, especially when there are lives on the line.

          • StudentMidwife

            I have a legitimate degree, and I don’t half-ass anything. Thank you for your insightful input though.

          • KarenJJ

            Why not use your legitimate degree for something useful then?

          • The Bofa on the Sofa

            But you are getting a CPM.

            Whoops.

          • Durango

            Then your choice of home birth midwifery isn’t for you. Not everyone can do it. Life does get in the way. Rather than choosing to become a sub-standard midwife (and leaving a trail of tears for children that died in birth), admit to yourself that you can’t do it safely and find a new career choice. You owe that to every mother and baby.

          • StudentMidwife

            I believe that it is possible to be a responsible, educated home birth provider as a CPM. I believe my preceptor is one of those women. She has worked for almost 2 decades now with no bad outcomes because she is committed to making responsible decisions.

          • The Bofa on the Sofa

            As I pointed out above, you are not qualified to determine whether your preceptor is good or not.

            You don’t have the knowledge base to make that assessment.

          • Durango

            But if in fact she has had no bad outcomes (as far as you know, there is no way to verify), it is in spite of her “education” not because of it. Choosing an inferior education because you really, really like home birth is wrong.

          • Karen in SC

            Being a doula (for hospital births) takes a weekend conference, right? Or maybe not even that. Pretty good money and gives one a “birth fix” in a safe setting.

          • StudentMidwife

            I am a doula. I don’t need a “birth fix”, but I do believe doulas offer valuable support to moms and dads. I’d have to disagree on the “pretty good money” part of your statement. Most doulas around here won’t take more than 2 births a month, and the most expensive doula here charges $600 per birth. I’ve made better money baby-sitting part-time. Being a doula isn’t a career.

          • fiftyfifty1

            “Being a doula isn’t a career.”

            Neither is pretending to be a real midwife.

          • StudentMidwife

            fiftyfifty1, you’ve converted me. I can see from this thread that medical professionals (which I’m assuming you are) are high-intelligence individuals who practice based on evidence and care about helping young, impressionable students become their best. Thank you.

          • theNormalDistribution

            I’m pretty sure you’re being sarcastic, and for the life of me, I can’t understand why. I’ve seen several medical professionals give you very good advice – explaining both the professional and ethical advantages of choosing a real education and becoming a CNM and imploring you not to waste your time and money on a “credential” that (if I have any faith in humanity) will eventually be abolished. You say you don’t need the years of education a CNM needs because CPM’s only deal with low-risk births. But the thing is, most births are low risk. Most of the time, nothing goes wrong. That’s why it take years of education and years of experience, training with teachers who actually understand high risk, to learn to notice and identify signs that a risky situation may arise. What you’re doing is simply not going to prepare you to do that.

            You keep arguing that your preceptor hasn’t had any bad outcomes in 20 years. There’s probably no way to verify that, and I doubt you’ve even tried. Regardless, it’s very unlikely. There is plenty of evidence that shows that homebirth is significantly risky even when attended by skilled practitioners (CNM’s, MD’s). If your preceptor hasn’t had a bad outcome yet, it’s damn lucky, and that’s all it is.

            You’ve been treated with a lot of respect, all things considered. You say you have a degree in biology, well sorry, use your damn brain. You can’t complain when not everyone wants to hand-hold you through making the right decision. You should know better than this.

          • Certified Hamster Midwife

            Some HBMWs, though not necessarily your preceptor, see infant deaths or injuries as unavoidable or defects incompatible with life when they were not. They don’t consider this a bad outcome, but their incompetence or hands-off stance or failure to perform certain tests led to the death of a child.

          • StudentMidwife

            I’m sorry. My sarcasm was aimed specifically at fiftyfifty1. For everyone who has actually been giving me information instead of snarky remarks, I definitely respect you, what you do, and how you have portrayed your views.

          • AlisonCummins

            fiftyfifty1 was being as clear as she could. If you think her very clear, direct statement was snark that you can disregard, you aren’t listening.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            The difference is in the basic level of education. For CNM you have the grounding of a nursing education, both in the sciences, and practically, while the CPM literally does not know what she does not know–it is merely an apprenticeship.

            You may think you don’t need such a thorough education, but believe me, you do, and at the most unexpected times. ESPECIALLY if you expect to be working in situations withou a full backup team.

          • fiftyfifty1

            ” I’ve made better money baby-sitting part-time.”

            So it is about the money after all.

          • StudentMidwife

            The choice to pursue a career in midwifery as opposed to a doula was about the money, yes. That would be true no matter which path I chose to midwifery. The choice to become a CPM rather than a CNM or OB was not about money.

          • fiftyfifty1

            CPMs: they wanna make the $ but they can’t be bothered with the practicalities of the real education.

          • The Bofa on the Sofa

            Would you take driving lessons from a guy who drinks and drives a lot, but has never had an accident?

          • StudentMidwife

            Do you drive an SUV or pickup, or any car that doesn’t have a 5 star safety rating across the board? Even though you know it is more likely to injure you, your passengers, and the passengers of other vehicles every time you drive it?

          • Amy Tuteur, MD

            The risk of death in childbirth is MUCH higher than the risk of death in a car accident. That’s why it is much more important that have a real midwife than to have a car with a 5 star safety rating.

            You need to understand that CPMs aren’t real midwives. They are lay birth junkies who couldn’t be bothered to get a real midwifery degree. CPMs are not considered midwives in any other industrialized country. If they are not knowledgeable and trained enough to care for women anywhere else in the first world, why should they be allowed to practice on American women?

            The most important character trait in any healthcare provider is the willingness to put the patients’ best interest above the personal and financial interests of the provider. If you can’t even bother to get a real midwifery degree, you don’t deserve to be a healthcare provider.

          • The Bofa on the Sofa

            Wow, did you really suggest that going with a MW is like trading safety for a cheaper option?

          • StudentMidwife

            You compared it to learning to drive from a drunk driver. And I never said anything about cheaper options. There are many factors people consider when buying a car. Price, look, luxury, gas mileage, effect on the environment, number of seats, etc.

          • fiftyfifty1

            Yep. Becoming a CPM is like learning how to drive from a drunk driver. In a Pinto.

          • Trixie

            Except learning to drive from a drunk driver in a Pinto is actually much safer.

          • Trixie

            Driving any car on the road any time day or night, drunk, is safer than having a home birth with a CPM. Them’s the facts.

          • Guestll

            Your preceptor has had no bad outcomes because she is lucky. No more, no less.

          • AlisonCummins

            How can a person without an education be educated?

            How can it be responsible to offer midwifery services without an education?

          • An Actual Attorney

            How does she know? Given the recent study of the increased rate of need for brain cooling (what is it, 18 times?), we can assume neuro issues are a real risk. Does she do follow up? Or does she tell her self “some babies just take time to pink up”?

          • Durango

            You can believe what you want. But you are choosing a path of less information and less education. I get that quitting a process you have already invested a lot of time and money in is really hard. But if you continue, you are doing it wholly for yourself. You prioritize yourself over the safety of the mothers and babies you will care for. Just like every other cpm who gets written about here.

          • anion

            Sorry, I’m confused. Why would a nursing degree require you to live away from your family for two years? They don’t force you to live on campus or anything. I get that your husband is military (and am grateful for his service) and bases are often kind of out-of-the-way, but you should still be able to live at home.

            (ugh have to pick up kids from school!)

          • An Actual Attorney

            I have a hard time thinking of any place where there’s a base that doesn’t have a community college where you could start a nursing degree. Overseas, yes, but I don’t think that’s what you said your situation is.

          • Beth

            as a doctor, I trained with more than a few people who had to live away from their spouses and children for 2 or more years in order to complete medical school or residency. It’s not unusual at all for doctors to have to do this for a few years.

            of course it’s not easy, but sometimes that’s what you have to do to become a professional with responsibility for people’s health and lives.

          • Amazed

            You see, that’s why CPM should be abolished. You have this reason and that reason that are just so important to you. Other women have this reason and that reason that is just so important to them. And the CPM gives all of you the chance to indulge your passion to the expense of mothers and babies who would be harmed one day thanks to the fact that no matter how studious and risk-averse you are, the lapses in your education will show when you least expect and want them to and you won’t be able to recognize them in time.

            Sorry but when lives are on the line, patients’ health and very life should take priority over future careproviders’ family life and better fits.

          • StudentMidwife

            Can you give specifics on lapses in my CPM training?

          • Amazed

            Yes. Your amazing confidence and trust in a preceptor whose only license seems to come from the very same place that licensed Jan Tritten, Christy Collins and the rest of them wonderful CPMs who happily left a baby die less than two weeks ago.

            You’re a brave one, I’ll give you this. Coming here immediately after an event showing the massive lapses in the CPMs knowledge as a whole and insisting that your better fit tops all and you can have an adequate knowledge with only one perceptor.

            Do you know that some of the midwives who actively assisted in Gavin Michael’s death by giving ridiculous advice actually teach midwifery courses?

          • Trixie

            Then FIND ANOTHER JOB. One that doesn’t involve killing babies. You act like your only alternative line of work is the CPM.

          • anion

            I have more than a few fond memories of helping my mom study when she was in nursing school, quizzing her with index cards and helping her attach mnemonic devices (“two elves throw a sock!” = twelve thoracic vertebrae) to a paper Halloween skeleton or a life-size outline of me/printout of the circulatory system.

            And she’d read her notes aloud and we’d listen to them in the car.

          • anon13

            What are the last minute complications that can be tragic? Shoulder dystocia, cord prolapse, surprise breech, cervical laceration, meconium aspiration, PPH. Entire teams respond to these in a hospital. Entire teams that drill for these emergencies.
            If your preceptor is truly outlining these scenarios, admitting that the risk of the death the baby is 3-5.5 times higher, that by the time 911 is called and the ambulance arrives it will probably be too late, that these are babies that would have lived if born in the hospital. And she (and you) are okay with those deaths.
            Then, I guess, have at it.

          • Trixie

            It’s a “passion.” In other words, a hobby. Should babies die due to the inadequate training you think qualifies you to pursue your hobby? If you’ve got a passion, get a real education.

          • Guestll

            I’d love to get my doctorate. I have a passion for my field, but I have a toddler and a full-time job. The requirements for more education don’t dovetail with my life right now.

            There are no shortcuts, only sacrifices. CPM is a cop-out.

          • Amy Tuteur, MD

            It may be a better fit for you, but it’s thoroughly inadequate for patient safety. That’s the primary problem with the CPM; it was created specifically to let women who couldn’t be bothered (or couldn’t qualify) for a real midwifery degree to call themselves midwives anyway.

          • Anj Fabian

            The CPM was meant to be a temporary certification until more, better trained (CNMs) midwives could take over.

            The problem is – we have more CNMs, but the CPMs aren’t going anywhere. They don’t want to. They don’t want to get more education. They not only want to continue practicing, they want legislation passed to protect their right to practice with as few restrictions as possible.

          • StudentMidwife

            I cannot speak for all midwives, but my preceptor does support current legislation being discussed allowing CPMs to do some suturing. That being said, because it is currently illegal in this state, almost all the training my midwife has in suturing was done by her preceptor. She is not comfortable suturing, and wants to take several classes and have plenty of practice so she will be competent to do them herself.

            And I know that in several places CNMs will not do home births because regulations make it very difficult for them to do so. All of the home birth midwives in my area are CPMs.

          • Durango

            The regulations are there to protect moms and babies!

          • StudentMidwife

            Which is why we follow them to a T. And it’s why right now there state regulatory committee working on a plan to develop requirements and train CPMs to do minor suturing. It’s for the 1 in 100 scenario where, after a successful homebirth, a woman currently has to go in to the ER to get 2 or 3 stitches.

            Seriously, I’m really glad I’m in a state that models good regulation of CPMs. It is terrifying to me that other states don’t. Not all CPMs are cut from the same cloth. I’ve heard the stories of the gung-ho CPMs who take on clients they shouldn’t.

          • anon13

            Please go to What Ifs and Fears Welcome blog (link to the right) and read the multi-part series of how Doula Dani abandoned her desire to become a CPM.

          • Young CC Prof

            Um, tear that needs 2 or 3 stitches is, I assume, a second-degree tear. That’s a whole lot more common than one in a hundred, although precise estimates of its prevalence vary.

            3rd or 4th degree tears, which involve muscle and connective tissue and require immediate repair from a surgeon, THOSE are the 1 in 100 situation.

            And if you never saw a severe tear in training, or you’ve only seen it once or twice, you might not recognize it when it happens to a patient. And if you don’t recognize it, you won’t transport, treatment will be delayed possibly weeks, and the permanent damage will be far worse than it needs to be.

          • StudentMidwife

            My one in a hundred sentiment was echoing a comment I read previous to writing this. And I agree that precise estimates are difficult when you consider higher tearing rates for first-time moms vs multips, and the skill of the birth attendant for preventing/minimizing tearing. As of right now, any and all tears that require stitching are hospital transports.

            I could see someone with so few first-hand experiences confusing a 3rd degree tear with a 2nd degree one. Again, total agreement. But anyone who misses a 4th degree tear is an idiot.

          • KarenJJ

            http://www.skepticalob.com/2012/02/vaginal-tears.html

            No they’re not an idiot, it means they’re not trained well and skilled. An idiot would be someone who thinks all is fine and dandy when they have actually no idea what they’re looking at. This is one of my favourite Dr Amy posts discussing vaginal tears and repairs. It can be difficult to tell the difference between 2nd, 3rd and 4th degree tears, especially as tearing through the muscle it snaps back like an elastic band and you are trying to find an absence of something. It takes experience, skill and frequent practice to diagnose and treat correctly.

          • StudentMidwife

            Actually, your link agrees with my point. She says that it is difficult for someone untrained to tell the difference between a 2nd and 3rd degree tear, but says nothing of the sort about a 4th degree tear.

          • guesting

            What is your point? If someone can’t tell a 2nd from a 3rd how would they tell a 2nd from a 4th? That seems clear – they wouldn’t and it doesn’t need to be stated since a 4th is an extension of a 3rd.

            Let’s review:

            Perineal tears are classified by severity.

            First degree tears do not need to be stitched.

            Second degree tears ought to be stitched but the results are not catastrophic if they are not stitched.

            Third and fourth degree tears MUST be stitched or the woman will be left with bowel incontinence.

            Third and fourth degree tears can only be diagnosed by someone with experience.

            Third and fourth degree tears will NOT heal by themselves.

            Third and fourth degree tears must be repaired by someone with extensive experience in repairing them.

          • Durango

            You follow them to a T but your preceptor would like to be able to do “some suturing.” Like every other skill, you need to do it all the time to become proficient and you need excellent precepting to learn. Suturing every few days at most isn’t going to make a person proficient. And poor suturing can disfigure and impair a woman for life.

            I’m responding to you very bluntly because I want it to stick. You are choosing a path that has harmed many women and babies. You are choosing to know less, rather than more, because of your life situation. You can’t have everything you want. You love home birth but you are not sure where you will be at any given point in the future so you choose self-study which is independent of location. I want you to recognize that you are putting lives at risk by choosing to become a poorly educated provider. You are trying to identify gaps, but you can’t fill them by just taking a class–you have to practice all the time and be critiqued by those who have done it many, many times. CPM credentialing absolutely does not provide this.

            Should women put their lives and the lives of their babies into the hands of someone who chose to know less because they were already married with kids?

          • Trixie

            Oh great, just what I want, a high school graduate with a correspondence degree taking a needle and thread to my vag.

          • PrimaryCareDoc

            If you think going to 100 births over 4 years qualifies you to be a midwife…

            No. Just no.

            FTR, I assisted at about 50 births during my 6 weeks on OB as a med student. And I am in NO WAY qualified to deliver babies. To think that you think you can deliver 30 to 50 more than that and be qualified…that’s scary.

          • StudentMidwife

            How does that compare to a CNM’s experience? I’m asking sincerely with an open mind here. I just don’t know the numbers for CNMs.

          • PrimaryCareDoc

            Not sure what a CNMs experience is.

          • Bombshellrisa

            Many of the CPMs here advertise on their websites that they attended 150 births before passing their written exam. They usually try to have only 3-4 clients delivering in the same month so even if they attend each of those births and the 3-4 that their partners in a practice have , they would only be attending 9-12 births a month.

          • MJ

            And I remember the medical student who assisted at the birth of my first baby. He assisted at eight births in that one shift and was walking on air. First thing he did when he got back on shift the next night was come and visit me. I swear his eyes welled up when I asked if he’d like to hold my son. That kid had the makings of a damn fine physician.

          • theNormalDistribution

            The people in the CNM group are actually educated, that’s what the difference is.

      • Medwife

        Why do you want to be a CPM?

      • NoLongerCrunching

        As someone with a science background, have you seen or heard anything during CPM training that has concerned you?

        • StudentMidwife

          Not with my current preceptor. There are some things I wish were different though. I wish there was a way to consult with an OB without necessarily being required to transfer care. I also wish there was some component to training that involved learning how to analyze scientific studies and reading current research as opposed to just the standard textbook material. Of course, I’m biased because my favorite class in college was an introduction to biological research. I really learned how to look at scientific studies and raw data and drawing my own conclusions from them as opposed to a journalist’s interpretation or even the researcher’s interpretation. For curiosity’s sake, can anyone tell me if a class similar to this is required at nursing or medical school?

          • fiftyfifty1

            Such a class was required for me as part of my medical training.

            I would warn you to be very, very careful StudentMidwife. I, too, was a top student at a top college and majored in biology. I also did a lot of bio research and took extra grad level classes (biology, stats, research methods etc ) just for fun before going to medical school. I found that I had a good base for the “book learning” part of medical school, but that what got placed on top of that base in medical school was quite large. And beyond the book learning there is the real life clinical stuff. And the real life clinical stuff is so important. After 100 babies I was finally beginning to realize exactly how much I really didn’t know. You see 10 or 20 or 50 women give birth with nothing more than minor complications (or more major complications but plenty of warning) and that can give you false confidence. Then the shit hits the fan with no warning and you realize that Childbirth is a force of nature like a hurricane and it deserves a lot more respect than that. I remember that day for myself: 2 women within a couple of hours of each other wheeled back for crash c-sections. One with an abruption, one with a cord prolapse. Both women 100% low risk and with no interventions (I was actually doing the admit physical on the second woman, listening to her lungs, when her cord prolapsed and the room exploded with nurses/docs etc because they had picked up the deep decel on the remote monitor). Both babies out within minutes and saved.

            If you are a bright student, INVEST IN YOURSELF. Get a real medical education. Get your MD or your CNM.

          • PrimaryCareDoc

            Yes. Many classes, not just one.

          • Karen in SC

            Yes, and yes. You could have chosen to become a CNM, which are legal and licensed in all 50 states. And is the level of training required for all midwives in developed countries.

            There are statistics courses available at community colleges. Or self-study at khanacademy.org. Many universities have free online courses as well (no credit given)

          • Houston Mom

            There is a 4 part stats class through Berkeley here https://www.edx.org/ that just started up last week.

          • StudentMidwife

            The kind of class I’m talking about is different from a stats class. I’m sorry that wasn’t clear.

          • Medwife

            There are specific research classes each semester of nursing school, a stats class, and research is mixed in with virtually all other classes. You pretty much breathe papers.

          • MJ

            I am studying psychology and we are required to undertake a research design and analysis class every year of our four year Bachelor’s that does exactly what you are suggesting and then some.

          • StudentMidwife

            I studied psychology as well, but my question was in reference to degrees involving the biological sciences.

          • MJ

            My point (which I didn’t necessarily make very clear), is that if my psychology degree (which is considered a health science here) requires that extent of research design and analysis knowledge, a more ‘biological’ degree would require as much if not more.

            Aside – so do you have a four year degree in psychology as well as biology? In Australia you require the equivalent of a four year accredited tertiary degree and a two year masters or two year accredited supervised practice in order to practice as a psychologist. Of course, I could hang up a sign as a counsellor tomorrow with or without training. I find it an interesting analogy between CPM and CNM practice.

          • MJ

            Oh, and at least where I live there is a way to consult with an ob without transferring care. It’s called being a nurse midwife. We have practice guidelines that outline when a midwife should consult with a peer, when she should consult with an ob, and when she should transfer care. During my last pregnancy my hospital based midwife consulted with obs, paediatricians, and endocrinologists on my behalf. She then managed my induction (the result of SROM at 37 weeks with no labour), delivered my baby and performed all newborn assessments. That was possible because she was a highly trained professional and was recognised and respected as such by other highly trained professionals.

          • StudentMidwife

            Up until a few months ago, midwives in my area had a backup OB (who recognized and respected homebirth midwives) they could consult with without transferring care.

            Your CNM could consult with all the people you mentioned because she is recognized and respected by insurance companies.

      • Squillo

        Less than half of CPMs attend an approved midwifery school, per NARM.

        The problem with self-study alone (or with a single preceptor, as NARM’s PEP process permits) is that you rely on your and your one preceptor’s experiences and knowledge. I think anyone in a field as complex as health care will tell you that this is dangerous. You need the perspective, expertise, and experience of as many experienced practitioners as you can get because without it, you don’t even know what you don’t know. Self-study alone (and study with a single preceptor) will tend only to reinforce your (or your preceptor’s) biases, play to your strengths, and overlook your weaknesses.

        You may be able to pass an exam with self-study, but you will have missed out on an essential component of what will make you a good practitioner–the perspective of other experienced practitioners with varying expertise, opinions, perspectives, and ways of doing things.

        Just my $0.02 as a layperson who has spent considerable time in self-study.

        • StudentMidwife

          I hear and can appreciate your concerns with self-study. I should have elaborated that I am not planning on studying under just one preceptor. In fact, one of the factors in my decision to go through the PEP process is because I have to move every 2-3 years with my husband’s job, so the ability to continue the process in different states with different preceptors was a good fit for me. I also attend peer-reviews in my area so I can learn how other midwives have handled difficult births and emergency situations. I agree that it is important to learn from many sources and to hear out different viewpoints.

          PS- Thank you for the midwifery school stat, and thank you for a well-educated response that did not resort to name-calling or blanket statements. It was a rare and refreshing experience :)

          • Durango

            But even 2 or 3 preceptors in 2-3 years is not enough. Nursing school and med school expose you to countless instructors and preceptors who all weigh in on your performance, good and bad. I think every one of the doctors and nurses here will tell you that passing the boards is not enough to be a fully competent practitioner (and those boards are insanely tough, btw). New nurses and MDs need to be surrounded by more experienced peers in order to learn how things are done “in the real world.” With self-study, you are so insulated. Working with so few preceptors is not going to give you a well-rounded education, no matter how great your preceptors are.

          • Trixie

            Especially when those preceptors are themselves graduates of correspondence courses.
            I bet if you added up all the births all her preceptors ever attended, it would be less than an average OB does in a year or two.

          • Karen in SC

            Please elaborate on peer reviews. Are any recommendations ever communicated to other birth attendants? Are midwives who make mistakes encouraged to take a step back, train more?

      • Medwife

        It’s funny you should say that bit about NARM self-study not being “as extensive as medical school” (understatement of the year, by the way!), but that that’s ok because CPMs don’t take on high risk, complicated patients. The thing is, they do. They take obviously high risk patients and they hold on to patients who become high risk. It is pervasive in the practice environment you plan to enter.

        • StudentMidwife

          I chose to work with my current preceptor because I she practices a degree of caution I am very comfortable with and I consider her to be a good model for the type of midwife I would like to become. I have seen her risk-out several clients in the past few months for breeches, development of high blood-pressure in the last trimester, and some other concerning lab work. She also has a transport rate that I’m sure many midwifes would consider high (9-10%) with a fairly low c-section rate (about 2.5%) and no bad outcomes in labor, which told me that she was not one to avoid going in to the hospital when she sees concerning signs in labor. I have also seen this acted out in her practice I am in agreeance with you that not all midwives practice this way, which is why I was very careful in picking who I chose to learn this practice from.

          • Young CC Prof

            Actually, 10% is the average transport rate in the USA. In countries with better outcomes, it’s higher, especially in first-time mothers.

          • DaisyGrrl

            For first-time mothers, the “magic number” seems to be about 40% for transfers (in a well-integrated system where the midwives have hospital privileges). I think 10-15% is the transfer rate when first-timers are excluded.

            Frankly, the 40% transfer rate should be enough to give anyone pause if they’re considering home birth for their first child. Who wants those odds that they’ll have to pack up and move when things are getting intense?

          • StudentMidwife

            So about 30% transfer for pain relief?

          • DaisyGrrl

            Probably not. I looked up the Birthplace study ( http://www.bmj.com/content/343/bmj.d7400 ) which I understand is one of the more comprehensive studies out there on relative risks of homebirth. They didn’t discuss reasons for transfer, but first-time mothers had double the risk of a serious adverse outcome (death, brain damage, etc). So, while I suspect a significant amount of first-timers transferred for pain relief and exhaustion, the chance of something going seriously wrong in a woman with an unproven pelvis is still double that of a woman who has already given birth.

            Some major differences between the Birthplace study and how homebirth midwifery is practiced in the US: the women were rigorously screened to be as low-risk as possible and for multips, any complications in previous labours excluded them from the study. Thus they were low risk and had a “proven pelvis”. The midwives were properly trained in an academic setting and integrated into the hospital network, so could provide continuity of care in both settings. I wouldn’t use this study to justify the safety of homebirth with a CPM in the US.

            Note, I am not a medical professional and do not have a background in science so my interpretation should be of limited value. Read the study and see what you think. You can also search this site for “birthplace study” to see Dr. Amy’s take as well as comments from the peanut gallery to get a broader idea of opinions on the study.

          • StudentMidwife

            Thanks. I have this saved to read when I get a chance. Right now I’m nursing my sick dog :(

          • MJ

            Anecdotal: I live in Australia where midwives are required to have a nursing degree or one of the newer four year direct entry Bachelor’s degrees. They are also registered by the same board that registers nurses and required to follow practice guidelines. I have five friends – a mixture of prima and multi-paras – who have between them, planned six home births in the last five years. Five of those were transferred for reasons including pre-eclampsia, haemorrhage, non-reassuring fetal heartbeat, and prolonged labour requiring pain relief. The only one born at home was a precipitous labour and the baby was delivered before the midwife arrived. All were perfectly normal and uneventful pregnancies. In light of this I worry about a transfer rate of 10%.

          • StudentMidwife

            It is a transport rate I quoted, not a transfer rate.

          • MJ

            What’s the difference? Even in Australia where midwives are pretty well integrated into the hospital system an independent midwife cannot usually attend her patient in hospital – so that any ‘transport’ to hospital is also necessarily a ‘transfer’ of care.

          • An Actual Attorney

            How do you come up with that number?

          • StudentMidwife

            I came up with that number by reading too quickly trying to respond to everyone. Not all first-time moms transfer for pain relief, as my response suggested. I don’t have my preceptor’s stats right in front of me, but 1/3-1/2 of her transfers were for pain relief, and most of those were first-time moms. Anecdotally, the multips who were transferred for pain relief did so because of back labor.

            Daisygrrl, where did you get that 40% from? And is it solely the transport rate (during labor) or does it include the prenatal transfer rate as well?

          • Medwife

            You feel comfortable with her management style and judge her to be a safe provider. However, with all due respect to your undergrad studies, you’re not really in a position to judge her practice model. You’re a student. When it comes down to it she’s flying solo, essentially answerable to no one. She’s got her NARM certification but she’s working outside of a framework of accountability. Does she carry malpractice insurance? Does she have a formal backup relationship with an OB?

          • Bombshellrisa

            It’s hard to take someone seriously who only wants to attend births and call themselves a healthcare provider and have attending births as their only training. It’s one thing to want to deliver babies and work toward that goal by attending medical school and becoming an OB or nursing school and then specializing as a CNM. It’s quite another to want to do only the fun parts and have minimal training and no other clinical experience. I found that my preceptors had patched together clinical experience: one was a doula who graduated pre med, another was a medical assistant and the other attended births with midwives in rural Kentucky. Not exactly well seasoned professionals

          • StudentMidwife

            She actually did have a backup relationship with an OB up until a recent incident involving another midwife in the area, who subsequently lost her license (I do not know the details). The OB has since been forced to no longer provide formal backup to anyone, but is still available to take transfers. She is also accountable to the state department of regulations, where anyone can access her license information and any disciplinary letters or actions taken against her. Malpractice insurance is required by the state if and when it becomes available. Other state requirements are an informed consent to midwifery outlining a midwife’s training, a statement saying that there are situations that can arise during birth that make hospital birth safer than home birth, and a statement saying that the midwife does not carry malpractice insurance. Peer reviews are also another part of the framework of accountability.

          • Trixie

            Peer reviews by other CPM midwives? Yeah. That’s a joke. They will cover each other’s backs til the very end.

          • StudentMidwife

            Again, state regulated. And while I agree that there are people who will cover each others backs, there are plenty who don’t want people who make poor decisions to ruin everyone’s chances of being able to practice.

          • Trixie

            Could you give us an example of a poor outcome in your state and how the CPM peer review board handled it?

          • Bombshellrisa

            I will volunteer one, just to prove how ridiculous the “state regulated” argument is: midwife is one of the owners of the birth center, malpractice case involving baby injured severely due to midwife negligence-midwife still practicing, still owns birth center, teaches midwifery classes at Bastyr University, president of MAWS and sits on the peer review board for our state.

          • Medwife

            StudentMidwife, I’m glad you’re still engaged with this conversation. If you hit a wall in explaining your educational course, I encourage you to take a break in the discussion if you need to, think about it, research, and come back. I was once considering your path as well as the one I wound up pursuing.

          • StudentMidwife

            It is hard to continue with this conversation when so many people are simply saying my education is lacking or “you don’t know what you don’t know”. Time and time again I have described varying parts of both my past and planned education, and so far no one has been able to give specifics of things that I am/will be lacking. The only time I have been given something specific has been when someone (maybe 2 people) brought up professional ethics, and that IS a part of the education I will be receiving.

          • Guesteleh

            It is not true that no one has given you specifics. I shared three blog posts describing the training and experience of CNMs versus CPMs, which you dismissed. You have also been getting many detailed posts about your lack of training in statistics and hard sciences, with examples of relevant classes you are lacking. I’m so pissed off right now because you are getting information and rejecting it because it doesn’t fit in with your plans. This is not a fucking joke, lady. Babies die because of clowns who refuse to get a proper education. But it won’t happen to you, right?

          • PrimaryCareDoc

            That’s because what you’re lacking is experience. You don’t know what you don’t know because you haven’t seen it yet. And you are unlikely to see it with the 80 births required.

            Why do you think doctors have to do a minimum 3 year residency AFTER medical school, during which all of our medical care is supervised? It’s not ’cause we’re stupid and slow. That’s how long it takes to get the experience needed to be a competent healthcare provider. In my 3 years of residency, I probably saw over 10,000 patients.

          • auntbea

            What specifics do you want? Your education is lacking on its face. Relative to a CNM, you will spend less time, see fewer births, and have fewer instructors. How would you possibly expect to know as much as a CNM does?

          • The Bofa on the Sofa

            You know, if “showing you everything you don’t know” could be done in a simple blog comment section, then we wouldn’t need the other things we do, like extensive schooling and practice.

            As Guesteleh points out below, the difference in training between CNMs and CPMs is pretty clear. Given that we think you should get a CNM vs a CPM tells you pretty clearly what we think you need to know that you don’t. Unless you think you already know everything that a nurse knows?

            You are a biologist. That doesn’t make you an expert in nursing nor a midwife.

            I have a chemistry degree. Shoot, I may have even taught your chemistry classes in getting your biology degree. I KNOW the pharm that you don’t. That doesn’t make me qualified to be a nurse or a midwife, either.

          • Young CC Prof

            Sheer number of births, for one thing.

            If you train as a CNM, you will spend many many hours in a busy L&D ward. You’ll see hundreds of routine births with many variations, you’ll see dozens of different complications and watch and/or assist as experts manage them.

          • Squillo

            If you want specifics, I’d suggest looking at curriculum descriptions for CNM programs to start with. Keep in mind that those courses are after nursing school, so they won’t be spending time teaching you the basic skills you’ll have to cover with your preceptor or in CPM school. Hour-for-hour, you’ll be getting more advanced training.

            Also, you’d be doing rotations in maternity clinics on a weekly basis (depending on they program, this may start in your first quarter or later), which means you’d likely see far more clients than you would in your CPM apprenticeship, and far more clients with a variety of health conditions and risk factors than you’d see in your preceptor’s home birth practice. Even if you plan only to serve low-risk women, you need exposure to conditions that elevate risk. In hospital, you will have the opportunity to see complications you likely won’t during CPM training because of the sheer volume of patients. (Wouldn’t you rather have seen–and maybe participated in resolving–a shoulder dystocia before you encounter one at home with no other experienced practitioner around to help?)

            Finally, you will learn not only from (and in some cases, train alongside) a variety of CNMs, but also from OBs, pediatricians and others with both more extensive knowledge and different perspectives than yours or other midwives’.

          • auntbea

            Shoulder dystocia is not low-risk. Homebirth midwives only attend low-risk patients. Therefore shoulder dystocias cannot happen while you are being attended by a homebirth midwife. It is logically impossible.

          • AlisonCummins
          • anion

            Wait, wait…are you saying your state requires malpractice insurance, but your preceptor doesn’t carry it? So she’s operating outside the law?

          • Bombshellrisa

            She said “when it’s available”-but how can you require something that isn’t available? Unless it IS available and you simply don’t seek it out

          • StudentMidwife

            I’m no legislator, so I don’t know how a law can say that something is required as soon as it becomes available and affordable, but that is what it says: “IF the director finds that liability insurance is
            available at an affordable price, [the direct-entry midwife] REGISTRANTS shall
            be required to carry such insurance.”

          • StudentMidwife

            The state law says it is required when it becomes available and affordable. I’m going to go out on a limb here and say that since this brand-shiny-new law is still not requiring it, and it is available, then it must not be affordable. Insurance is not something I’ve looked into yet.

          • AlisonCummins

            It’s affordable if it’s built into your fee. That’s how doctors afford it. Why would you be special somehow? If it’s available and you are ethical, you will have it whether or not it’s required by law. Period.

          • PrimaryCareDoc

            Right. Who determines if it’s “affordable.” My malpractice is almost $20,000 a year. I think that’s not “affordable,” but it doesn’t matter- I still carry it. It’s required by state law AND it’s the responsible thing to do.

          • auntbea

            A pharmacist named Chris Gassen, apparently. http://cdn.colorado.gov/cs/Satellite/DORA-Reg/CBON/DORA/1251632299138

          • The Bofa on the Sofa

            The state law says it is required when it becomes available and affordable

            Why isn’t it affordable? Do you understand why some insurance is expensive and some insurance is cheap? You can still buy life insurance policies at the airport to cover your flight for $10. And that is an example of a complete ripoff. Meanwhile, a doctor might pay $20K, and it is not a ripoff. What’s the difference?

            This is something that I never understand – midwives complaining about the high cost of insurance. Don’t you realize that’s telling you something very important?

            (HINT: insurance companies set their prices in order to cover the cost of the damages against which they insure)

          • Bombshellrisa

            SO what happens if that doctor isn’t available for a transfer?

          • StudentMidwife

            By “transfer” I meant that he is someone who gets most of our referrals when a patient is risked-out. Transports during labor are always taken by the on-call OB at the closest hospital.

          • Trixie

            WHY don’t you know the details of why this woman lost her license? Wouldn’t that be an important and valuable example for you to learn from?

          • StudentMidwife

            She allowed an intern working under her license to manage a birth without supervision. I do not know the details of the outcome of the birth. This “important and valuable example” was that she was doing something she specifically knew she shouldn’t do under the current laws/regulations.

          • Trixie

            And it doesn’t alarm you that that’s common and part of the prevailing culture under home birth midwifery?

          • anion

            StudentMidwife, do you see that quote above about the twenty-minute-resuscitation and the woman who almost died (despite having a piece of placenta shoved in her mouth :rolleyes)?

            Do you think the midwife in question counts that birth as a “bad outcome?”

            Do you think it’s possible that when your preceptor claims she’s “never had a bad outcome,” she’s counting similar stories as “successes?”

            StudentMidwife, I honestly and truly believe that you’re sincere when you say you want very much to provide women with safe, responsible care. I don’t doubt that for one second. I believe you’re a very good, very caring person and that you want to help women give birth in the best possible way.

            Unfortunately, I believe you’re trusting people who are not totally worthy of that trust; in the case of your preceptor I think that’s likely because she also doesn’t know how much she doesn’t know, but in the case of many CPMs it’s because they just don’t care as much as they should, and see themselves as the star of the show. That’s neither here nor there, though. My point is, because I am certain you care so deeply, and because I am certain you are completely committed to the idea of providing superior, trustworthy, and competent care, I really do urge you to get a nursing degree and become a CNM. I think you’d be great at it. (Not to mention, as others have said, it would mean you could work anywhere, in any state, and nurses are always in demand.)

            If nothing else–and I feel bad playing this card, so to speak–think how you might feel if something goes wrong at a birth, and you realize that the problem stemmed from a lack of knowledge on your part. I don’t think, based on your comments here, that you would have an easy time getting over that, if you ever did manage to. Please look into what you might need to get that degree.

            I hope that doesn’t sound patronizing; it’s kindly and sincerely meant.

          • The Bofa on the Sofa

            chose to work with my current preceptor because she practices a degree of caution

            Says her, of course. As others note, if you don’t have the knowledge to do it in the first place you don’t have the ability to assess whether you are acting with appropriate caution.

            A typical OB will not agree that she practices “a degree of caution” that is acceptable to THEM, as evidenced by the fact that she will do a HB in the first place.

            So let’s see….you say she is cautious enough for you. An OB says she is not cautious enough for them. Who’s opinion do you think is better informed?

          • Trixie

            Aren’t you the one who posted awhile ago about taking classes from Cheyney? Is she your preceptor?

          • StudentMidwife

            No. I don’t know anyone named Cheyney.

          • Trixie

            Who trained your preceptor?

          • StudentMidwife

            My preceptor was trained by a few different women. I do not know all of their names, and for privacy reasons I do not like to give out names on the internet.

          • Trixie

            You don’t have to give out names, but you should learn those names. And type them into the search feature here. There’s a limited number of people who could have precepted two generations back, some of them might be rather infamous. My point being, trace the knowledge tree back to its origins and then see if you can really get behind what those people stand for. You’re in Oregon, right?

          • StudentMidwife

            For the names I know, I have done just that.

            No.

          • Trixie

            CPM peer review in action.

          • Bombshellrisa

            Resusing a baby for 20 MINUTES, and she was doing it alone, since “none of the other helpers had arrived yet” and it still took someone else to “bring the baby around”. So since the pit didn’t work in this instance, she is going to stick to “God given remedies”. There is so much stupid in this paragraph. I feel so much compassion for this fragile woman who was bleeding so much all the while seeing this “midwife” trying to get her baby to breathe for 20 minutes. I can’t imagine how long that must have felt to the mother.

          • Trixie

            Marlene is the one who called Dr. Amy “Satan.”

          • KarenJJ

            Fear mongering, name calling.. And people tone troll Dr Amy..

          • Squillo

            Wow. Waechter is admitting in writing to stomach-turning negligence.

            She was deliberately unprepared to deal with easily foreseeable emergencies by a) neglecting to have another (or any, really) professional available (here’s a hint, Ms. Waechter: you have TWO clients relying on you for their lives); b) choosing not to carry a medication that is, as I understanding it, regarded as the standard first-line treatment for PPH because it doesn’t always work in favor of untested, unregulated herbs that have never been proved to work at all.

          • Karen in SC

            And she said “bucchal placenta” which I guess means under the tongue but since she used a quasi medical term that MEANS it was good, right?

            NO, NO, NO!!

          • http://momofmanyfeet.wordpress.com Bambi

            Mom and baby are lucky to be alive

          • Bombshellrisa

            But if there were concerning signs in labor and she had the patient transfer, any bad outcomes wouldn’t be on HER record since she had transferred care.
            I do agree that there are some very observant and cautious CPMs, there are bad Yelp reviews for one in my state because she transferred the patient’s care to an OB when the patient developed GD or had high blood pressure only to have “nothing bad happen” after all (meaning nobody died or got hurt, so they didn’t understand why she wouldn’t care for them anymore).

        • Bombshellrisa

          They take high risk patients in part because they don’t have the education and training to be able to diagnose conditions that make someone high risk, they also lack the experience that comes with training in a setting that exposes them to many different conditions and situations. I had no idea just how quickly a low risk patient became high risk until I left my self study and attending births as a student with midwives and went through nursing school. Although I do agree that a lot of CPMs take on patients who would be labeled high risk by an OB and then “treat” them with herbs, special diets and homeopathic remedies.

      • http://momofmanyfeet.wordpress.com Bambi

        Wow. Seriously??? If you have a biology degree, why not be serious and get a CNM degree??? Your position isn’t respectable no matter how much you try to twist it!

        • StudentMidwife

          What are your thoughts on the CM degree?

          • http://momofmanyfeet.wordpress.com Bambi

            I say go for it.

      • DaisyGrrl

        I really appreciate that you’ve stuck around to discuss your studies and motivations with us. You probably aren’t aware, but in addition to the many educated lay people you’ve been chatting with, at least 2 OB-GYN’s, one anesthesiologist, one doctor (FP?), 1 CNM, two nurses (one a former CPM trainee), and one ICBLC have chimed in on this discussion. That’s the ones whose qualifications I’m aware of. You also have had a loss mother chime in (her baby died due to her CPM’s incompetence). That’s EIGHT health care professionals who are all telling you the same thing: a CPM is not enough. Bambi’s experience is tragic proof of that.

        I know you feel you’ve done your research and that you aren’t in a position to currently pursue CNM studies, but if you want to be a midwife and your husband is in the military, the CNM has the most portability. There are states where lay midwifery is illegal.

        Have you spoken to CNMs about their paths to midwifery? What they felt were the strengths in their education? What they think about CPMs? Because I really think that if you want to do it right, you should be pursuing a CNM. You’ll have better oversight and a broader learning experience. You won’t have to worry about whether you can legally practice in whatever state your husband deploys to. And you’ll have insurance that protects your family’s assets should anything ever go wrong. I’m aware of two lay midwives currently awaiting manslaughter trials because of homebirth gone wrong. Go to the Sisters in Chains website. What they don’t mention is that most of the midwives who have been charged presided over births that resulted in a dead or severely brain-damaged baby. None of these are trivial things.

        • An Actual Attorney

          The insurance is an important thing. I’ll tell you, as an attorney, when people don’t have insurance or other assets: I’ve taken their cars for sale at public auction; I’ve put a lien on their house; I’ve taken their whole life savings. Now, I think it was justified in the various circumstances, but know what you are putting on the line. And that’s not even getting to the criminal trials DaisyGirl speaks of. You miss a lot of family time in prison.

          • StudentMidwife

            My understanding was that only business assets could be taken in a civil suit?

            And malpractice insurance is required by this state as soon as it becomes available.

          • Bombshellrisa

            I guess it depends on how the midwife has her business set up? I thought that setting up a business as an llc does protect personal assets

          • An Actual Attorney

            A. It depends. There’s a very dirty-sounding but boring concept called “piercing the corporate veil” (which I just like to say because part of me is still a 12 y.o. boy); and

            B. You think CPMs know law better than they know medicine and set these things up right?

          • Trixie

            Actually, I believe there are lawyers who help these midwives set things up right. I think the lawyer who defended Diane Goslin specializes in this.

          • An Actual Attorney

            Maybe, but there are plenty of bad lawyers out there. From what I saw of the lawyering in the GCC lawsuit, I wouldn’t say that the lawyers specializing in defending / working with midwives tend to be top notch.

          • Trixie
          • An Actual Attorney

            She was who I was thinking of. Not the sharpest rocket scientist in the shed.

          • Trixie

            Lol

          • Karen in SC

            And of course, there are all those tips in the ebook, From Calling to Courtroom. Advising lying, changing records, keeping all assets in your spouse’s name, etc.

            The midwives sued by the Snyders filed for bankruptcy and closed the birthing center so any recovery was impossible, IIRC.

          • StudentMidwife

            (1) It’s only dirty sounding when you don’t explain what it is and leave it to our imaginations :P

            (2) No. I think CPMs who want to protect their personal assets will hire help to set up their business, or will at least use free state resources.

            I was also asking because I have friends who have set up LLCs for other birth-related businesses and because it’s a good thing to know in general.

          • An Actual Attorney

            Basically, “piercing the corporate veil” means going behind the corp wall after the assets of the directors. Not my specialty at all, so I will defer to others for more details. My point was, though, there are ways built in to the law to get to personal assets of directors / owners. Wasn’t that more interesting when left to the imagination?

            I’m also not sure if an LLC will protect a person’s assets from their own mistakes/negligence/malpractice. I think not, but other lawyers should weigh in here.

            That said, and LLC will help shield your personal assets from things your employees do wrong.

          • StudentMidwife

            That makes sense. And LLCs are not something I’ve looked into extensively, so any information is definitely helpful.

          • Bombshellrisa

            Oh true! I thought that since they seem to be good at writing those “contracts of care” that basically state “I trained to do this attending births in people’s living rooms, I don’t have to accompany you to the hospital if you need to transfer and if you eat anything not in the special diet I am outlining, any complication will be YOUR fault” that they would be able to write something that protects all that cash they seem to be so good at exploiting out of people.
            My husband is co owner of an LLC and he and his partner do mobile auto paint repair. They are required to have this massive amount of insurance for themselves and their business. No dealership will let them work on their lot without it, nobody who just wants to paint because they are good at it and loves it need apply, you have to be fully insured and licensed or no dice. They also have to abide by strict laws that allow them only a certain amount of work days per month, per location. The minimum fine for working even ONE DAY over the maximum allowed days in a month is TEN THOUSAND DOLLARS. They can also have their business licence taken away. And all he does is spray a little paint on a car in the back of a dealership lot.

          • Trixie

            Another great way to protect your assets is to get paid in cash and not keep much in the bank. Which I’m sure they almost all do.

          • Bombshellrisa

            And offer trade-remember the midwife who will accept gold, silver, hay and firewood? She also accepts “gas for her vehicle” and “medical supplies”

            http://www.foothillsmidwife.com/#!billing/c1s05

            ((This midwife recently bought a house across the street from a small hospital in her community and is trying to get people to fund her so she can make the house a birth center))

          • Certified Hamster Midwife

            Hay and firewood should be assets!

          • Bombshellrisa

            Unless your horse eats the hay and you burn the firewood! ((OT, but this particular midwife is so proud to be a Bastyr graduate and has attended 200 births. She only attends 3-5 births a month. Scary. Also google “Enumclaw” and read about the hospital her future birth center is across the street from. She is more than 10 minutes away from a place that has the ability to deal with a true emergency that is already happening even if the birth center is across the street from the hospital)

          • Medwife

            So basically it’d be a great money laundering scheme?

          • An Actual Attorney

            They are great, it seems, at mind-f%%%%ng women into not suing. But children who are damaged at birth have until early adulthood to sue (or have a suit brought on their behalf).

            It amazing that there are so many regs on your husband (which I think is at it should be) but so few on women who care for women and babies.

          • Bombshellrisa

            It blows my mind too, although like you say, the regulations SHOULD be there. They are strictly enforced too, which makes it that much more insulting that I could just call myself a midwife, make much more money and not have to carry insurance or worry about regulation while painting just one more bumper on a Kia could cost us our business altogether.

          • Durango

            “My relationship with my clients IS my insurance.”

            Gives me chills every time–be the mom’s best friend and gaslight her into not suing.

          • anion

            Their “insurance” actually seems to be the lack of regulations, the way the midwife community rallies to erase deaths and mistakes and act like the midwife in question is a hero, and the horrendous grief of the families which seems often to lead them to withdraw. Or the way the midwives have managed to convince the families that it’s somehow their fault or that “some babies aren’t meant to live,” so there’s nothing that could have been done. Or the shame the families feel at having taken what, in the aftermath, seems like a pointless and unjustified risk, which makes them not want to publicly discuss what happened (not that they are to blame, or to blame for feeling that way).

            Or, of course, their “insurance” is that they have no insurance, so suing them is pointless or impossible.

            It’s disgusting.

          • An Actual Attorney

            Ugh, I think I had blocked that one. It makes my skin crawl. It’s saying she won’t pay for any mistakes she makes.

          • An Actual Attorney

            Nope, in a civil suit, you can take anything that the person owns, or will own. And malpractice insurance covers some possibilities, but if the recovery is higher than the insurance caps, the remainder comes out of personal assets.

          • Elizabeth A

            I’m not an attorney. I have taken the law classes required to sign up for the CPA exam. It was made extremely clear to me in these classes that if I am sued, the complainant can sue both me personally and the company I work for (if the lawsuit arises in the course of work)r. They can go after the company’s assets and my assets. If I’m a sole practitioner, there is no legal difference between business assets and personal assets anyway – it’s all my stuff.

            You should very clearly not be relying on the CPMs you know for legal advice.

          • StudentMidwife

            I did not get any of this information from a CPM. Neither did I get the information from a lawyer, which is why I posed the question for clarification.

          • Elizabeth A

            If you really need clarification, talk to a lawyer in person. I believe An Actual Attorney, but you cannot get legal advice from some guy on the internet who might not know your state law from a hole in the ground.

          • StudentMidwife

            I’m sure I’ve mentioned it before, but I’ll say it again: My state has resources available to people starting small businesses. I am not yet at that point, but I was still trying to participate in a discussion I found interesting.

          • Trixie

            I have a better idea. Why not start a small business that doesn’t involve putting tiny innocent lives at risk on a daily basis?

          • AlisonCummins

            It’s irresponsible to practice without malpractice insurance, period.
            > You get independent, objective bounds on your scope of practice: you aren’t stuck making it up as you go along.

            > It protects your clients.

      • Squillo

        I think the bottom line is this: as a CNM you will have more education and more experience with a broader range of women by the time you go solo.

        You will also be able to offer a lot more to your clients and your community, including:

        1. The ability to practice in any setting (home, hospital, birth center) in most states.
        2. The ability to work on a more equal footing with physicians (yes, this is not perfect, given certain states’ requirements, but far better to have some relationship than to be considered a quack by the physicians in your community, whether or not it is a fair assessment), which will ultimately mean better care and more options for your clients. In some cases, it will also mean you can continue to co-manage pregnancies and births of women with some complications, helping them to achieve the kind of birth they want with the safety they need. (CNMs in our university practice can co-manage women with diabetes, for example.)
        3. You can influence change from the inside, either by working in hospitals alongside other midwives and physicians, or by conducting research to add to the evidence base.
        4. If you also get credentialed as a women’s health NP (our university offers this to CNM students), you can provide a broader range of care for women beyond just pregnancy and birth.
        5. Personal flexibility–In addition to being able to practice in multiple settings, you will be able to practice legally in all 50 states (although there are a handful that still prohibit CNMs from doing homebirth). If by some chance you move overseas, you may even be able to get a credential without starting over to get the university midwifery degree most other developed nations require.
        6. The trend is likely to be expanding scope of practice for advanced practice nurses. The future of the CPM/LM is far murkier, in my opinion.

        There are masters entry programs in nursing (MEPN) that could be a great fit for you with your bio background and would let you get your RN and masters (for the CNM) in three years, rather than having to go to nursing school first.

        • StudentMidwife

          Thank you for your input. I respect it and will take what you said into consideration.

          And thank you again for not getting nasty about it.

      • Jocelyn

        StudentMidwife, would you bet your life that your CPM training has no gaps at all?

        Would you bet your children’s lives on that?

        Because you’re betting other women’s lives on that.

        You are betting other children’s lives on that.

      • AlisonCummins

        A person who lives in, say, Colorado, say, on a military base, should have no trouble going to nursing school. There are nursing schools in Greeley, the Denver area and Pueblo. There are military bases up and down that axis. It looks perfect.

        Yes, the postgraduate training in midwivery for nurses is only in Aurora, but you shouldn’t have to worry about that until after you got your RN. Which you can get.

  • NoLongerCrunching
  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah
  • Guest
  • Ellen Mary

    Okay this is the question I have tho: maybe some on here have some insight. I did choose hospital birth for my last birth. This ended in a likely necessary cesarean. However, when I look @ the numbers for VBAC vs. ERCS in terms of intrapartum survival, it seems that it is a choice somewhat similar to the most optimistic numbers @ home vs. hospital (the numbers I saw were 1.3/1000 VBAC vs. 0.5/1000 ERCS.

    So now it seems hospital VBAC birth will be worse for me (more monitoring, more stuck in the bed time) & the intrapartum mortality will be similar to choosing a CNM HomeBirth. It is a small price to pay for my baby, but any thoughts? I don’t feel like I could sign up for an ERCS but if the goal is lowest achievable risk for the baby . . .

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

      To me the issue is one of risk factors for mom afterwards. If you’ve had a c-section there is a set of risks that accompany that in the future (like adhesions, for example). If you have a vaginal birth there is a set of risks that accompany that in the future (like pelvic organ prolapse). Unless you are planning a large family it might be wise to just limit the risk factors to one set of issues, especially since you could just end up with another c-section anyway. That’s my personal take, but I am not a physician so take it w/a grain of salt.

    • Trixie

      I had a hospital VBAC and it was a great experience. I was NOT stuck in bed. No one pushed pain meds on me. The CNM even took the clock off the wall and dimmed the lights! I did have monitoring, but was able to unhook for 20 minute stretches, and could move quite a bit even while hooked up. I did have a heplock, for GBS antibiotics as well as fast access in case surgery became necessary. But it didn’t bother me at all.
      If you really want to avoid an RCS, I’d think harder about hospital VBAC. For me, the peace of mind of knowing my baby would be safe in the 1/200 chance of uterine rupture was worth the minor annoyance of a couple of belts around my stomach. If a rupture happens at home, your baby will not make it,at least not without brain damage. In a hospital with an OB and anesthesiologist right there, your baby will live.
      Your hospital might even have wireless telemetry monitoring these days.
      Remember, the numbers for CNM home birth you’re looking at aren’t VBAC numbers. Home VBACs are always more risky than the type of low risk birth most CNMs would attend. So you can’t compare CNM home birth stats to hospital VBAC stats. They aren’t the same.

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

      Oh I forgot to mention they can tie your tubes while they are in there if you want. I just found out about that recently and don’t know if you are planning for more kids, but if you aren’t then it will save you a lot of trouble.

      • Ellen Mary

        Avoiding a hysterectomy and/or a tubal is a big goal of mine, although my next would really ideally be my last. If we did decide to go with permanent BC, it would be the V . . . But we are (Marquette) NFP only. I have had 2 prior vaginal births. So that is part of why I would not opt for ECRS, necessarily. My comment is really about how once you commit to reducing fetal risks at ALL costs, it could lead you toward elective Cesarean in VBAC . . .

        • Ellen Mary

          Also, a tubal is not a reason to have a cesarean: Tubals can be done laparoscopically after vaginal birth.

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

            A tubal is a reason to have a c-section if a woman decides they would rather not have surgery again later on.

          • theNormalDistribution

            Not necessarily. There is a non-surgical sterilization option.

      • Medwife

        Not if you’re in a Catholic hospital!

    • anion

      Sorry, but why is “more monitoring” a bad thing?

      For me, the main question is, if something goes wrong, where are you and your baby safer?

      If you try HBAC and there’s a problem, without monitoring you won’t know until it becomes an emergency; a serious, life-threatening, seconds-count emergency. In a hospital, that emergency is highly likely to be solved before it becomes life-threatening.

      Also, there’s actually a huge difference between 1.3/1000 and .5/1000. I’m not a numbers expert, but it looks to me like 1.3/1000 is over twice as high. That’s not similar afaic.

      Why do you feel you couldn’t just go straight for a section? What does your doctor say?

      (Note: forgive me if any of my comment sounded short or rude; that was and is absolutely not my intent at all.)

      • anion

        From the recent post here in which a stats professor analyzes the MANA stats (http://www.skepticalob.com/2014/02/a-statistics-professor-analyzes-the-new-paper-from-the-midwives-alliance-of-north-america-mana.html):

        “The TOLAC [Trial Of Labor After Cesarean] death rate was 5 out of 1052, that is, 4.75 per thousand. This is significantly larger than the hospital comparison rate of 0.7 per thousand even when controlling for multiple comparisons.”

        4.74 out of a thousand. That’s high.

        • anion

          (Sorry, 4.75. 4.74 was a typo.)

      • Trixie

        Having had 2 prior vaginal births, she may be an excellent VBAC candidate. If her doctor feels she’s a good candidate, and it’s something she desires, VBAC in a hospital might be a great option for her. Of course choosing an RCS is also fine, but VBAC could be a perfectly rational and safe choice for her.

    • ngozi

      The only reason I didn’t like the whole “stuck in the bed” thing with the hospital is that it can be very inconvienent when you need to go to the bathroom. Some women (like myself) need to go to the bathroom a lot during labor. Nurses do not always show up in time when you ring the call bell, a bedpan can be almost impossible for a pregnant woman to use, and a contraction can rinder you speechless. Not to mention that some nurses can be quite childish when they didn’t show up on time with the bedpan.
      Of course, all of this is a small price to pay for monitoring that helps produce a living infant. If the worse thing that a nurse/doctor has to endure during a labor and delivery is a dirty chux pad, then I would say that labor and delivery went very well.

    • fiftyfifty1

      Talk to your OB about this. If you have had 2 uncomplicated vaginal deliveries already, your VBAC success rate and risk may be better odds than they are for a typical VBAC candidate.

  • anion

    I also think “Some babies just aren’t meant to live,” is a great line to play off of. Do you want someone who says that openly to be in charge of your labor and delivery?

    • Karen in SC

      If we could have a post with screen shots of all the CPMs and MDC commenters that have said that, that would be stunning, and not in a good way.

  • Ra
    • Staceyjw

      FANTASTIC

  • Ra

    Here’s a c-section meme. Not quite the homebirth one that’s needed–but in the same genre.
    http://i.imgur.com/f6zQQEv.jpg

    • S2A2

      This argument is certainly valid for many babies, sure…however, there are also some babies delivered via c-section who are not born with all brain cells intact because of hypoxia, etc. Being born via a timely c-section DID likely help to preserve brain cells that would’ve otherwise been lost if not for getting them out quickly though. I get your point, just being a pest for sake of argument I suppose.

  • Dr Kitty

    What do evidence based guidelines say is the correct response to low AFI on a BPP? Immediate delivery.

    What do CPMs suggest?
    Stevia, homeopathy, massage and ignoring medical advice.

    That is ALL the information anyone planning HB with a CPM needs.
    They know nothing and they revel in their ignorance.

    At least traditional birth attendants know they are poor substitutes for actual doctors. The hubris of CPMs is stunning.

  • Karen in SC

    I’d like to see one comparing cinnamon candy breath to active management of third stage…perhaps a medieval setting vs hospital room or something?

    • Trixie

      Which midwife said that?

    • Young CC Prof

      Their OWN study found 15.5% of home birth women suffered PPH and 4.8% lost more than a liter of blood. Most of those women were not transferred for immediate medical treatment.

    • Meredith Watson

      Not cinnamon breath from candy! The red dye 40 counteracts the clotting. You need Vietnamese cinnamon, freshly ground. Preferably organic.

  • Trixie

    Okay, I did one, but the crappy meme generator I used won’t let me add the hash tag to it. Dr. Amy, I got the image from your site, so I’m assuming it is public domain?

    • NoLongerCrunching

      I think the bottom text should read:

      Ina May Gaskin, CPM, “the mother of authentic midwifery”

      • Trixie

        I’m trying to drive home the fact that CPMs are fake midwives and the “professional” in their title is a joke.
        But there is room for more than one Ina May meme, I’m sure.

        • NoLongerCrunching

          [url=https://imgflip.com/i/7b3gw][img]//i.imgflip.com/7b3gw.jpg[/img][/url][url=https://imgflip.com/memegenerator]via Imgflip Meme Maker[/url]

    • Beth

      I love this but I would put a little more of her quote. I just checked and it goes “so I touch them, get in there and squeeze them, talk about how nice they are.” I think that brings out the horrific lack of professionalism beautifully.

      • The Bofa on the Sofa

        Wow, that would be really funny if it weren’t so friggin scary!

      • Trixie

        Do you think I have room for one more line? Was just trying to keep it brief.

        • NoLongerCrunching

          I like the first one best. The word “tits” from the world’s most famous midwife is shocking enough. Too many words just clutter it up, imo.

          • Trixie

            Agreed. Which picture do you like better?

          • NoLongerCrunching

            Definitely the first. She looks like a sweet granny about to bake you some cookies… then you read she touches her patient’s tits. In the second pic, she looks all around crazy, so it doesn’t have the same shock value.

          • Houston Mom

            She looms like the crypt keeper in the second picture.

      • Trixie

        Here’s another try, but do you think the text is too small?

        • theNormalDistribution

          It doesn’t quite have the feel of a meme. “CPMs aren’t professionals” belongs on an infographic.

          • Trixie

            Really? Do you spend much time reading vaccine meme sites? Because the tone is very similar to mine above.

          • theNormalDistribution

            What I was trying to say is that a meme isn’t a clever quote on a picture. It’s an idea that spreads organically. Meme generating sites don’t make memes. They make pictures that hope to become memes. I think we would do better to make the equivalent of advertisements or, as I said, infographics, because the issues here are just too hard to unpack. Pretty much no one knows about/understands the issues of homebirth, so there are very few one-liners we can use. And that’s what you need to make a good meme. (Good, as in, it’s going to propogate). That’s less true for anti-vax.

        • Captain Obvious

          Friggn’ Tales from the Crypt

    • BeatlesFan

      Does anyone have a link to a reputable site which details her saying these things? IIRC, these quotes are from a previous edition of one of her books, and were removed from the most current version. I’d like to have a source if I bring up these quotes to Ina May supporters, and I haven’t been able to find one. Google doesn’t turn up much about her newborn son she watched die, either.

    • Amazed

      Might sound flippant but who on earth would want their tits touched by someone with such gross yellow teeth? Anyone else reminded of the Big Bad Wolf?

      Going to change the red pajamas I intended to wear for tonight… And I don’t even OWN a riding hood.

      • Certified Hamster Midwife

        Can’t we discuss someone’s professionalism or lack thereof without calling them ugly?

        • Amazed

          Sure we can. And in fact, I am not discussing how ugly she is. I am discussing the fact that if someone is going to make the decision for me to cross my personal boundary by fondling my tits, they’d better warn me in advance, so I can raise my objections. There are certain things that gross me out and this wolfish smile she thinks friendly is one of them. I can tolerate it just fine from a safe distance. Straight to my face while they’re fondling me… not so much.

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

    I had an idea for a poster that has a barber cutting hair on one side of it that says “You have to be licensed to cut hair….” and then a pic of a home birth on the other side, captioned “but not to deliver a baby?” its for states w voluntary licensing. I think most people would find it shocking. I am just amazed at the graphic artists in this thread and thought someone might make better use of the idea than me.

    • NoLongerCrunching

      I love it, but how about someone giving a mani-pedi instead of cutting hair? I don’t know why, but that feels more ridiculous.

    • MLE

      I’ll do that tonight if someone doesn’t beat me to it.

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

        THANK YOU!

    • Jessica S.

      Do bakers have to be licensed? I’m visualizing a baker removing a tray if buns from the oven, or something like that, playing on the term “bun in the oven”. It may not fit, if they don’t need a license. A bakery would be subject to health inspections, though, and I don’t believe there’s anywhere near that oversight for CPMs, correct? However, that may be difficult to convey concisely.

      • auntbea

        Well, if you want to be a real pastry chef, you have to go through at least several months of full time education. Le Cordon Bleu offers an associate’s degree.

    • Staceyjw

      Yes! A massage practitioner would work well too. Here they need something like 500 hours, plus actual anatomy classes! To massage people, not even the kind of stuff chiro’s do!

      The bottom of any of these could compare the hours required, etc.

    • Staceyjw

      You could add “(must be the scissors!)” under the last line.
      LOL.
      I LOVE this one. There are so many great ones here.

  • anion

    1. Does anyone have a full screenshot(s) of the original MT thread (the “What would you do?” thread?

    2. I’ve been on Twitter since early 2008. Here are some things to know about tweeting:

    *If you tweet at a specific person, only that person, and anyone who follows both you and that person, will see it. So if I tweet @Jantritten (starting my tweet with @jantritten), only Jan Tritten and anyone who follows both myself and Jan will see it. The way to get ALL of my followers to see it would be to add a period before the @. Like “.@jantritten.” The . keeps it from being a direct reply “hidden” from my other followers. If you start all of your tweets with @jantritten, chances are your followers aren’t seeing it.

    The same, of course, goes for anyone else you tweet.

    *Don’t use a link shortener if you can avoid it, when tweeting people you don’t know/who know you. Especially people with a large number of followers. If a stranger tweets a shortened link at me, I generally assume it’s a spam link and I don’t click it. Also, explain the link, i.e. “.@NevadaAG an unlicensed lay midwife’s negligence killed a baby in NV recently: http://www.skepticalob.com/2014/02/in-memory-of-a-baby-boy-who-did-not-have-to-die.html” (Twitter will shorten the link to fit, but will not mask or hide the link source the way bit.ly or a similar service will do). (@NevadaAG is the actual Twitter account for the NV AG’s office, btw.)

    (Safery Midwifery, I believe you said you have a list of contact info for NV state legislators & LE officials? Do you have their Twitter handles?)

    *Which reminds me: Dr. Amy, if you could write a post outlining the entire sequence of events from the beginning, that would be very helpful for people to tweet or link to. (Or if anyone else wants to do this and post the link?) If that post could include screenshots, even better. If we want to link people to the info, we want all of the info to be right there where they can see it, so they don’t have to click to other pages or figure out what’s part of the story and what isn’t.

    *If you are tweeting media personalities/news channels, emphasize if you can the “public interest” aspects of the case. Like, saying “A midwife killed a baby,” while TRUE, isn’t necessarily going to attract media interest. There’s no larger angle. But say, “Unlicensed midwives are lying to women about their abilities and babies are dying. A recent shocking case: [link]” or “A “Certified Midwife” crowdsourced patient care on Facebook and a baby died; not the first time [link]” or “Midwife’s negligence kills baby, other midwives try to help her cover it up: [link]” may draw more attention from them. You want to show the case isn’t isolated and has larger implications, and involves widespread system protocols rather than being one crazy woman. Emphasizing that this happened in real time as we all watched, and that the midwife was dinking around on Facebook while an infant for whose life she was responsible died in utero, may also attract interest. (I truly hate to sound so cold, but that is an angle which may interest the media.)

    Do the same on Facebook, although of course on FB you have more room and can give a little more info:

    “Recently a ‘Certified Professional Midwife,” (a title which requires little to no education to receive) crowdsourced patient care suggestions on Midwifery Today’s Facebook page. The advice she received there was completely inappropriate, and the baby died. This happened on the internet, in real time, while hundreds watched in horror. Rather than examining the tragedy to see how they could improve care, the midwifery community deleted all mention of it, rallied around the midwife, attempted to blame the baby’s mother, and lied–repeatedly–about the circumstances. This is not an isolated incident, but the lay midwife community works very hard to hide their death rate and to bury stories of the heartbroken families they leave in their wake. Please see [link] for more information, and please consider covering this case and the widespread problem of uneducated lay midwives and the damage they cause.”

    *Do NOT tweet or leave FB messages more than a couple of times a day, or every other day. Too many messages and you’ll look like a crank.

    I also suggest using the Contact pages or “Report News/Report a Story” pages on the websites of any media outlet or personality whose attention you’re trying to attract. Again, keep it as brief and professional as possible. If you yourself are a loss mom and feel comfortable mentioning it, DO. It’s okay, too, to say how shocked and disgusted you were to watch all of this unfold on Facebook and to see how the midwifery community is trying to bury this baby a second time, and how this family deserves justice, and how women need to know this is happening. Just try to stay calm in your email. Again, you don’t want to sound like a crank.

    I hope that helps!

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

      1. “the internet never forgets” is the post on this site w the full series of screen shots from Jan Trittens FB page. You have to download it.

      2. thanks for the info!

      3. I don’t have their twitter handles. I will look for em tomorrow. If you want to (you probably have more time than I do) you can look at their names here http://www.leg.state.nv.us/App/Legislator/A/Senate/77th2013/

      • anion

        Sadly, I can’t d/l it. :-( And it would be best to have the whole image up and visible, as many people (myself included) won’t download documents or images from sites they don’t know.

        • Trixie

          Plus, it’s hard to read on mobile that way

    • Karen in SC

      Very helpful. I’m new on twitter but hope to do my part.

      One question – do people tweet these picture memes or those are more for FB and Tumblr (which I dislike but maybe someone else here could set up).

      • anion

        You absolutely CAN tweet images. Click the little “Compose” icon (upper right corner if you’re on the actual Twitter site). It will open a new box in the center. In the lower left of that box is a camera icon.which says, “Add photo.” Click that and it will open your computer’s Photos folder. Just click the photo you want to add and it will automatically load it.

        It’s best to add a line of text, like, “Think ‘Certified Professional Midwife’ is a real credential?” or Dr. Amy’s “Thinking about homebirth? Think again,” depending of course on the image you plan to tweet. (Type the line before clicking the Add Photo icon.)

        Then click Tweet, and up it goes! The image will appear in your timeline (it may be slightly truncated there) but when people click the photo link they’ll see the whole thing. Also, the image will appear in the “Photos and videos” box on the left side of your profile.

        (If you’re doing it from your phone it’s slightly different; let me know and I’ll explain that process.)

        • anion

          Lol, sorry, I just realized you asked if people DO tweet these, not HOW.

          Yes, people do, all the time.

          And actually, setting up a Tumblr for this sort of thing is a good idea. Tumblr has become something of a clearinghouse for tortured souls and woo, but it’s still a very good place to share things, if anyone wants to set one up. And Tumblr is very easy to use.

          • Karen in SC

            Thanks! Explaining how was very helpful.

          • Trixie

            It might be nice to have a tumblr repository for all the memes people are creating.

    • DaisyGrrl

      I’ve been wanting to put together a timeline for this. I’ll finally have time this evening, so I’ll do it then.

      Things I plan to put in the timeline: Facebook post, “suggestions”, response that mother has died, deletion timelines, the midwife’s postings on FB and twitter, denying accountability. The letter from the mw. SOB posts/comments (properly attributed).

      I’ve put my email in my disqus profile, so if anyone has screenshots I’d love to have them. If anyone has a blog and would allow me to guest post the timeline using my user name, please email me and let me know. Otherwise, I’ll do a document and link it on dropbox.

      • anion

        Awesome, thank you!

        I have a screenshot of the devolving thread up to 251 comments, I think. (Since my computer died, I’m on a netbook with limited capabilities–I know I saved the page but don’t know if it worked.) I will try to get it to load, and if I can I’ll email it across.

  • Renee

    Also- I wouldn’t focus too much on CNMs, because they have bad HB stats too. Maybe one that shows the difference between HB, and an ACCREDITED CNM birth center. If that is not too confusing.

  • Renee

    IMO, #3 needs to be replaced with info about the 18x risk of HIE, and the need for cooling cap therapy, which is the ultimate in interventions, especially ones that separate mom and baby for a considerable amount of time. This is a great graphic because it isn’t too in your face, but it should have the HIE risk. Calling for eliminating the CPM just doesn’t fit as well, and is really the next step after you understand the actual stats.

    Additionally, I would have one that shows a baby on life support and cooling cap that says “You refused all interventions, but your brain damaged baby may suffer all the high tech available because of it” , Or maybe “Choosing HB can take away that first snuggle. HB has an 18x risk of brain damage, requiring extensive life support. IF you are lucky. ” Or something like that.

    Plus, almost zero HB moms even know brain damage IS a HUGE risk. They may have heard of a few deaths, but I bet even fewer have ever heard of the lifetime of serious disability and often suffering that comes with severe brain damage. It is a very big thing. Even lesser amounts of brain damage will show up as learning issues and such, all of it preventable.

    Seeing a sweet child that should be walking and talking, but cannot due to HB, is actually more of a warning than death of a baby is. Deaths are easier to ignore because no one sees the baby, no advocates go to the funeral, and few help the family for very long afterwards. The baby was never known, so it is easier to sweep under the rug, or wall off in their minds.

    Eisk of HIE is very critical info, because some people may still look at the death rate and think “Well, that is still not too likely to happen”, but add on the odds of HIE and the number of bad incidence rises. For some, severe brain damage is a worse fate than death. Besides, it can lead to financial devastation, and adds complication and hassle to everyday life. .

    I think one with a focus on just the dangers is most important because so few even know this stuff. The MANA stat ought to be in there, just as the 3-9x rate, and the 18x for brain damage.

    “Thinking about HB? Informed consent requires knowing the facts” then list the facts.

    • DaisyGrrl

      “Can you hold your breath while you drive to the hospital? Neither can your baby.” followed by “Your baby’s risk of needing cooling therapy for brain damage is 18x higher with homebirth. Informed consent requires knowing the facts.” Cite the study somewhere on the photo so people can look it up themselves.

      Btw, I love the tagline “Informed consent requires knowing the facts.” So well put!

      • NoLongerCrunching

        With a picture of one of those poor babies struggling in the NICU.

        • anion

          One of those, with a line like, “No-intervention birth?” or “The mother chose homebirth because she was promised no medical interventions. Now her baby is getting a lot of them.” And then the “Informed consent requires actual information,” line.

          (Do we have any moms willing to share photos of their babies? It seems to me that as much as those photos will make the point strongly, it’s a fine line. We want to educate, not horrify/upset. Don’t get me wrong, I like the idea a lot and it’s very effective, I just want to be careful. We’re not the ones who don’t care about what happens to the babies, you know?)

          • Staceyjw

            Vylettes mom would undoubtedly share. I can think of a few others too, like Abels mom, Sams mom may too. Poor Sam, RIP, killed by MWs after having his brain function stolen by them.

            ****Vylettes MWs were NOT CPMs, They’re CNMs!***
            BOTH are out there, still working. Makes me sick.

            Vylettes pics will make even a hardened criminal cry. She is in a room without other babies because the life sustaining equipment fills it up. IIRC, Mom could not hold her until after they decided to take her off life support. Basically, when her sweet baby died in her arms, it was the only time they got to be together alive.

            Mom was told it takes 2yrs to resolve and have action taken by the Board of Nursing. (??!!!). Meanwhile, one is working in a pediatrics office (IIRC). hope he is not as bad as her. I’m not sure agouti the other one.

          • anion

            How awful. :-(

            I just can’t understand how someone can know their negligence and ignorance led to that and still seek work as a midwife.

          • deafgimp

            A tagline of “The first time I got to hold my HB baby was as she was dying” would probably be very effective for the “hospitals don’t let you hold your baby right away and therefore they screw up your bond” myth

            Also, “I bonded with my HB baby while she was on life support. My baby did not get the chance to bond with me”

          • Jessica S.

            That’s a good idea, asking moms who’ve experienced this. When dealing with an adversary that will find any little thing to discredit your argument, you definitely want to make sure the pics you use are actually attributable to the event you’re discussing. Otherwise, it derails into being a faux-controversy over misleading materials, not the substance. (Since we all know the substance is something they can’t really argue against!!)

            I hope that makes sense. I think you’ve got a great idea going! :) I wish these moms weren’t in the position of having such photos. It makes me so angry.

      • OBPI Mama

        Love that!

  • MLE

    Ok last one for now.

    • MLE

      (All images are stock photos purchased by me)

    • KarenJJ

      You could also use the image of the kale and the image of the midwife with the wooden ear trumpet thingy and do

      Certified Organic
      Must conform to FDA Food Safety Laws (or whatever it is).

      Certified Professional Midwife.
      Must conform to ZERO safety laws from MANA.

      Sorry so brief, trying to cook dinner.

      • MLE

        There’s that zippy phrasing I was searching for but not finding at two am. I will do that tonight after my real job is over, arg!

    • Renee

      This is EXCELLENT.

    • Trixie

      May I make a suggestion, since you’re so good at this?
      MIDWIFE EDUCATION
      UK (huge stack of books)
      Canada (huge stack of books)
      Holland (huge stack of books)
      US CNM (huge stack of books)
      US CPM (flimsy Business Reply Mail envelope)
      “It only takes a correspondence course to be a home birth midwife”

    • http://whatismyreferer.com/ MikoT

      Line 2: should/would

  • MLE

    Another. Obviously I am focusing on the fact that there is a difference between CPMs and CNMs, which is something I never would have known without this site. The deliberate blurring of the lines between the CPM and the CNM by NARM, et al, is the root of the fraud being perpetrated on unsuspecting mothers.

    • Bomb

      This is excellent!

    • NoLongerCrunching

      This is amazing.

    • The Bofa on the Sofa

      For the CPM, you could add something like “Only since 2010…”

  • MLE

    Here’s another -

    • Renee

      Too bad CNMs that do HB are often just as bad, and holding them accountable is not too much easier (at least it exists, but barely).
      They STILL have a significant increase in deaths.
      HBis dangerous period.

      Maybe one that shows the most dangerous HB events- HBAC, Breech, and first time moms.

      • MLE

        True. I am taking one step at a time. CPMs are charlatans and this is one way to illustrate that and maybe gain a foothold.

        • Trixie

          I agree. If we got to a place where all we had to worry about were rogue CNMs, it’d be a dream come true compared to the situation today.

    • deafgimp

      What is the photo on the left supposed to be? I don’t get the connection between the photos.

      • Young CC Prof

        Statue of a mourning mother, I believe.

  • Trulyunbelievable2020

    With all due respect– and you deserve a great deal of respect– I think it’s too early to be making memes. The pressing need right now is to publicize the most recent preventable death and attach that to the recent research that’s
    come out.

    You’ve listed the email addresses/twitter handles of a number of hardcore homebirth advocates, but I don’t think that will accomplish much. What would be far more useful is a post with a comprehensive list of more mainstream figures to contact along with detailed instructions on how to use twitter to effectively publicize this ( I get the sense that a lot of people here are twitter-illiterate and don’t understand that a person with no followers tweeting to no one accomplishes nothing).

    The list should include contact info for:
    -Nevada legislators
    - Local news outlets in Vegas
    - Health experts with national nam pe recognition (eg I just tweeted to Dr. Oz, even though I think his show is pretty ridiculous)
    - health and science editors at widely-read websites (e.g, Laura Helmuth at slate.com)

    • MLE

      I have a feeling there are many irons in the fire.

    • SouthernGal

      This isn’t a “meme,” it’s a fact-based informational graphic. Pretty huge difference.

    • KarenJJ

      Multi-faceted approach. I think the news will pick up on something if it is big on social media these days. That’s what I’m noticing in Australian news at least.

    • Renee

      I fully agree with making a graphic with “what to do about this”. It would be a great, useful tool, but this does not mean we cannot do more than one image!

      Now IS the time to unleash everything we can come up with, while people care and are looking. Eyeblls are everything, sand we have them for once. This will not last, no media attention does. Holding back and being “polite”, and doing all of the standard things has never worked in the past. It unlikely to work now, without enough attention to make a journalist bother with this story, enough people worried to catch the eye of lawmakers.

      These graphics can cause confusion, anger, even outrage. This shock, followed up by enough outrage to actually be transferred into real, hands on action, is much more successful. In Oregon, the outrage from Abels brain damage law suit, and a highly publicized death (Shahzad), made enough people mad they formed a work group and got laws changed.

      “Sound bytes”, like these graphics, are more likely to be seen, spread, and read than pretty much any other form of communication on this issue. They are also more likely to provoke the annoyance, even anger, in the target audience, often leading to finding out who says this outrageous stuff!, and reading it in order to refute it. This leads to more educated moms than you would ever think.

      Short version: No change can be made if no one notices, or cares enough to bother making the next steps you want to see (I want to see them too!). Graphics that can provoke feelings are a great way to start the conversation.

  • Trixie

    So, a very weird Disqus thing just happened to me. I clicked on KarenJJ’s picture, and all of a sudden I WAS KarenJJ. I had to logout as her and login as myself again. Just an FYI in case this happens to anyone else or in case someone seems to be posting something out of character.

    • KarenJJ

      Wow.. Bizarre. I haven’t posted a pic here before…

      • Trixie

        Oh. Geez! The new meme below had your name beside it. Now I refreshed and it just says “Guest”. Malkovich malkovich

    • prolifefeminist

      Just happened to me too! Freaking WEIRD.

      • KarenJJ

        Uh oh. What have I done….

        • Trixie

          If I find myself on the side of the Jersey turnpike in an hour, I’m blaming you.

          • KarenJJ

            Heh. I have absolutely no idea where the Jersey turnpike is (or even what exactly a turnpike is) however I can safely say that I am absolutely nowhere near it :)

          • Trixie

            Oh, it’s just a reference to the movie Being John Malkovich. You jump through a portal and you end up in control of John Malkovich’s body, but after awhile you get spit out on the side of the New Jersey turnpike (a toll highway).

          • KarenJJ

            Fair enough then. I am in control of my body so that’s a relief but if I end up in New Jersey I can start worrying. Although second thoughts it’s probably a lot cooler then where I am right now.

          • Trixie

            Anytime you end up in New Jersey, it’s time to start worrying.

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

            MALKOVITCH!!!

        • prolifefeminist

          You’re everywhere! ;)

      • Trixie

        I see you have your old name back, though.

        • prolifefeminist

          Yes! I figured it out, finally. :)

    • realitycheque

      Same thing happened to me the other day.

  • Guest

    I’d like to see one as follows:

    Side 1: a doctor who committed malpractice resulting in infant death/injury – and the consequences s/he faced (I think a few have been mentioned on here)

    Side 2: a CPM who committed malpractice and likewise the consequences s/he faced. I think that would be very, very revealing for lay people.

    My mother had homebirths in the late 80s/early 90s, is now an advanced practice nurse, and worked in OB for many years and she had no idea that CPMs have essentially no consequences if they mess up.

    • Trixie

      Perfect!

  • flygirl

    OT, but I’m writing a research paper on the HB crisis for a class I’m taking – does anyone have the link to the recent study showing an 18x increase in HIE (I think it was) in HB neonates? I know Dr. Amy wrote a post on it not too long ago, but it’s not coming up for me in the search function.

  • KarenJJ

    OK I haven’t done this before. The photos are creative commons license from Flickr and I don’t know if I’ve attributed correctly. This is my attempt.

    • KarenJJ

      My thoughts are that by focussing on the lack of education and professionalism of CPMs and their inability to practise in any other developed nation would at least make people rethink this particular style of homebirth. I do think there are a lot of issues with midwifery in general and homebirth especially, but CPMs are just mind-boggling for people that live in countries where homebirth is more regulated and the midwives that practise more integrated into the medical system.

    • Renee

      I like this one a lot. This graphic IS true. The death risk of CNMs is lower than a CPM, and might be a good one for moms hell bent on HB.

      But I have one concern- There are way too many CNMs that cause deaths at HB. They are almost as bad. To posit them as as safe enough to lead to good outcomes is kind of misleading, IMO. Some of the most egregious deaths have been CNMs, and it took YEARS to get them suspended/revoked, if at all. If they do HB, they will not carry malpractice either, a major issue in cases of brain damage.

      CNMs have good rates at ACCREDITED BCs and in hospitals, likely because they actually screen and refer properly.. But a 2x higher death rate is still ugly.

      • Trixie

        But, I think you’ve got a better chance of reaching a potential home birthed by making this distinction, which they probably aren’t even aware of.

      • KarenJJ

        It could be changed to “The difference between choosing to give birth at home vs giving birth at a hospital in the USA can be the difference between night and day” or life and death…

        Theoretical “dead baby cards” being much easier to dismiss then graphical ones.

        I chose to focus on CNMs because I feel that midwifery should really draw the line between quacks and real midwives, similar to how doctors have had to do in the past.

  • Trulyunbelievable2020

    How would calling CPMs CBAs “emphasize that CPMs are ineligible for licensure in other first world countries?”

  • CanDoc

    A totally picky bit of grammar, but the 3rd bullet point, 4th line, should read “CPMs” not “CPMS”.
    Alternatively, I’m not sure about a change to CBA. It still sounds professional because of the word “certified”?

    • Sue

      Agree – should change to ”certifiable”.

  • flygirl

    I don’t like the recommendation (changing CPM to CBA) – it doesn’t seem logical to me. Who’s the audience for this – parents who are considering hiring a HB midwife, right? And you’re warning them that a) home birth carries a higher risk, and b) CPMs are inferior midwives. But then you recommend changing the name of CPMs to CBAs. You’re trying to spur your audience into action, and the action they hopefully will take is not to change the name of CPMs to CBAs (they are powerless to make that happen), but to fully understand the real risks of home birth, and if they choose it, to hire a better-trained CNM over a CPM.

    I disagree that the whole CPA to CBA name change will accomplish anything important but it will dilute the focus of your message and use up a lot of energy best spent elsewhere.

    IMO…this campaign needs to focus primarily on a couple of different points:

    1) Educating the public on the difference between CPMs and CNMs
    2) Educating the public on the difference in safety of home vs hospital and the MANA coverups
    3) Educating lawmakers on points 1 & 2 and putting pressure on them to protect the public from CPM negligence

    Not an all-inclusive list of course, but in my mind (as a former HB mom) those are the top points to hit.

    (Btw, this is prolifefeminist – finally got logged in to disqus!)

    • manabanana

      Isn’t it TBA – “traditional birth attendant” – that is what lay midwives are called throughout the world?

      Midwives hate this term. HATE. IT.

      TBA implies no formal training, only empirical knowledge. So, quite fitting, no?

      • Medwife

        I am loving this suggestion.

        • flygirl

          Me too.

        • manabanana

          Midwives refuse to have policies for safety or education or standards of practice.

          BUT

          They have a policy against using the term “traditional birth attendant” to describe lay midwives.

          http://www.midwiferytoday.com/iam/gmc_tradmw.asp

          • Jessica S.

            *commencing eye roll sequence* Too much!!

      • Trixie

        Much better.
        Still think that introducing this idea in the fine print of a meme is confusing.
        Then again, people aren’t turned off by TCM for traditional Chinese medicine. They think it’s some kind of fancy ancient wisdom.

      • MJ

        I haven’t posted here in quite a while but I strongly support the notion of describing these women as traditional birth attendants. It puts them on par with all other non-clinically trained birth attendants in the world. If a woman in western society wants to pay the equivalent of a skilled village elder to serve her and her baby then so be it. But that service cannot be confused with that of a trained midwife. For the record, I have great respect for traditional birth attendants. I have been part of international development organisations that have made significant strides in maternal and child health in developing nations by working cooperatively with these women and recognising their significant place and service to their (usually medically-under served) communities.

        • NoLongerCrunching

          Funny, I think the opposite. I think it’s insulting to real traditional birth attendants. There is nothing traditional about western white women making up a bunch of woo and scaring women away from medical resources that people in underserved areas would kill for.

          • MJ

            I think your point is pretty valid. What I would say, though, is that ‘traditional’ is the space the CPMs have carved out for themselves. They claim to be doing things the ‘traditional’, ‘natural’, noble savage way but they simultaneously insist on the prestige and legitimacy of being a professional care provider. I think pointing out that they are the American equivalent of a traditional birth attendant highlights the ridiculousness (and the disturbing cultural aspects) of adopting (read: misrepresenting and misappropriating) third world practices in a first world society.

          • anion

            They’re the American equivalent of a nosy old woman at the grocery store telling you that if you eat lots of spinach and avoid watching violent TV your baby will slide right out and start reading at sixteen months.

            They’re Prissy in GONE WITH THE WIND, advising you to put a knife under the bed because it cuts the pain in two. They know everything about birthing babies…until there’s an emergency, and then they just hide in the corner and scream.

        • manabanana

          “If a woman in western society wants to pay the equivalent of a skilled village elder to serve her and her baby then so be it.”

          I read this wrong, I thought you were saying “If a woman wants to pay (with her life and circumstances) to become the equivalent of a village elder to serve her neighbors as a birth attendant, so be it.”

          Meaning – if a midwife wannabe wants to make her living in slums, rummaging through garbage and providing the most basic and primitive health care to the humans in her community, so be it. But no woman in the US has paid this price to become a midwife. No one.

          I, too, have deep respect for traditional birth attendants. I can’t imagine that any one of them would thumb their noses at access to hospitals, clean supplies, further education and real and tangible means at increasing the survival rates of the women and babies they serve. They are doing the best with what they have in deplorable circumstances.

          In the US we have incredible access to resources, (training, education, access to medical and technological services) and midwives openly and rabidly eschew them.

      • Renee

        Lay MW, or LDEM is what they are called here in Oregon if they are not a CPM, and are licensed. I would like to see a return to this for ALL non CNMs.

        Traditional is good, but makes me a little annoyed. Old time MWs would never be so reckless and ignorant. Using what you have is not the same as forgoing what can save lives.
        Just a nitpick.

    • Trulyunbelievable2020

      I agree 100%. Women hire CPMs because they assume that a certified professional couldn’t possibly be an ignorant, inexperienced hobbyist. Changing that to CBA accomplishes absolutely nothing.

    • Amy Tuteur, MD

      I don’t think it matters what we call them as long as we take away their ability to call theemselves midwives.

      • flygirl

        Oh I agree that’s a worthy goal, but the “thinking about home birth” meme above is directed at expectant parents, and they’re not the ones who would be doing the name-changing. It’s off point. The recommendation on that meme ought to be to investigate the difference in safety of home vs hospital and to avoid a CPM at all costs.

      • Sally RNC-NIC

        Disclaimer: It’s late and I’m skimming, so there’s a great chance I’m not super on-topic with what I’m about to say, but here I go.

        So, I started my nursing career in a Level 3 NICU at the largest birth center in my city. I ran to crash deliveries all the time. Perfect pregnancies, shit hitting the fan at the last minute. Sometimes we had more warning, sometimes we
        went from triage to tubing mom to getting baby in 9 minutes.

        Only once did I, as the NICU RN assigned to the Code NPR Team that day, participate in an emergency section, due to abruption, where we never got the baby back. 19 minutes – which in retrospect is too long – but feels like 30 seconds when
        you’re desperately trying to resuscitate a perfect PERFECT neonate. Later it was determined that the initial triage heart tones were likely artifact from mom, meaning the sweet little guy was already gone when we got him.

        I’m now working at our Children’s Hospital, on the Dialysis, CRRT and ECMO team, and am frequently in the Level 4 NICU. While I’m not attending deliveries anymore, I’m caring
        for some of the sickest babies in the midwest. And sadly, many are brought in from water-births, homebirths, free-births, you name it.

        And you guys, these kiddos are sad. They hate it. Their quality of life is shit.

        So, to try and circle back….I don’t care WHO is gathered around the bathtub or birthing pool or family bed….the best OBs, the best NICU nurses, and even a couple of
        neonatologists are not much good, if an OR is not right down the hall.

        Even the best, most intuitive midwife who says, “We’re going to the hospital!”, is likely making that decision too late…fetal circulation compromise does not improve with time.

        Homebirthing = child endangerment. And yes, I understand that babies aren’t real people until they make their debut….dead or alive. But, once they’re out….they are
        like, real peeps. With real rights. And they should be protected – by law – from endangerment.

        Wishful thinking, I know.
        Baby steps….

        • Renee

          I wish I could like this 100x

  • Adrienne

    Question: Do the death rates mentioned in the first bullet include births attended by both CPM and CNM? Or do most homebirth statistics on this blog refer to births attended by CPMs?

    • Mariana Baca

      CPM. CNM homebirths and birth center births are also riskier than hospital birth (CNM or OB), but a) not as bad and b) the risk is more easily isolated to birthplace as opposed to competence of provider. But the study linked was about CPMs.

  • Guest

    Why does this Meme show a good outcome tho?

    • Meredith

      I think Dr. Amy was going for a cognitive dissonance between happy photo and grim text to jolt the viewer.

      • Amy Tuteur, MD

        Actually, I was going for the pharmaceutical ad look, where happy pictures are accompanies by grim warnings. I also think it is important to acknowledge that for many homebirth advocates, there are big upside benefits. I’m not trying to deny that. I want to be sure that they know the downside risks.

        • flygirl

          “I also think it is important to acknowledge that for many homebirth advocates, there are big upside benefits.”

          I think that’s wise. You want to get people thinking about whether the higher risk of death/disability is worth the upsides of giving birth at home. This is a point that HB advocates don’t want parents to consider.

        • Meredith

          Ahhhh, so it’s along the lines of the couple frolicking through a sunny meadow while the voiceover warns that side effects can include death.

        • fiftyfifty1

          “Actually, I was going for the pharmaceutical ad look, where happy pictures are accompanies by grim warnings.”

          Drug companies use pharmaceutical adds because they INCREASE use of the product. The warning boxes may scare a few people, but the happy picture convinces even more, or else the drug companies wouldn’t do the adds.

    • Karen in SC

      I had the same thought, maybe one of the heartwrenching pictures we’ve seen from loss stories here would make an impact.

      But that might be knocked away immediately as too extreme, that won’t happen to me, etc., and ending up not being effective at all.

    • Life Tip

      I think the positive image makes mothers/mothers-to-be more likely to give it a second look.

  • fiftyfifty1

    Who, exactly, has recommended that the CPM designation be swapped out for CBA? Will this actually be a good idea?

    Pros:
    Less confusion between CPMs and CNMs among the general public
    Insurance companies can make a clear distinction when choosing who to cover.
    Groups such as pediatricians can also draw a clear distinction (e.g. yes to a birth with 2 CNMs, no to a birth with CBAs)

    Cons:
    The acronym is still very similar. 3 letters, starts with a C.
    They are still certified–sounds official to me!
    Appeal to libertarians “I’m actually a midwife, an ancient and honored profession, and now the nanny-state GOVERNMENT wants to step in and muzzle me! Can you believe that!?”

  • Trulyunbelievable2020

    I highly doubt that changing CPM to CBA will change anything.

    • NoLongerCrunching

      I like the idea, because it shows that Dr. Amy recognizes that these birth junkies and the women who want them aren’t going anywhere, and she’s not trying to restrict their choices. She just wants them to stop lying about being midwives, and she wants the mothers to understand what they’re getting.

  • Amy Tuteur, MD

    I swapped out the image to a copy with a bigger warning box.

    • Trixie

      Might want to add a #notburiedtwice

    • Trixie

      It’s still pretty tough to read on an iPhone. I would edit down the text a bit more, get rid of the confusing language about CBAs, and use a hashtag and link to refer people to more info.

  • Allannah

    Dr Amy, I wish you would do more to avoid confusion about what your message really is.
    You are campaigning to abolish the CPM credential, achieve enforcement of safety standards and risking out criteria for home birth candidates, and for true informed consent.

    Attacks on a mother’s choice for home birth itself will only serve to fuel accusations that you are trying to take women’s rights to choose the circumstances of her birth.

    • Amy Tuteur, MD

      I’m confused. How is this an attack on a mother’s choice?

      • Allannah

        The main punchline doesn’t mention midwives, just home birth.
        A lot of the opposition to your campaign from otherwise reasonable people comes from the misconception that you want to abolish the very existence of home birth itself.
        It is my opinion that you would find a lot more support with a meme that makes it clear at first glance that untrained midwives working without safety standards are a very dangerous choice that does not deserve to exist. I would personally never choose home birth but I support other mothers right to do so in the right circumstances.

        • fiftyfifty1

          Hmm, I don’t read it that way. I’m reading it more as “here’s what you need to know if you do choose it”.You bring up a great point however–just because it appeals to me and seems very fair doesn’t mean its target audience will read it the same way.

        • Meredith

          You know, Dr. Amy asked for everyone to contribute their memes, so if you can come up with one that you think will be more effective, go for it! Put your choice of headline on the photo and share it in the comments. (I’d offer to help, but I have zero photoshop skills.)

    • Meredith

      Dr. Amy is presenting facts as well as a recommendation about the CPM title in this image. What’s the “attack”?

    • Melissa

      Nobody wants to outlaw homebirth. But just getting rid of CPM’s, while a start, does not eliminate the fact that the safety of homebirth has been lied about repeatedly by MANA and by NCB supporters.

      The benefits of homebirth are all based on aesthetics and comfort, not safety. I can’t speak for Dr. Amy, but my personal issue with homebirth is that the supporters continue to talk about the safety benefits (and spreading falsehoods about the dangers of hospital births and c-sections) in an effort to justify their decisions. The falsehoods get heard by people who are doing actual research about birth options leading people who are concerned about safety to have a more dangerous homebirth out of fear and falsehood.

      I just want homebirth supporters to be honest. It is more dangerous, but they believe that the greater risk of death and serious injury is an acceptable tradeoff to avoid c-sections and medicalization and to have a certain aesthetic experience. We let people jump off buildings even though it is dangerous as long as they know the real risks. I just want the same with homebirth. It’s fine if you do it, but it’s wrong to lie about the reasons and lead others into doing it for the wrong reasons.

    • Karen in SC

      Isn’t it the baby’s birth?

    • Susan

      My opinion is this. Even if CPM were abolished and MD’s or CNM’s were providers it would still be less safe than hospital birth. The stats I believe back up that opinion. Women need that information too. I would guess though, if homebirth providers were fully trained CNM or MD that there wouldn’t be the same level of outrageous stories. Yet if you read the issues with lets say Dr.Biter and the case that finally got his license revoked you start to see how having real accountability works to provide some recourse when a real professional goes off the wall.

    • Trixie

      There can be more than 1 message. Basically,
      1) home birth will never be as safe as hospital birth, but
      2) if you’re going to do it, at least use a CNM because CPMs are uneducated hacks, and
      3) the culture of home birth midwifery is led by a small cult of dangerous babykillers with no interest in improving practices

  • Amazed

    The Jan Tritten topic just got deleted from the viper nest, aka MDC. Do your reasearch, mamas! To the winners in the lottery, congratulations!

    • Trixie

      Well, valiant effort. I’m not sure if you’d want to blow your cover, but if you are the OP, well done.

      • Amazed

        Unfortunately, no. These chics get on my nerves faster than any boss I might have had (never got one). I wouldn’t have lasted a minute there.

        No, the thing is, when I got to page number 2,4,6 and so in my daily quota, I take 5 minutes of rest and then give myself a minute to look at this site and the viper nest. This way, I am usually aware of what happened there within the last hour. I must admit to some sick curiosity: I checked there often specifically to see whether someone would dare bring it up and how long would it last.

        Good for the OP, though, I second you on that.

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

      They have a policy of not posting anything negative about a care provider. Its pretty messed up.

      • realitycheque

        Does the same rule apply for OBs?

        • Jenn

          Last I checked, if applied to all care providers, including OBs. It needed to be there because people were bashing hospital workers by name on the local boards.

      • Jessica S.

        Yeah, but isn’t she technically not a healthcare provider anymore? Or is it a “once you are, you always are” thing? Of course, I’m asking these questions as if MDC rules their board with any impartiality and logic! :)

    • Trulyunbelievable2020

      I’m the OP from the MDC thread. Can’t imagine I’ll be there too much longer after the response I just posted.

      Perhaps we should all take turns reposting about this every time those idiots delete the thread.

  • Trixie

    I think a grandmotherly picture of Ina May with a short quote about how she likes twiddling nipples or something else crazy she said, with the caption, “CPMs aren’t professionals” might be a good one.

    • Trixie

      And every single meme should have the hashtag #notburiedtwice in the corner.

  • MLE

    Dusted off Paint for some fun.

    • Amy Tuteur, MD

      Yessss!

      • Trixie

        This is a good one for the dads, too.

        • MLE

          Yeah I was thinking of adding Dads: to the beginning as an alternative. I will add the hashtag later as well. Curse these short nap times!

    • Trixie

      That’s what I’m talking about!

    • Allannah

      THIS is what I was talking about in my previous comment. Show the difference between a real medical professional and a CPM, and let people draw their own conclusion from that. This one will appeal to fathers, too! Great job.

    • Anj Fabian

      I’m tempted to use a new keen knife versus an dull, cheap looking one.

      …but cutting implements won’t go over well with the target demographic.

    • Renee

      MY FAVORITE. This is so awesome. LOL forever.

  • Bomb

    I also can’t read the text on my tablet. I would put “Thinking about homebirth” across the top, with the text in the center, bolded, then “think again” on the bottom. I’d have the image be a background drop instead of central, and I might go so far as to find one of a woman screaming in a bathtub, I mean, having a ‘labor rush’.

    • Bomb

      Kinda like is meme, but I might go black and white since it conveys a darker image. https://www.facebook.com/photo.php?fbid=484043891665625&set=a.414675905269091.96547.414643305272351&type=1&theater

      • Amy

        Seriously. Even casual observation leads to this conclusion. Both of my in-laws are in their late 60s and very, VERY obviously on the spectrum. I know numerous others in their age bracket who exhibit similar behavioral quirks. But back in the 1950s, if you could function in a public school, you were “normal” and that was that. Today they’d be eligible for all kinds of services and therapies to help them navigate their issues.

        • Dr Kitty

          Umm hmmm
          I have a relative who can speak 6 languages, has perfect pitch, an eidetic memory, took apart every clock in his mother’s house to see how it worked before he was 5…and when I was visibly very upset about something suggested that I might like to try squaring numbers ending in 5, because that usually makes him feel better.

          Nope, he doesn’t have a diagnosis…but I’m pretty sure he’s on the spectrum.

          Things were different back then.

          • Trixie

            That’s actually a very touching story about squaring numbers.

          • theNormalDistribution

            What a nifty idea! I can totally see how doing that could be soothing when you’re upset.

          • Dr Kitty

            Don’t get me me wrong, he’s very sweet and was trying to help, but…it was the most emotionally tone-deaf comment in that particular situation.

            He taught me to play backgammon when I was 4 and is just great with kids because he does magic tricks and knows all sorts of cool trivia. But some things he’s totally at sea. There is a reason he doesn’t go to many funerals.

          • The Computer Ate My Nym

            when I was visibly very upset about something suggested that I might
            like to try squaring numbers ending in 5, because that usually makes him
            feel better.

            …5s are good, but I like the higher multiples of 2 myself. There’s something soothing about a very big number that’s really just a bunch of 2s multiplied together.

          • An Actual Attorney

            Oh, um, before my bat mitzvah, I remember doing algebra in the rabbi’s study, because it calmed me down. Yeah….

        • Meredith

          I read a book on autism (sorry, I can’t remember the title) that linked the California upswing in autism diagnoses with a law change that gave autistic kids better access to services. What was really interesting was that at the exact same time that autism diagnoses went up, the diagnoses of… general retardation, I think… went down a commensurate amount. Conclusion: professionals had been diagnosing autistic kids as retarded so they could get much-needed services.

        • Melissa

          I was born in the late 70s. I have a half-brother born in the mid-90s. When my brother was diagnosed with ASD, my father didn’t believe it because the traits that they pointed to as showing autism (little eye contact, trouble with social interaction, repetitive actions) were all things that I did. Except my teacher’s said that it was just that I was gifted and was a little eccentric.

          I’m glad that the dx was expanded so that he could get help. I had to learn through trial and error how to fit in (and I’m still not great at it). At the same time, it is sort of upsetting to hear people freaking out about the epidemic of children who may be acting like me.

  • Guest

    Can you get the “warning” box bigger, doc? It’s hard to read. Great graphic.

  • http://babyandbump.momtastic.com/wtt-journals/1424393-because-journaling-message-board-cheaper-than-therapy.html Proserpina

    I’d suggest uploading a larger version of that image. I’m having to squint at my screen to read the text.

  • Karen in SC

    Excellent!

  • Anj Fabian

    Observation 2:

    I recently saw an online discussion by someone who is currently pregnant and wants a home birth. (Multi para, VB followed by c-section for twins.) She excitedly reported that she had called about two dozen midwives before she found one that her family could afford.

    This will be an HBAC, high risk. The only criteria that I could see that she used was how much the midwife would charge.

    How do bad midwives find clients? This is how they find clients. Clients who are unlikely to get anything resembling informed consent. Clients who are thrilled with the idea that they’ll be able to get this wonderful home birth. Clients, who if they are lucky, will end their pregnancy just as blissfully ignorant as they began it.

    • Melissa

      I was reading over in the MDC unassisted childbirth forum and saw many of the stories that included not being able to afford a midwife (and equally unable to afford hospital birth). Of course they are all quick to point out that their decision isn’t motivated by the money, it just so happens that they wanted to UC and also didn’t have the money for any other option.

      One of my theories is that most people who are choosing HB or UC have some fairly specific and practical reasons for doing so, but that those opinions are the types which aren’t accepted in society and so the mythology of the evil hospital birth is created so they can have an out.

      • Anj Fabian

        The Evil Hospital is commonly accepted and will gain them immediate support from certain groups.

        If you point out all the government resources available to pregnant women, they’ll immediately find reasons not to make use of those resources.

      • Renee

        IRL, I live where OOH comprised 4.5% of all births, and it is much higher in this particular town, more like 1 or 2 in 10. I find that practical reasons are very few and far between. I rarely hear cost mentioned as a primary motivation. It seems the other way around- they want their blissful, no medical experience, but know people understand not affording it, so they use this excuse for those unsupportive of HB.

        These days, the hospital is more accessible to more people than in the past. Unless you are a Quiverfuller that refuses to accept any government or Obama related programs, pregnancy coverage has improved.

        Medicaid picks up MANY moms that cannot afford it, and with Obamacare, all births MUST be covered if mom is insured: no more pregnancy waivers. Even high deductibles will be around the cost of a HB. Also, no hospital makes you pay up front.

        UCers have a huge number of reasons, but the “I trust my body, why do I need a MW?” is a big one.

  • Anj Fabian

    Observation 1:

    I’m now noticing that there are more home birth stories that include neonatal resuscitation. The narrative used for this is the standard “Midwife as hero.” and “Everyone lived happily ever after.”. It goes something like this:

    “The baby was born not breathing. My midwife swung into action, skillfully performed CPR and everything was fine. We are so thankful to have such an amazing midwife attend our birth.”

    There’s no mention of transferring the baby to the hospital where the precious squish was pronounced “perfectly healthy” by a pediatrician and sent home. That’s supposed to happen to make sure that slow start wasn’t caused by something serious.

    • Guest

      I am curious what the long term effects will be. To me it seems awesomely ludicrous that people worried about potential damage from vaccines have no concerns about the effects of oxygen deprivation at birth. I will be curious to see whether a study ever comes up looking at possible negative consequences of all those blue babies we keep seeing in home birth pictures.

      • Certified Hamster Midwife

        Vaccines aren’t natural. Entering the world being squeezed through a vagina is.

        People seem to believe that the placenta keeps the baby oxygenated until it draws its first breath.

        • Anj Fabian

          If that was true, HIE wouldn’t exist.

          • Young CC Prof

            If that was true, my son would probably have been a seven or eight pound kid rather than a five-pound kid. I don’t trust placentas…

      • OBPI Mama

        It is interesting what things can coorelate with traumatic birth. My son never drank much of his bottle (4 ounces at the most per feeding… till he was weaned at a year). Then when my son wasn’t eating chunked food at 17 months old, wasn’t walking, and was purposefully burning himself on our heaters and stoves… AND when I told the pediatrician we started seeing at the time about his birth (we had previously seen a pro-homebirth “family doctor” who was horrid)… she immediately sent him to get a CT Scan because she feared CP. Turns out he had Sensory Processing Disorder. The books I’ve read said a possible cause was traumatic birth… The only thing under causes that was the most likely…

    • OBPI Mama

      Oh, the midwives think once the baby is breathing and the heartbeat is strong again, then you can call off the ambulance. All is well. Our midwife told us to call off ours once she got our son going again (even though he was being given oxygen at that time still) and since we believed she was competent, we called them off. Once I came to my senses, I realized she should have made me and baby boy both go… especially as he had large hematomas and bruises all over his head… Vitamin K to prevent brain bleed after traumatic birth? Oh no, that causes leukemia! Arnica salve… healing. I am so lucky to still have him.

      • Medwife

        Oh my. You weren’t transferred after all that? I missed that part when I read your story :(

        • OBPI Mama

          No. I had to go to a doctor the next day to get stitched up (she let me go 24 hours with an almost 4th degree tear). I remember thinking, “That doesn’t sound safe.” and not wanting to do the “herbal bath”, but I was so out of it and just wanted to rest so I went with it all. Got stitched up the next day by a homebirth-friendly family doctor and then started getting my son seen by specialists 1 week later.

          • Medwife

            And a family practice doc stitched you up the next day???? Of for the love of…. Your “caregivers” should be ashamed of themselves.

          • OBPI Mama

            Yes, I think so too. I had pain during intimacy with my husband for almost 3 years after that and I wonder if it’s because of the repair work the family doctor did… we finally switched from him when he started telling me to water down my 2nd son’s formula because he was “too fat” as a baby. I had just read in the news about a baby almost dying from that exact same suggestion and knew it was high time to get out of his care.

    • Elaine

      I’m sure midwives are experts in normal babies.

    • Young CC Prof

      In reading through the MANA study, I noted that only about half of the
      low-APGAR (<7) babies were transferred to the hospital either before or after birth. That was actually one of the most disturbing things in a document filled with WTF.

      Since when is your child being blue something you shrug off?