An insider’s chilling view of homebirth midwifery

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A guest post from a registered nurse (RN):

I used to be an assistant to a lay midwife who delivered babies in her own home. I was so ignorant, and I didn’t KNOW I was ignorant! The midwife didn’t recognize her ignorance either.

I really had no idea of the difference in education between CNM, CPM, and DEM. This particular midwife is completely self-taught, a “granny” midwife with no medical background. When I was assisting her, she delivered approx. 200 babies a year. She did not have OB back-up, but she did have a certain amount of respect from the local doctors and hospital, who accepted her transfers without hassle. That respect was probably because she at least didn’t try to do vaginal births at all cost and she did not wait too long to transfer. Also some respect simply because of her persona. She makes you feel like she is in charge, and just knows things. I’ve heard local medical personnel make remarks like “K really has a knack and intuition for midwifery, doesn’t she?” This persona is what makes the mothers feel safe with her. At first I thought she “knew” everything too. But as I worked with her, I began realizing that it wasn’t true. I tried to change how some things were done, but the lay midwife became upset. No one was allowed to threaten her little kingdom! So I left.

I became a registered nurse, and got a job working in a Labor and Delivery unit. Then I began to understand how little I really knew, and how deficient and downright dangerous the lay midwives are! As has been pointed out on your blog so often, when you are ignorant you don’t KNOW you are ignorant!

I used to believe what the midwife said, that the apprenticeship model is just as valid as formal education. She used to say “I would much rather have an experienced midwife (DEM) attend me than a CNM just out of school.” I, of course, thought that made complete sense. But that is complete BS, because you have no idea how the DEM practices or how accountable she is. The new CNM has real medical professionals looking over her shoulder until she has the necessary experience to practice safely.

This is why there should be uniform standards of education and practice for ALL midwives. The following paragraphs are very specific examples of direct entry midwifery practices as I experienced them.

She accepts anyone who wants to VBAC, regardless of the client’s history. I never heard her asking anyone what type of uterine incision she had. It wasn’t until I became an RN that I learned a woman should never TOLAC after a classical incision, I doubt she even knows that. Now I’m amazed that we never had a rupture that I know of (during the time I assisted her at least).

There’s no understanding of hemodynamics, and what acute blood loss can do to the body. What are signs of too much blood loss? Um, we didn’t know. We took one blood pressure after delivery and that was it. No pulse, no O2 sat. I didn’t know what a dangerously low blood pressure was until I was in nursing school. I knew how to take vital signs, but I had no idea how to interpret them. I didn’t know what they would look like when a woman was hemorrhaging. I don’t think the midwife knew either because she never took vital signs. So when did we transfer for hemorrhage? When the woman was lying in a pool of blood and passing out. Estimated blood loss? No idea. We estimated it in terms of a little, medium, a lot. No idea how many mLs. This is why it is easy for me to believe that the midwives in Australia didn’t recognize the signs of acute blood loss in Caroline Lovell’s case. Lay midwives are not trained professionals, they don’t know!!!

She didn’t know how to do perineal repairs. She always told the women to “keep their legs together for several weeks” and the lacerations would heal just fine. Once or twice I saw her put several random stitches in the perineum, but never any vaginal repair. She had no idea how to do it; therefore it would heal “just fine”. Not enough education!!

Prenatal visits consisted of a blood pressure check, FHT with doppler, manual palpation of fundal height and estimation (no actual measurement), and external position check. No weight check. Cervical exams were done close to term. A primip was sent to her PCP for a blood type to check RH. No other blood work was ever done, unless a mom specifically asked for it. Most moms were routinely given oral iron to cover any potential anemia, and they all got calcium and a prenatal vitamin. There were no urine checks for protein, no GBS testing, and no testing for gestational diabetes. No ultrasounds, unless the midwife had a question about position or the woman had a prior infant with an anomaly. Of course she had mostly low-risk women. They were “low-risk” because she didn’t check for any conditions that might make them high-risk, or really even know what conditions are high-risk. Not enough education!

So we didn’t have any gestational diabetics (because we didn’t test for it), of course we didn’t have to follow any newborn glucoses either. But of course, we had no idea that newborns might have a problem with their glucose because we had never learned about that!

She did no newborn exams, no newborn vital signs. She never laid a stethoscope on the newborns at all, nor checked their temperatures. And even if she had, she didn’t know normal parameters for newborn respiratory rates. Most babies got apgars of 9/10, some even 10/10. No babies got any eye prophylaxis or Vit K. There was no breastfeeding support offered.

There was no continuous fetal monitoring during labor, only doppler checks every once in a while. She did no charting at all, so there were no scheduled time intervals by which checks must be done, just when she happened to think about it. I had no idea about decels or fetal distress. I thought if you put a Doppler on the belly and the FHT are below 120, the baby is in distress. I didn’t know there was such a thing as late decels or what they meant. In second stage the baby was monitored once or twice. When we had a baby with low apgars, it was always “with no warning”, and “the baby was fine all through labor”.

She was not NRP certified nor was she even CPR certified. She carries oxygen and an infant bag with mask, and attempts resuscitation if needed. It impresses the parents, but isn’t much good actually. Now I have a NICU resuscitation team 30 seconds away from each delivery and I realize how inadequate our efforts were. Not enough training and education! Her assistants now are not required to have even CPR training and have no idea how newborn resuscitation is done.

She attempted external versions for breech and transverse lie. She delivered breech and twins. She had no idea of whether twins are di/di or not, nor any idea of the significance of that.

She used “black market” Pitocin for postpartum hemorrhages. But she didn’t stick to postpartum use. She gave it to augment stalled labor. How could she do that, without IV access? Simple, she gave it subcutaneously, in small amounts. And it worked. Now I’m appalled, aghast, at how recklessly dangerous that is without CEFM. I had no idea! Not enough education!!! There are many other OOH midwives doing the same thing.

She never used sterile gloves, or set up a sterile field for deliveries. Sterilization of instruments consisted of wiping them off with alcohol.

This midwife’s clientele is almost exclusively Amish. She practices near one of the largest Amish communities in the US in a state where lay midwives operate in a “gray area” legally. She likes it that way because the Amish women don’t question her, trust her implicitly, and will not pursue litigation or repercussions of any kind. They call her for any kind of medical questions they have, even outside of women’s health, and she freely dispenses medical advice over the phone without seeing the patient in question. Sometimes her advice even contradicts a doctor’s advice. . .guess whose opinion carries the most weight?

The only way to make homebirths safer is abolish the CPM and DEM, and require all midwives to be CNMs. I do think the Amish should be able to have an OOH birth option, as this is more compatible with their lifestyle. They are not doing homebirths to be crunchy or because they believe in vaginal births at all costs. They have never even heard of the “Business of being Born”. But they do deserve better care than they are getting. Every woman deserves professional medical care!!

  • Jessa

    I find this article frustrating. This person you’re talking against is a lay midwife or a granny midwife and yet you’re lumping her into a group of dangerous “midwives” along with CPMs. This woman was not a CPM and CPMs are competent midwives who are conscious of all the points you made. I’m in a 3 year midwifery program learning how to be a CPM. When I graduate, I will have attended at least 55 births and I will have all the skills you listed.
    It’s fine if you want to talk poorly about lay midwives and it’s fine if you want to talk poorly about CPMs but don’t lump them together, they are certainly not the same midwife.

    • Amy Tuteur, MD

      CPMs don’t meet the international standards for midwives used by ALL other industrialized countries. They are grossly undereducated and undertrained and would not be allowed to practice in the UK, the Netherlands, Australia or anywhere else. They are not real midwives; they are hobbyists who couldn’t be bothered (or couldn’t hack) getting real midwifery training. Too bad you are unaware of this basic information.

      • The Bofa on the Sofa

        Yeah, we could make a joke, although it wouldn’t be funny:

        Why do CPMs do service in 3rd world countries?
        Because they aren’t qualified to practice any where else.

    • Sarah

      CPMs aren’t competent midwives. If you want to be a midwife, that’s a brilliant thing to learn to do. Why not train to be a CNM?

    • Amazed

      55 births? Do you realize you just made up our point for us? Just how many deviations from normal do you expect you’re going to see for 55 births so you can recognize them when you encounter them in your practice? Do you know the rate of shoulder dystocia? The rate of uterine rupture? Dead breech babies? Do you?

      It isn’t too late for you. You aren’t a CPM yet . You don’t have 10 or more years of your life invested in the scam you think of as your “education”. I know you don’t want to hear it but facts are facts. CPMs are dangerous, no matter that they think themselves qualified. They can’t be anything else. 55 births is NOTHING.

      Please reconsider before you waste years of your life and kill or maim someone.

    • Who?

      Think about the years of training CNMs do, then think about what you are doing. How on earth can someone on your path know as much as someone on a CNM path?

      And more importantly, why are the women who see a CPM deserving of lower quality care than other women? Why would you want to be the person delivering that care?

      A CPM Is little more qualified than a granny midwife, or a taxi driver who has to deliver a baby on the way to the hospital.

      Don’t waste your time and money on a junk qualification.

    • Daleth

      I’m in a 3 year midwifery program learning how to be a CPM. When I
      graduate, I will have attended at least 55 births and I will have all
      the skills you listed.

      I’m really sorry, please don’t take this personally, but I laughed out loud when you said that when your 3-year program is complete, you “will have attended at least 55 births” and “will have all the skills.” Omg wow 55 whole entire births!

      You do realize, don’t you, that nurse-midwifery students (i.e. nurses training to be CNMs) and OB-gyn residents attend massively more births than that, right? And that statistically, 55 births is not even close to enough to experience all the relatively common complications even once, much less the multiple times you need in order to become competent in dealing with those complications?

      Also, about the skills mentioned in the post: no, you will not know how to read CEFM strips. You will not know how to use pitocin, because at least in most states that’s not something CPMs are legally allowed to do. You will not even remotely have the “skills” to help someone safely VBAC, because the only thing that makes a home VBAC or birthing-center VBAC safe is blind luck–no amount of midwifery skills can prevent a uterine rupture or prevent the death of one or both patients if it happens.

      If you want to be a competent midwife, if you really want to help women and babies, then attend a CNM program. It’s not too late at all. If you’re not already a nurse it will take more time than completing the CPM program, but it will be a REAL qualification (see below) that gives you real skills to help women and babies, and it will also give you far, FAR more options as far as where to work–you’ll be qualified to practice in any US state and, with minor paperwork hurdles to overcome, all foreign countries–and far better salary prospects.

      You are being scammed for tuition money by your CPM program. Just to show you how deficient a CPM qualification is, why don’t you look into how many states and how many countries internationally (developed countries I mean, not like war-torn third-world countries) allow CPMs to practice as midwives. Hint: only about half of US states, and precisely ZERO other countries.

    • rosewater1

      I can understand why you don’t like being lumped in with such a midwife. You do sound like you care and that you want to do things right for moms and babies.

      Ever hear the phrase about the road to hell and good intentions?

      Birth is dangerous. Period. Yes, most times it DOES go well and everyone is happy. But when it doesn’t? You’ll be sitting in someone’s living room and not be able to do a damned thing to help the mom and/or baby.

      No, not all CPMs are bad. But when you look @ the course of study for a CPM and a CNM, the difference is clear.

      Go to the Hurt By Homebirth site. Ask yourself if you could live with an outcome like some of the midwives on there had. If you can’t, then don’t finish your CPM training.

      Yes, babies-and moms-die in hospitals too. In hospitals there are so many more options and tools to help them.n

      I really hope you make the right decision. Good luck to you.

    • Namaste

      You do realize that most obgyns and cnms see fifty five births in a month, right? Hell, I am in the last semester of a Masters of Social Work program. I’d logged in 55 hours of therapy by the end of my first semester. Runch the numbers, and I’ve probably logged in 300 hours of therapy by now. And I am still nowhere close to being anything other than a wet-behind-the-ears inexperienced novice.

      • Heidi

        I had to successfully draw blood 100 times before I could do blood draws on my own.

  • JJ

    hmmm, what are the outcomes of this midwife’s practice? How do they compare to general medical practice outcomes? Is there any documented statistics somewhere to see? Thanks!

  • content generating machine.

    Holy c**p. This is disgusting. I live in a heavily populated area of Amish folks.
    Now I’m wondering who delivers their babies. This is terrible. My god, I know people who deliver *calves better then this woman does babies.
    Heck, I could do a better job! At least I understand aseptic technique,

  • Danielle

    Quick question about possible midwife ignorance. My sister went to her midwife for a checkup at 32 weeks. She describes her appointments as non invasive and casual. Midwife told her everything was great and the baby was in the head down position, which was a huge relief because her last pregnancy was transverse lie until 39 weeks when they successfully turned and induced in the hospital.
    This surprised me because just looking at the exterior, she looks abnormally wide, like last time. We went to her ultrasound appointment that afternoon, sure enough, still transverse lie.
    Is this something that should be easy to spot at this stage? I hate to say it, but I suspect the midwife is trying to keep my sister in her care. If the baby remains transverse, she would have to deliver in a hospital and/or c section and this midwife practices exclusively in her birthing center. I suppose ignorance is preferable? Could this be an honest mistake?

    • Karen in SC

      Replying to bump this to the Latest Posts listing. I think your suspicions are correct. Many times it seems that midwives aren’t that skilled at telling position. Is it the policy of that midwife to get an OB sign-off at 35 weeks? (a birth center I know has that policy)

  • pipsersmom

    Here’s my story, Skeptical OB. For some reason it isn’t showing up correctly on my blog! Right after the c-section surgery and tubal ligation I was sent to a recovery room. There, my blood pressure dropped to 70/35, but the anesthesiologist gave me some medication through my IV to get it back up again. Half an hour later it dropped again and the same medication was given. I was told that an epidural can cause your blood pressure to drop, so we weren’t all that concerned about it, though I was monitored closely. During my recovery time I felt a sharp, stabbing pain in my right side, above where the c-section scar was. Whenever they touched on my uterus and got to that spot I would try to push whoever was doing the pushing away. They told me that was normal as I had just been through surgery, that there was alot of soreness there. Two months leading up to the birth, I was *aways* pressing on that spot, trying to counteract the pressure of the baby and thinking it was just round ligament pain that would go away. It would for awhile, but then it would always come back. The night before she was born, Monday night, I couln’t sleep, because that spot hurt so badly. It was stabbing through me like a knife. Anyway, they brought me back to my room and I spent the better part of the day holding onto that spot and asking the nurse to please not press so hard on it. I told her I needed more pain medication; that what she was giving me wasn’t enough, and I distinctly remember her saying, “No, the pain medication you’re being given should cover it.” Being the pleaser that I am, I just assumed that this was normal c-section pain and I’d forgotten about it. I really wasn’t paying much attention to the baby and hadn’t even checked her over. I’d cried like I was a baby myself when she came out, unable to believe she was so perfect. She had the cord around her neck, but it was quickly unwrapped and her apgars were 8,9,9. I had been so relieved, and I need to recount her birth story, too. Anyway, the next several hours were a blur. I was sweating so profusely that Scott had to literally sit by my face and wipe it down every 5 minutes or so. It was literally dripping off of my face. The nurse would come in to “palpate the uterus”, and I shoved her hands away when she would get to that spot. She didn’t seem to understand that that spot really hurt. I think I have a very high pain tolerance, because after both Lucy and Asher’s c-sections I walked out of the hospital the next day without any by-mouth pain medication. In this situation, I don’t think a high pain tolerance served me very well. Where someone else may have passed out from the pain, I was just highly uncomfortable but still able to think rationally that it may just be my c-section incision. My mother in law came to visit around 4, and at that time I felt like a bigger knife was stabbing me. She was on the phone with someone and I yelled at her that I needed the nurse, now. She went yelling into the hall that I needed a nurse, and the nurse I had came slowly walking down the hall and told me again that the pain medicine she had me on was the only medicine she could give me. At 6 pm that night, my father in law came to visit. As he entered the room I was bracing myself against the bed, trying to counteract or distract myself from the pain in my abdomen. I greeted him by saying I wasn’t a very good hostess and please take the baby. He took her, and then Scott came in. Scott told me my leg was falling off of the bed, and as he tried to put it back on the pain in my side got more intense and I screamed at him, “NO!” I still had my eyes closed. He said to his Dad, “Dad, did she look this white when you came into the room?” I don’t think his dad had really noticed one way or the other, but later Scott told me I had looked like a moving corpse. You couldn’t differentiate where my lips ended and the rest of my skin began. I heard Scott say, “This isn’t right, I’m getting help.” I was amazingly lucid this entire time. When he came back in with the nurse, she looked at me and said, “Oh, my!” and then ran over to do my vitals. My heart rate was 132 and my blood pressure was 60/30. She picked up the phone. Scott told her the phone didn’t work, but she fumbled with it anyway. The message finally got to her and she ran from the room, saying, “I’m going to get some people.” Before she left, I watched her pull the “Code Blue” switch. I think it was 1 minute and the room was suddenly filled with people. Doctors, nurses, anesthesiologists, they just kept pouring in. At one point the count was 17 people in our little room. The bed next to me was moved out of the room as everyone set up shop. Phoebe had been forgotten. I watched her in her little bassinett, sleeping peacefully away. The anesthesiologist took up residence at the head of my bed. He was literally pulling vials out of his pocket as soon as he came into the room. Scott was watching him the whole time and he said he would sort of sort them through his hand, choose one, and dump it into my IV. He’d look at my vitals for a minute, frown, and then try something else. My bed was elevated at the feet so all of the intact blood in my body could keep my vital functions going. I wanted to panic but I don’t think I had the energy. I looked at Scott, standing at the foot of the bed, hands in his back pockets, looking like he was ready to vomit. I couldn’t look at him again. There were about 7 nurses surrounding me at this point, asking me where I hurt. “I HURT RIGHT HEEEEEEEEERE!” I said, pointing to the spot that felt like it was being knifed. My nurse went in for the kill, determined to show her aptitude at torturing patients, I guess, poise and ready to press on the spot. “I think she may be bleeding,” another nurse said. “I wonder where?” I shoved Nurse Rached’s hand away and said, “I’m bleeding right here! IT’S RIGHT HERE!’ They kept pontificating, at which point the anesthesiologist said, “She’s bleeding. She’s bleeding. She’s bleeding.” At this point he was actually pushing the bed toward the door with his knees. Everyone was waiting for my doctor to get there and make the call for me to go to the OR. What seemed like 45 minutes was probably about 6. Her partner arrived, and nurses were trying to talk to me and keep me distracted. They had pasted-on smiles and none of them told me I would be OK. I knew they didn’t know that, and they were probably assuming I wouldn’t be. All this time I kept returning my focus to an outfit Phoebe’s Grammy had given her, size 3 months. I imagined Scott dressing her for church all alone in that outfit, in me never getting to see her wear it. Then, I started praying that I would be able to see her in that outfit, to go home to my kids, to live life with Scott. I started tuning everything else out and just kept praying. My doctor’s partner came in and the anesthesiologist gave her the rundown. One nurse said, “We need to do a sonogram to see if she’s bleeding, and where.” The sonogram technician came in, very leisurely-like, and said, “Well, this machine will take about 5 minutes to warm up.” The OB just looked at him and then at the anesthesiologist, who shook his head. She said, “She doesn’t have 5 minutes.” At this point I said, “I don’t want a sonogram. I want to go to the OR.” I have never seen a medical team move more quickly once a decision has been made. There was already a male nurse behind my bed who was ready for the call to be made. He had braced himself so as to be able to push me towards the door, and there were about 10 people trying to get me out of the room. When we came back to the room later, you could see where my bed had actually damaged the wall and the door as they tried to ram me out of there. At first everyone was walking, and then the nurse at the head of the bed said, “She’s crashing!” Then everyone started to run, as in, sprint. I vaguely remember thinking that I thought this kind of thing only happened in episodes of ER. Scott and I always thought that was so cheezy. Guess it really does happen. We got to the prep room and by that time Scott had completely lost it. He was sobbing. His tears were hitting my cheeks and he said, “You can’t leave me. You’re my best friend. I love you. We haven’t had enough time together yet.” I was surprised the critical care team was letting him be there until it hit me that they figured this was the last time he’d see me alive, and so did he. At this point the anesthesiologist was whispering things in my ear, I’m not sure what. I asked him if he knew what my blood type was, and he started chuckling and said, “Yes, sweetheart, I know your blood type.” I turned my attention back to my Scott. “You have to pray,” I said. “What do I pray?” he said. “Pray this,” I said. “Dear God, please don’t let Rachel die. Let her live. Dear God, please don’t let Rachel die. Let her live. Dear God, please don’t let Rachel die. Let her live.” Dude, I’m so eloquent. My doctor arrived and told me it was probably a bleed in my uterus, and she may have to give me a hysterectomy. “Take it! Take it all! Throw it in the trash!” haha, that was my response. She smiled and said, “OK.” At that same point, I recall thinking that I would either wake up in a recovery room or looking at the face of God, and that neither place would be so bad. I heard one nurse say to another, “How is she still talking?”, and I looked over to the corner of the room where my parents and Scott’s dad all looked like they themselves were going to pass out. My mom stood on her tiptoes and waved to me and said, “Lots of people are praying for you!” My mind flashed back the past 32 years and all the times my parents had been there for me, all the things they’d done for me, all the times they’d sacrificed for me, and now they were watching me about to die. Then I heard, “She’s coding,” and lots of alarms going off, and everything went black. – See more at: http://pipsylou.blogspot.com/2011/07/part-1.html#sthash.00PKG7H4.dpuf

  • pipsersmom

    Wow. I’ve been told I wouldn’t have lost my uterus with my last pregnancy had I had a VBAC homebirth. Never mind I had a c-section with my first because her twin died midway through tthe pregnancy and she would not have survived a vaginal birth due to all of her birth defects. I had a repeat c-section with my next child two years later. After this, I was so intent on having a VBAC I went through two OB’s who said they wouldn’t do it.

    I lost a baby at 9 weeks pregnancy, then had an ectopic that took my right tube and nearly my life. Were it not for the quick-thinking skill of my doctor, I wouldn’t be alive today. After that, I became pregnant with identical twins, miscarrying at 8 weeks.

    I was then tested for blood issues; came back positive for MTHFR and Factor V Leiden. I have several great aunts who lost many babies to stillbirth, and I believe the genetic predisposition for MTHFR and FVL had something to do with it. I was advised to take extra folic acid and a baby aspirin a day. I had a c-section at 39 weeks.

    I lost my uterus.

    I still blame myself.

    Here’s my story: http://pipsylou.blogspot.com/2011/07/part-1.html

    It’s interesting that women think they should be able to have as many babies as they want, with no complications, just because it’s 2014. People wanted us to sue the hospital.

    Stuff happens. It’s no one’s fault. It just happens. Right?

    RIGHT?

    Anyway, thanks for assuaging some of my guilt. I live in this fantasy world where, had I had a VBA2C, I wouldn’t have lost my uterus.

    • Young CC Prof

      I am sorry you’ve been through so much, and I’m glad you and your youngest survived.

      Yes, it’s true, even in 2014 with the best hospital care, birth can go badly. We can make it safer, but there are no guarantees.

    • KarenJJ

      Definitely stuff can just happen and it’s not anybody’s fault. My immune system is wonky. It has made me lose a significant part of my hearing, started to take my eyesight (thankfully on top of that now) given me an early start on arthritis and it looks like it is now starting to mess with my kidneys – it had also made me infertile.

      When i was finally diagnosed I had genetic testing and a mutation was found that caused all my issues. It first randomly occurred in one of my parents. Nothing could have been done to prevent it or cause it. That hasn’t stopped people saying things like – maybe your grandmother ate too much yeast while pregnant.. People try to look for reasons as to why things like that won’t happen to them. Bad stuff can happen to good people and as much as someone tries to say otherwise it’s usually because they are trying to sell something….

  • Ducky7

    this is a great post, thank you!

  • Tired

    I could name a few registered midwives around here where I am (Canada) who would regard this woman as their hero practitioner…

  • Tao

    Dr. Amy, I would love to reblog these directly to my wordpress page. Is there a reason why this option is disabled? Another great post, as usual!

    • Certified Hamster Midwife

      I believe that isn’t an option for blogs based on WordPress.org and self-hosted.

  • Jenny_from_da_Bloc

    It is amazing that in this day and age of education and technology that a pregnant woman would allow herself to be treated with such sub-standard care and put herself in such a dangerous situation. I mean seriously, keep you legs closed is the proper treatment for vaginal tears? I’m sure keeping your legs closed will help when your uterus is falling out too!

    • I have a firm conviction that part of the attraction that virginity has for a lot of men is not only because the man can be a little more sure that his wife isn’t passing off another man’s child as his, but because, after several births, with unrepaired tears, a nice, tight virgin must seem entrancing…

      • Medwife

        That’s an… interesting observation. :-/

      • Trixie

        Uh…WTF?

      • lola

        Actually, odd as it seems,I could see that. The idea of women being, uh, less so after childbirth would be perpetuated in a culture where access to postpartum repairs and suturing are available.

  • staceyjw

    You have to be purposely, willfully, proudly, ignorant to not have any of that information in this day and age. You would also have to lack even the most basic amount of curiosity, and interest, in the human body and the process of labor to never bother to learn this stuff. Then there is caring for the actual outcome, but as always, that comes in last place, and is often an irritant to the failure MW. Whether they are so wedded to their cultic beliefs of NCB, or they are simply lazy and compliant, the results are the same- deadly.

    No one should have care this poor, even if they want it, it should not be easily available. Honestly, care this wholly ignorant and lacking, shouldn’t even exist in a nation where the information exists for the taking. Being truly skilled and educated takes time, but an average, interested, person would learn more than that woman did, just by reading widely, and asking lots of questions. How scary that someone with my level of knowledge, gained from this blog and cursory reading of evidence based publications, knows a thousand times more than this “granny” MW.
    Even I know better than she, and I have never had one class on it.

    Let me give a guess to who this is- I am guessing it is the multiple murdering “MW” Brenda Scarpino-Newport, from Ohio. While I am sure she is not the only deadly, ignorant fool, that exploits the Amish and other plain women, this just sounds like her. If not, I will still bet this is in Ohio, around Holmes county. My bio family lives there, so I am familiar with the area, and I know MWs are in a legal grey zone in Ohio (grey, just like the babies they deliver).

    There is no religious excuse for this kind of MW to be allowed to operate, especially with impunity. In OR we also have a loop hole for these “traditional” birth attendants, as if the world would be worse off if we actually did the right thing and banned the ignorant fools from delivering babies, like we should. Sometimes tolerance and cultural sensitivity goes way too far, and we end up hurting those that we claim to want to protect.

    There is no reason at all you cannot have a real CNM doing these deliveries. I think it is the worst of the worst, skill-wise and of the cynical, that focus on these groups of religious women.

    • Amazed

      Stacey, I suppose that some of these “granny midwives” are not in step with the wealth of information coming to us for the last 10 years or so. If one is of advanced age, getting used to doing something as simple (to us) as a Google search of veritable information might not be this easy. After a certain age, adopting new ways does become harder.

      This sad, it is NO excuse for poor performance. I remember a professor of mine around 200o. She was a very knowledgeable old lady, close to retirement and quite baffled by this wonderful new way of using internet in our life and work. Simply put, she was not adaptable. But she recognized that the world changed and she tried. She thought that for as long as she walked the university halls, her students deserved the best she could offer. So she swallowed her pride and ask for help. I cannot imagine she enjoyed asking her students to help and educate her about something as trivial as computers and internet. But she did it. And that was a humanities specialty, not holding lives in her hands!

      Why the hell can’t granny midwives do the same? I suppose the granny midwife that taught Christy Collins, babykiller, was the one who taught her how to use a dopler? So Christy is a provider of granny type, despite not being physically limited in the way real grannies are, and she loves it.

      Sinister.

      • Haelmoon

        I remember teaching one of my senior consultants how to use email. Humbling for both of us. I thought he knew everything, but he had to learn to adapt too.

        • Amazed

          Email was a vicious enemy to my professor as well. I simply couldn’t get it what was so hard about remembering the right sequence of actions. But my appreciation of her grew considerably as she kept fighting this battle.

          The bottom line – she fought it. She didn’t bury her head in the sand and keep doing things the good ole way.

    • Anna T

      I’m wondering about the actual maternal and neonatal outcomes among Amish women. Has anyone ever done a study about this?

      • Trixie

        It’s going to vary from community to community depending on the type of medical care they get. Amish are prone to some genetic disorders that are much less common in the general population, and that might have an effect also.

        • Anna T

          Oh yes, I remember I’ve read that they suffer from some specific genetic disorders because they marry among themselves. I think their church leaders should do the responsible thing and promote pre-marital genetic testing, it could save so much grief and suffering. It’s now routinely done in certain Orthodox Jewish circles where people have a chance of being related to some degree. I would have done it if my husband and I had been ethnically close.

          • Trixie

            They do, in some instances…you might be interested in the work of Dr. Holmes Morton and the Clinic for Special Children.

          • Haelmoon

            Anna, it is well known in the Amish communities that they are at increased genetic risk. Each of the Amish communities are distinct genetic pools due to inbreeding and founder effects. They are actually encouraging their children to marry outside of their communities, albeit into other Amish (sometimes Mennonite) communities to distribute the genes. In Ontario, there is a specific newborn screening program just for the Amish. They are not interested in testing before marriage, because most of the genetic concerns are autosomal recessive, that means only a 25% chance of their child being affect (I think it is high, but they are willing to accept that risk). They are very aggressive (in a good way) about getting their children the medical care they need (at least the populations in Ontario). I have worked in several hospital that have a horse hitch in the parking lots because enough of them come to hospital for appointments, and tests and so forth. I am disheartened when I hear stories about these lay midwives preying on the Amish because they are a simple, but loving people. They don’t deserve it.

          • Medwife

            Similar to Orthodox Jews in the US. I have been told that there are sophisticated databases being used in the courting process to avoid diseases like Tay Sachs.

        • sdsures

          IIRC, they also tend not to vaccinate.

          • Trixie

            That’s actually another myth. It varies a bit from community to community, but there’s nothing about being Amish that precludes vaccination. When Amish don’t vaccinate, they do it for the same reasons secular people don’t — fear of side effects and poor science comprehension.

          • sdsures

            Oh, OK.

      • Young CC Prof

        And of course they tend to marry fairly young and have many children, so that’s also a variable.

    • Anj Fabian

      I don’t think it is Brenda.

      That said, I would not be surprised if this granny midwife is only one of many midwives who have decided that their “style” of midwifery is not only effective, but superior to “cookie cutter care” they think hospitals deliver.

    • Medwife

      There are plenty of midwives who go through the motions of monitoring a pregnancy but have the exact same outcomes. Collecting the data and not following through on management happens all the time.

      (By midwives I mean CPMs and also CNMs who have crossed the border into malpractice land.)

    • AgentOrange5

      Well, many of the midwives serving the Amish are either Amish or Mennonite….meaning its pretty unlikely they are using the internet. Hence, they really are totally ignorant of their ignorance.
      As you said, there is no reason why a CNM can’t do home births (while many don’t even want to go there, there are some who already do.) A CNM is the minimal standard for hospitals, so why should it be the minimal standard everywhere?
      Otherwise, I think women are better off birthing unattended then with an incompetent midwife (given the stories of the midwives giving false assurance & encouraging women not to transfer out….at least a women laboring unattended may be more likely to call 911 at the first sign of trouble instead of being talked out of that idea by her “midwife.”

  • areawomanpdx

    “Once or twice I saw her put several random stitches in the perineum, but never any vaginal repair.” ACK. That made me cross my legs involuntarily. But the whole list is horrific.

    • sdsures

      I’m clenching just thinking about it.

  • Sue

    Thank you for this article – it eloquently sums up almost everything we discuss here. Nothing beats mature insight!

  • Haelmoon

    Quick rant, even in Canada we have some woo-infestation. I had a patient tell me that her midwife thought it would be ok to have a homebirth of a baby known to have trisomy 21. That is of course as long as the echo was normal. What the heck, like that is the only concern for this little one. The patient also asked if I could recommend which paeds physician would be most supportive of not vaccinating, when she takes the baby in at 6 weeks. I asked her why is she waiting six weeks to have the baby seen by paeds, and she replied because the midwife would care for the baby for the first six weeks. Because a baby with trisomy 21 would be a normal healthy newborn. She is refusing to come back and see me becuase I wanted to “medicalize” her pregnancy. She came for the echo at 22 weeks, and I doubt we will see her again, if she even comes to hospital for delivery. The sad part is, her midwife probably actually supports her. UGH!!
    Sorry for the rant. But stupidity is not just limited to lay midwives. No everyone is willing to acknowledge limitations to care they can provide.

    • Mishimoo

      Argh! I’m not a medical professional, but even I can see how dangerous that is! I hope bub comes out okay and gets the medical care that they need.

    • Young CC Prof

      Oh, dear. Not good at all.

    • Beth S

      Wow that’s kind of scary. I named my daughter after a cousin’s daughter who had passed away with Trisomy 13 (the last facebook post my father made before he passed was asking for prayers for this little girl and it stuck with me.) I just don’t understand why people think medicalizing pregnancy is a bad thing, especially with certain disorders like this.

      • Lost

        Re. Medicalising pregnancy – tv and movies ‘normalises’ non-medical pregnancies, i.e. exciting viewing. I do not know of a show which thoroughly depicts a true normal pregnancy, i.e. humdrum fundal heights, glucose tests, radiologist at nucal scans & looking for heartbeats, etc.

        My first pregnancy was exciting. My second (I regret to admit) interfered with my ‘normal’ life, even though I was super-pleased to be gravid.

    • Sue

      Can she be offered information to read about airway issues, congenital heart disease, prematurity and such? I don’t know any refs – maybe the T21 support organisations?

    • theadequatemother

      Agree – woo is alive and kicking in Canadian midwifery. I wish our midwifery education included more exposure to other areas of medicine. I want midwives in training to see what sick people and sick babies look like. I want them to see heart failure and resp failure etc I sort of think the CNM system might be better – more exposure to pathology.

      • Haelmoon

        I think the problem in the midwifery training is the over emphasis on patient autonomy. I don’t think it is a bad thing, but I don’t think the students are understanding it the proper way. Respecting patient autonomy does mean you support the patient making stupid decisions. It means you provide them information (the best that is available) and support their decisions. The big difference I see it that is I have a patient making a stupid choice, I will tell them I think it is a stupid choice (in a very nice way of course) and try to find out why they are making that decision and try to guide them to a safer choice. Some of my midwifery colleagues will just say ok, its the patient’s choice so I will respect that. It is not about letting people make choices, but help them good decisions.

        My favourite example of this is active management of thei thrid stage of labour. I recommend it, the midwives offer it. Subtle difference, but significant. Often it is presented as an equal options as physiological management of the third stage. I don’t think that is right. I think women should be told that there is good evidence that the best way is to actively manage the third stage. If they ask about physiological management, the discussion should be about why it is an inferior option. So midwives are so afraid of not respecting patient autonomy, they are afraid to advise patients.

        • Anj Fabian

          For a home birth, I would tell women that active management lowers the chance of PPH and being transferred to the hospital.

          That would be because I would insist any woman with a significant PPH transfer for evaluation at a minimum. If all a midwife does for PPH is advise bed rest if the woman isn’t “feeling well” then she has little reason to promote active management.

        • Tired

          As someone who went through midwifery schooling in Canada while being an MD trained somewhere else, I have come across the concept of patient autonomy as being fairly rigid regardless of who the practitioner is. As Dr. Daugherty (my USMLE crush) put it, you work as an intellectual waiter of sorts – here are your choices, what would you like today? Choices, of course, are meant to be presented in an unbiased manner and contain accurate info, and that’s where we run into problems.

          • Haelmoon

            But even more than offering “choices”, we are highly trained specialists. We can offer our advice without being directive. Sometimes there is a clearly better choice, and we should be able to say that. Just because there are alternative practices, it does not mean I am obligated to offer or mention them (if they are not evidence based or harmful). Using the same example, when I describe a delivery I flat out say that the standard of care is active management of the third stage as it is proven to reduce bleeding and reduce the risk of a postpartum hemorrhage. I do not offer or explain the alternative is to do nothing, because that is not the standard of care. I came across something not long ago that drove home the philosophical differences. I don’t remember what it was, but basically the summary was midwives should offer active management, but physician recommend it. Ironically, it is something that we have good evidence for it, but it is often eschewed by the NCB crowd. Good figure.

          • Tired

            My life would have been so much easier if I could operate within the standard-of-care framework. But this isn’t what’s ‘allowed’ by our so-called professional standards. I don’t like it but I cannot change it, unless I want to practice solo somewhere in the Yukon.

            Funny, about ‘alternative’ practices, my preceptor during the senior year made me learn some retarded homeopathic regime for labour induction and would quiz me on compounds/dilutions or some like BS. Oh man, it’s a warped reality out there.

          • Empliau

            I had my daughter with a CNM at Kaiser. After she was born: What are you putting in my IV? Pitocin. Why? It helps you deliver the placenta. Oh. Okay.

            I was a bit woo-ish (thought i probably didn’t want an epidural, but wasn’t sure), but had no convictions about what would happen after my baby was born. And the only thing I cared about in re the third stage was that (in my experience) it was way easier to deliver a placenta than a baby. Seriously, I would have happily delivered ten placentas. They don’t have a big head.

          • Medwife

            Active management of the 3rd stage is my default. I don’t bring it up for discussion. Sometimes I have people who tell me (usually in their birth plan that was printed out from a website) that they want the third stage managed “naturally”. Once I explain why I DONT want that, they generally tell me that I can do active management. I can only think of once when someone really held to their guns.

        • theadequatemother

          I agree – that’s also a problem. But I would still feel more comfortable with midwives who had seen some sick people during their training. Nurses see sick people during their training. I would think that a nurse that had spent some time looking after people with CHF and MIs in the emerg or medical floors and then went on to midwifery school would be better positioned to pick up the rare pregnant woman with peripartum CM or angina and would be less likely to say that severe flu is just normal 3T SOB. I think that you need context of knowing abnormal to understand normal. But that’s just my ebil over-medicalized paternalistic side, apparently.

          I was consulted for postpartum chest pain once and my habit is to explain the findings to the nurse looking after the patient and consulting provider. So I did that – EKG, trop, need for monitoring and more trops over time. The RN got it. The midwife was blank. And that concerns me. pregnancy isn’t a single system condition but it seems that midwifery education in Ca treats it like one.

          • Tired

            Hehe, that’s what I though, too. That having gone through med school would make me a better, more rounded, midwife. This is absolutely not the case in real life in Canada. I could only get a job after I took anything medicine-related off my resume. I have not told anyone. The practice where I was trained as a senior student – they knew- refused to offer me a job. They gave me a goodbye card instead. It said, learn to use your knowledge in the right way. Or something along those lines.

            My uni program gave me a graduation gift – a cute box filled with homeopathic remedies.

            I’m tired.

          • Medwife

            Are you kidding? All that stuff has literally happened to you?

            smh

          • Tired

            Indeed, and it happened very recently. The box was tossed. Now have a made up degree in ‘health sciences’ – it got me farther than 6 years of med school plus some post-grad research studies.

            In all honesty, midwives-in-demand here are either the uber crunchy white girls with an agenda or experienced immigrant midwives who know how to go through the motions. Evidence based midwifery is not happening.

          • Medwife

            That makes me ill. What does my title mean if this is becoming the standard of “care”? I’m in the US but Canadian midwives are actually held on a pedestal here, in my experience.

          • Haelmoon

            Tired, I am sorry to hear that. We need more medically minded midwives. I hope that things will work out for you.

          • Tired

            Thank you.

          • sdsures

            That’s terrible.

            It’s as scary as the fact that there’s a hospital in London ENTIRELY devoted to homeopathy.

            smh *HUG*

          • Haelmoon

            Theadequatemother – I totally agree. I can recall many times where I had a very sick patient, and the midwife gave me a blank stare. However, I am lucky that I work in an environment where we have some stellar midwives too. I had a patient that I transferred to ICU to management of severe preeclampsia and a stillbirth, but left the midwife to delivery because they were able to assist the ICU nurse with management of labour. It is a very collaborative environment. I was in the ICU when she delivered, but not in her cubicle, because it was nice for the patient to have that bit of privacy for a difficult time, but I was available if there were any complications (like retained placenta). This particular midwife is very good, but was a nurse first. She understood how sick her patient was, and she was the one who got me (as MFM) involved instead of just on call OB because of the complexity of the situation – now your comment makes me think – most of my favourite midwives are either nurses first or trained in Britain. The new graduates just don’t seem to get it the same way. Sure they are new and will take time to build up their experience, but their philosophy is different. I must be old school.

          • AgentOrange5

            That is unfortunate. In the US, CNM’s must be RN’s first, they would have exposure to sick people before becoming a midwife.

        • Young CC Prof

          Yes. Patient autonomy depends on having the complete, real information available. On one occasion, I refused a recommended course of treatment because I didn’t know all the facts. I knew precisely what the side effects were, but I incorrectly believed that the benefits were small. A doctor saying, “Are you sure? It’s going to take you a lot longer to recover if you don’t do this,” might actually have changed my mind.

          I am glad I had the option to refuse. But I wish I’d had more advice.

        • Mishimoo

          When we had our eldest, active management was mentioned in the newspaper as being available, but that it was hard to access. I expected to have to argue for it, so wrote down the names of some studies, and began asking about it at my first appointment…only to discover some very relieved CNMs who were glad they didn’t have to talk me into it.

        • Stacy48918

          “So midwives are so afraid of not respecting patient autonomy, they are afraid to advise patients.”
          I think this is an astute observation and likely applies to all health professionals – a fear of upsetting the patient/client/owner for whatever reason.

          • Mishimoo

            My personal opinion is that decent health professionals don’t want to offend their client as they’re concerned that an offended client is one that will forgo necessary medical treatment.

            There will always be people that insist it’s about the money, but considering the overheads and the debts incurred while studying to become a doctor or proper health professional; I think that would only be an issue in a small amount of cases.

          • Medwife

            Yes. The longer I practice the more confidence I have in not just offering options and trying to lead people to conclude they want to follow the plan I make, but in flat out saying, This is the safest thing to do. This is what I recommend. I do think my midwifery training matches what Haelmoon is describing and I am training away from it, to the benefit of my patients.

    • The Computer Ate My Nym

      Does she want a live baby? Because if she doesn’t, I’d recommend she induce labor quickly and get it over with. If she wants a live child, she should have a high tech delivery in a hospital with a really good neonatal nursery. And vaccinate.

    • Tired

      A trisomy 21 baby requires at least a paediatric consultation as per the College guidelines. If the baby is seriously unwell, a transfer of care. Since we cannot predict what the little one’s struggles are going to be when transitioning, a homebirth is a bad idea.

      Sometimes though, you get a client who states that they will absolutely not deliver at a hospital. We can’t drag them there against their will, you know. We can’t abandon them, either. So then it becomes all about trying our best with what we’ve got..

      • Haelmoon

        Tired, I agree. I do support patient autonomy in that they are free to make their own choices. However, I think there is a difference between supporting patients and encouraging poor choices. I have seen too many cases where poor choices were not only supported, but patients were encourage to continue this decision making process. I think that it is not contrary to patient autonomy to tell them they are making a less than ideal choice. I would support a midwife attending this patient at homebirth because the patient refused to deliver in hospital. I am opposed to a midwife telling her that this is a reasonable choice.

        • Tired

          Oh, I agree, absolutely. Our standards of practice, however, require that we offer every alternative option out there, regardless whether (surprise!) it is evidence-based or not. We are supposed to say in our informed choice discussions, “this is the standard of care” implying that that’s the safest way to manage a situation. But – and this is where it all goes sour – “here are the alternatives”. Now take a fringe client and guess what…they will, of course go for the alternatives out of who knows what? Defiance? Sticking it to the man?
          Now, I know midwives who will try to do some damage control and offer only somewhat reasonable choices. But I also know many who are similarly anti-establishment – those will downplay the standard of care in favour of alternatives.
          Many can and will get away with it given how few babies we deliver. It’s just being lucky.

  • Infinite Sovereign

    I have a friend who is pregnant. Like me, she is a natural childbirth/ home birth proponent and participant. Her last child was a home water birth babe. For some reason she didn’t feel safe at home with this pregnancy. She has opted for birth center birth with a dangerous and un ethical CNM who actually has the distinction of being one of the negligent midwives attending the death of one of the angel babies on the Hurt by Home Birth website. My friend, like many NCBers I know places her feelings about birth above facts or truth, not because she is unethical, but because she truly believes in motherly instinct and intuition. She says she trusts this midwife, even after hearing whispers of deaths and unethical behavior on the part of this midwife. I believe she wants to believe in this midwife because she really has no other choice–other than hospital birth, which she fears and distrusts. I want to help her, but what can I say? What would you do if this were your friend?

    • jenny

      How close are you with her? How familiar are you with you local hospital? I’ve taken friends on hospital tours before and that helps demystify the process somewhat. If you know any friendly nurses, social workers or OBs, sometimes getting together so they can sit down and talk about what it is really like can alleviate a lot of fear.

      • InfiniteSovereign

        Unfortunately, she’s already had three hospital births. I don’t know about all of them, but the most recent one was a very negative experience where she was yelled at and berated and threatened by L&D staff while in hard, transition labor for declining certain procedures. There are hospitals in our area that are supportive of parental choice and I always hear positive stories about them, but that experience really turned her off of hospital birth. Luckily, she’s never had a cesarean and I’m pretty sure is low risk by any standards, but still, I’m worried for her.

        • Cobalt

          Why were they yelling? There is always a chance of just getting a bad nurse (they are human and can certainly have attitude days), but usually there is a reason when the staff gets excited and starts recommending any particular action. You may not be able to in the moment, but asking for details, reasons, indications, whatever afterwards can help prevent a lot of future pain and confusion.

        • Sue

          It’s possible that the experience was due to a poor relationship between the invividual staff and this woman, rather than a characteristic of the hospital.

        • jenny

          Has she ever had the opportunity to debrief about this incident? Or make a complaint? It might be good to encourage her to do both. Patient Relations or the L&D nurse manager or head of OB (depending on which staff yelled) might a good place to start.

    • Cobalt

      It’s mostly just getting out of the bubble, talking to women who have had hospital births, who understand the reasons the hospital has protocols, and not just self reinforcing horror stories that leave out the reasons why a particular action/intervention/decision was necessary.

      “Do your research” goes both ways. Talking to women that have had positive hospital experiences and reading up on “the other side” is just making sure you have actually done it. And at some point you have to step back and let people do what they want to do. In the end, it is her choice.

    • Jenny_from_da_Bloc

      I would send her the link to hurt by homebirth with the stories about that specific birth center/midwife and find a CNM that works with a natural birth friendly hospital. A lot of hospitals have birth center like atmospheres that are like home or made to be more NCB friendly. I would very gently explain to her that she has other option besides this dangerous place. It is hard to help the woo infected but maybe if you do the leg-work for her she will be more inclined to listen to your concerns and accept some help.

  • araikwao

    Not sure if this has already been pointed out (if so, sorry), but we don’t have lay MWs in Australia. Caroline Lovell had bachelor’s or master’s-level MW’s. Obviously the woo is still here, and likely strong with those involved in her case, but we can’t even blame lack of MW education for her death.

    • Phascogale

      I was coming in to write this. The midwives here are registered midwives (and possibly nurses) with a minimum 3 year university degree. They should’ve known how much blood was there and it’s quite possible they are playing dumb to cover their own butts.

      • Anj Fabian

        According to the inquest, Caroline Lovell was in the birthing pool until she complained of feeling ill. The time given between the birth and Caroline exiting the pool was 45 minutes IIRC.

        She did not deliver the placenta until she was out of the pool.

        It’s debatable if the MWs knew how much blood their client had lost, but it should have been obvious that she had indeed lost a significant amount.

        • Sue

          YYes – I’m not sure whether we can blame lack of training here, so much as attitude and lack of oversight. Hospital systems don’t allow “I don’t really know how much”.

          • Aussiedoc

            Definitely attitude and lack of oversight. Firstly with a previous history of significant PPH – she wold have been risked out if water birth to start with!

            Secondly – with water birth in a hospital setting – they get out as soon as the baby is born.

            Also I have a sneaking suspicion Caroline Lovell went with a physiological third stage which given her previous PPH was risky and in a homebirth environment – well the results speak for themselves.

            A sensible midwife, or at least the ones I work with, would have been able to tell her all of that and would have immediatly referred to more oversight if she resisted. The fact that these midwives didnt even seek out a second opinion speaks volumes for their hubris.

          • Sick of Woo

            Here’s one ‘illustrated’ version on speaking volumes

            Recent fb conversation:
            “In fact, ‘history of hemorage’ [sic] is not even on our risk factors for licensed midwives …” Gail Hart

            Bio for Gail Hart:
            … Gail is interested in ways to holistically incorporate evidence-based medical knowledge with traditional midwifery understanding. She travels extensively teaching midwives, doulas and other birth professionals. She contributes to midwifery publications, and is the author of Research Updates for Midwives and the forth-coming “A Textbook for Midwives.”

            Gail Hart- Key speaker at the 2014 Trust Birth Conference in Sydney for … ( drumroll please) …. Third Stage Problems

            http://www.trustbirthconference.com/schedule

            … Learned hubris complete with CEUs

        • Trixie

          Oh silly Anj. According to a certain Public Health Scholar, homebirth midwives know exactly how to measure exact amounts of blood loss in a kiddie pool.

  • Beth S

    It always amazes me how much we don’t actually know about what we think we know. Especially when it comes to things like childbirth, parenting, and life in general, I always said I was the perfect mother until I had kids.
    Uneducated birth junkies tend to prey on these types of people, the ones who’ve done their research with Dr. Google, and the ones who believe in the naturalistic fallacy of “warrior woman” mommas.

    • anion

      Yes. As I’ve mentioned here before, my mom is an ER nurse (RN). She was first an RMA–went to school for that when I was seven–and then went to nursing school for her RN when I was ten. I used to help her study all the time. We had one of those Halloween paper skeletons–you know, the ones you hang on the wall, that you can pose in amusing ways–and my mom labelled all of the bones. She used to record herself reading her notes, and record lectures, and play the tapes in the car. I used to spend whole days hanging out in the doctors’ lounge where she worked–first at a Doc-in-the-box and then in the ER of one of Miami’s largest hospitals. I used to love hearing about patients and symptoms and diagnoses and asking the docs questions. My brother is a pharmacist and I’ve learned from him, too. At one point I planned to go to nursing school myself so borrowed and read some of my mom’s old textbooks–not to study, but just to read.

      So for most of my life I had people discussing biology and medicine around me. I was always that kid everyone went to when they cut or scraped themselves or banged their heads or whatever; once at camp I performed minor surgery on a friend’s infected wound–it had started to heal over the infection, leaving a pus-filled boil, basically–with a surgical blade sterilized in boiling water, alcohol wipes, antibiotic ointment, and a dressing I made her come to me twice a day to change, because I was also that kid who kept a good First-Aid kit with me and the camp had no nurse or medical supplies. (I applied a lot of Neosporin and Band-Aids to other kids all through school.) My mom taught me how to suture wounds on my stuffed animals (I of course never ever would have tried it on a living creature) and how to administer shots with a syringe on an orange, because not only was I curious but I’m allergic to bee stings so carried an ana kit with me for a long time. (My reactions were never really anaphylactic, but there was a concern they could become so.) I helped a woman in shock after a car accident once by covering her with a blanket and forcing her to stay awake until the ambulance arrived, and was able to tell the Rescue guys what was going on.

      TL;DR: (All of which means that) I imagine I have a little more medical knowledge than many people. But the operative words there are “a little,” and “I imagine.” I’m pretty smart and a quick study, medicine and biology have always interested me, and I’m a good layman to have around in an emergency, but I am not a doctor or a nurse and I *know* I am not a doctor or a nurse. I would never in a million years presume to think I know more than they do about anything. It astonishes me that these women do; the hubris!

      I’d love to see any of these people who know so much better spend just a single eight-hour shift in a busy ER or an L&D ward, and see if after those eight hours they still think medical professionals are just overpaid dingbats who wasted a bunch of money playing with cadavers. I honestly think most of these people imagine that it’s still 1890 inside most hospitals or something, with docs administering leeches and morphine and wandering around hoping their patients just magically heal on their own–the way they themselves do.

      (Sorry for the length!)

      • Beth S

        I have two aunts who are RNs and one who does billing for my pediatricians office, I’ve spent my life listening to medical talk. I used to life guard so I’m First Aid and CPR certified, what does that make me an expert at? Bandaging wounds and keeping you breathing until the real professionals arrive.
        I don’t think people think it’s 1890 however I do think they think it’s 1950, if I have to hear about the enema, shaving, and episiotomies again I’m going to scream because that just doesn’t happen anymore.

        • Aki Hinata

          Yes. The shaving! My MIL was just warning me about how I’ll be shaved when my baby is born (due in Sept). As I am not expecting my first I was able to inform her that isn’t done anymore.

          • Amazed

            OK. I really don’t understand why shaving is such a big deal. I shave quite regularly. I go to the beach, after all, and the sight of hairs sticking from under my bathing suit is not something I relish. Let alone the time of my monthly cycle. And that’s only when shaving is MORE important than usual. I’d think that shaving is part of the everyday life of a quite large subset of women, so why it’s suddenly the Vilest of All Vile Medical Procedures?

          • Siri

            When I had my first baby at 21, no razor had ever been anywhere near my private parts. I found being shavEN (by someone else, with a horribly blunt razor) and given an enema unbelievably humiliating and unpleasant. It felt infantilising and cruel. I now shave regularly, which is a very different experience; I’m by myself, use my own razor, and there is no one lurking with an enema…

          • Durango

            I would venture to say that everything is better when there is no one lurking with an enema!

          • guest

            On the topic of enemas (HA!), I asked my mom (L&D nurse for 15+ years) why we don’t do enemas anymore, and she said “I’m not sure, they’re a really great idea – can help get labor moving, don’t have to worry about pooping during pushing.” So now I’m curious why they don’t even offer them anymore (I’m not sure what happened back in the day, did women not have the choice to decline?) I probably would have said yes!

          • Cobalt

            I’ve wondered that too. I can see wanting the option of turning down an enema (forcing something like that on someone is just plain wrong!), but why is it completely off the table and not even talked about now?

            Not to be totally gross, but one of my deliveries would have probably been much more comfortable if I had had a little help ‘clearing the pelvis’ first. I felt like I had that baby twice!

          • guest

            Agreed! My last baby it was kind of ugly. I think I might ask next time, depending on the circumstances!

          • Medwife

            You can absolutely still poop while pushing after an enema. Women did not have the option of declining routine procedures in the past. You got separated from your husband, shaved, given an enema, and depending on your socioeconomic status, strapped to a bed. I completely don’t know if that was universal, but it was common.

            Women tend to come to the hospital pre-shaven in my experience. More so now even that 5-10 years ago, when I was training. It isn’t that great, there’s a lot more folliculitis. Not a very healthy practice.

          • AmyP

            Yeah–feeling the urge to poop during labor is not great.

            If I had another baby and I was offered an enema, I would probably go for it.

          • Tired

            This one really made me laugh! Thanks!

          • Aki Hinata

            All I can say about shaving is that my skin hates it. I <3 board shorts!

          • KarenJJ

            Conversations I’m glad my MIL has never had with me. Some stuff is just too personal.

          • The Bofa, Being of the Sofa

            As I am not expecting my first I was able to inform her that isn’t done anymore.

            I thought you were going to say, “I was able to inform her that it wouldn’t be necessary.”

            Now there’s an

        • Sue

          Shaving may be a non-event in these days of The Brazilian!

        • guest

          shave, enema and 2-3 stitch episiotomy in 1987 in the USA with a fabulous OB/GYN who is still practicing today, fertility specialist, and who I would trade in my last two awesome midwives to birth with again if necessary

          • guest

            the episiotomy required 2-3 stitches

  • Ash

    Look at all the BS wrapped in “autonomy” and”informed choice”.

    http://eriehomebirth.com/wp-content/uploads/2013/03/partners-in-care.pdf

    Licensure means that midwives are accountable to insurance companies and medical professionals. That is bad.

    18 years of experience and 80 births as primary. Golly gee, about 5 births per month!

    She says she can use IM Pitocin under guidance of a physician. How is she getting that? She has no prescriptive authority in PA.

    She will do episiotomies.

    Does not recommend ultrasounds, RhoGam, GTT, Vitamin K, Vaccines, abx eye ointment. All of this stuff is under “how homebirth is different from hospital birth”.

    I don’t think most people realize the level of crazy in the USA homebirth movement. I know people who think polio vaccines are good, flu vaccines are bad, OBGYNs are necessary to exist but do too many C-sections, so homebirth could be reasonable. But they would be shocked that some HB midwives discourage ultrasounds, and worse: no one in the NCB community stands up for unsafe practices. It’s not just 1 outlier. It’s a whole group of people will never condemn any practice, no matter how unsafe, in order to support the NCB homebirth movement.

    • Mariana Baca

      isn’t that <5 birth per *year*?

      • Ash

        Yes, you are right, mistyping. Less than 5 per year. Oh my.

    • The Computer Ate My Nym

      Ok, what’s with the drugs bad herbs good thing? Why is, for example, aspirin bad but willow bark ok? (I can give you an answer for the opposite: willow bark is unstandardized, contains other possibly toxic ingredients, and is salicylic acid rather than acetyl salicylic acid and so rips the stomach up more…so I can think of plenty of reasons to take asa and not willow bark, but none the other way around.)

      • Cobalt

        Also, the salicylic acid in willow bark is difficult to extract and concentrate using methods available at home. Even doing a strong decoction would require the patient to drink gallons of the stuff to get the same dose as two regular aspirin tablets. Then you have to treat the damage all the tannins in the bark do to the stomach, and you can’t avoid extracting the tannins with the salicylic acid.

        Basically, if your willow tea is strong enough to replace aspirin, the taste and side effects of the rest of what’s extracted will have you puking it up pretty quick. On the upside, this is an incentive to make it very weak, which is way safer and works off the placebo effect.

      • Somesense

        Well it’s natural…so of course its good!! /sarcasm

    • anh

      seriously, wouldn’t avoiding RhoGam be potentially deadly? what is wrong with these idiots? I don’t get it! it’s a tiny little shot that takes 10 seconds. what is the damn issue with it?

    • Amy M

      If pre-term birth is “emanate” you need to transfer…

  • lilin

    Regarding the Amish clientele, it’s amazing how well midwifery isolates and preys on vulnerable populations. Reminds me of payday loans and refinancing scams. Find a complicated subject and a group that hasn’t had a lot of exposure to it, yet, and keep extracting money.

    • Ennis Demeter

      They are indeed vulnerable. Amish don’t typically have formal education past the 8th grade.

    • Trixie

      That’s Diane Goslin in a nutshell.

  • Dezi

    Wait, how are the Amish using a phone?’!

    • Stacy48918

      They have communal phones between houses or out on the road. Sometimes in a barn or out building. Most communities simply do not allow them in the house itself. Or they rely on “English” neighbors

      So even more time delay if a true homebirth emergency while someone runs the mile or more to the closest phone.

      • wookie130

        This is true of our nearby Amish communities…there is one phone for the entire community, mounted on a telephone pole, and someone stays near it at all times. Then, when it rings and gets answered, the phone person runs and locates the person who is to take the call.

        • Therese

          Wow, are they just standing there doing nothing but waiting for it to ring? Or do they stay occupied doing other things?

          • Trixie

            No, it rings really loud. Sometimes they have voicemail. Around here it is permissible to have a phone “for business” too, so lots of them have phones in the barn or whatever.

    • ManaBear

      New Order Amish are allowed to have phones in a central location in their home. Some Amish even use cell phones for business activities. It depends on the order of the Amish, and specific rules of their church district.

    • V

      I’ve worked with the Amish before. Most of them did have phones, but they kept them in the barn (out of the house) for emergency use only.

    • Trixie

      Like every Amish person I interact with uses cell phones. Not smart phones though unless they are teenagers. Lots of them have business email, too.

  • The Computer Ate My Nym

    So, how many babies died “without warning” after being “fine” throughout labor? How many mothers bled to death or got lethal infections? Because it doesn’t sound like the answer to either question is going to be zero.

  • Guest

    Slightly OT: Have any of you read this blog? http://midwiferyramblings.blogspot.com/ SO full of garbage. Her post The Bitter Homebirther’s Wishlist is especially a gem.

    • Amy M

      I came across this blog recently, when trying to answer someone’s question about powerbirthing. I think the blogger is an idiot, but the one thing I can get behind is her denouncement of the powerbirthing movement and her support of its victims. That does not, of course, excuse the rest of the drivel there.

    • Anna T

      ” You’ll have strangers coming in and out of your room, an IV and ice chips as your only sustenance, transferred to a terribly uncomfortable postpartum bed, and you’ll be woken up every few hours to have you and baby checked on.”

      Yup. Well, I wonder what she’d say if I told her I had two hospital births during which I was mostly alone with my husband, with the midwife just coming in to check on us from time to time (and being there for the delivery of course)? Or that I had so much sleep in the hospital that I was bored by the end of my stay and had to find something to read (and that’s with baby in the room with me)? Or that I freely ate and drank during labor and nobody blinked an eye about it?

      And the bonus? The blood and amniotic fluid messed up the L&D ward, not my home; and I stained the hospital gowns, not my clothes.

      • Guest

        And you’ll have an actual TEAM of medical experts at your disposal should you need them. Oh the horrors!!!

        • Guest

          Grrr…I really need to make an actual account so that I can edit responses. That should obviously say, “Oh the horror…not horrors…” 🙂

          • The Bofa, Being of the Sofa

            Wasn’t “Horrors” baby Elfaba’s first word in Wicked?

        • Anna T

          Oh and I wasn’t even hooked to an IV! Amazing! Truly an exceptional hospital.

      • The Bofa, Being of the Sofa

        you’ll be woken up every few hours to have you and baby checked on.”

        You have a newborn. Who is expecting to sleep for more than a few hours at a time?

        With our babies, the nurses woke us up every couple of hours because it was feeding time.

        • Danielle

          I will admit, I do understand this criticism. I got almost no sleep during my two days in the hospital after birth. One cause was the fact I was constantly pumping for visiting NICU.

          The other was that any time I did lie down, a nurse would come in and want to do something. Every single time.

          In retrospect I should have slapped a sign on the door telling everyone to stay away for the next hour.

          However, that would have required me to have been thinking rationally, and I was a bit beyond that point.

          • Anna T

            I agree with you nurses should be considerate. If they see the patient is sleeping, and it isn’t an emergency, they can come later. In the newly post-partum state, sleep deprivation is torture.

            Also, there was this one nurse who wasn’t aware that our room was a rooming-in room. She would come in and say “feeding time!” (after the baby just had a long nursing session), or “diapering time, you are required to take the babies to the nursery!” (yeah, right. I chose to room in, you gave me a stack of diapers for the baby, now you think I can’t use them? Where’s the logic?)

          • Anj Fabian

            One reason for all the people coming in and out of a patient’s room is what I call “Check the boxes syndrome”.

            If you are only in the hospital for 48 hours and you are a new parent and breastfeeding, there are a lot of boxes that need to be checked so that you have been given you decreed dose of education. Breastfeeding, nursing, baby care, well child visits, shaken baby syndrome and the usual checklist of your medical condition.

            I wondered why I didn’t have the same experience that some women reported – when it struck me that I was in the hospital for four days due to my c-sections. All that checking boxes happened over four days, not crammed into two.

          • anion

            I had that with my first–one nurse actually entered my room and woke me up (I had *finally* fallen asleep) at three in the morning by just switching on the overhead light–but my hospital stay with my first in general was not optimal.

            My second, though? The hospital didn’t even have a nursery but the angels posing as nurses were very happy to help me out by taking my baby to the nurse’s station for a few hours. So I got plenty of sleep despite the forced rooming-in. I also got nice meals brought right to me, a bed I didn’t have to clean, my dishes washed, and everything else taken care of so all I had to do was nurse, admire, and change my baby. It was awesome. I never wanted to leave.

            But with both of them, I had a team of medical experts monitoring me and my baby, ready to jump into action should anything go wrong.

            So yeah, not every hospital experience is great, but despite my miserable first experience, I’d rather do that exact thing a hundred times than have something go wrong and no one there to help.

          • Anna T

            “I also got nice meals brought right to me, a bed I didn’t have to clean, my dishes washed, and everything else taken care of so all I had to do was nurse, admire, and change my baby. It was awesome. I never wanted to leave.”

            Yeah, it really was nice to be taken care of this way. Especially since I knew I’d get no help at home (husband worked long hours, family was far away, and we couldn’t afford household help).

            My MIL confessed, “after having a baby I always hoped I’d get fever or something so they would keep me in the hospital longer”. I wouldn’t go as far as to wish for a fever, but it just illustrates what tough lives some women have. My MIL WALKED to the hospital during contractions, it took half an hour or more, because they were saving on bus fare. And 4 times out of 5 she did it alone, and stayed there all alone, because my FIL had to stay home to look after the other children. For some, being in a hospital after having a baby is the closest thing to a vacation in a hotel they will ever experience.

          • moto_librarian

            This was my experience with my first to a tee. I was either visiting our son in the NICU or pumping. I wanted to sleep, but felt guilty about not working hard enough to get nursing going. I was also recovering from a pph, a cervical laceration, and a 2nd degree tear. I should have been resting.

            After my second, I prioritized sleep. We still have a well baby nursery, and they did wake me up to nurse, but I rested as much as I could. I left the hospital in much better shape that time.

        • Cobalt

          I had one delivery where this one nurse kept trying to take my blood pressure while I was finally sleeping, 18 hours after delivery (delivered at 3am, visitors and new baby excitement all day). My blood pressure had been normal the entire time, so I have no idea why she started hourly checks (also all normal). She also kept trying to take the baby to the nursery while I was asleep. I about lost my patience.

          I asked my doctor about it in the morning and he had no idea why she did that.

        • Renee

          I expected to sleep al night! Thats what night nurseries are for. Late night feeds can start once I get home.

        • Elaine

          With both babies, our nurses had us buzz them when the baby woke US up, so that they could check me and baby out and not have to wake us later.

      • Pseudonymous BC

        What a mess! I sadly have a friend who is rather woo-infested. Mixed with an insatiable desire to turn every conversation about child-rearing into a competition of “teachable moment.” Spare me. She’d likely agree with this list and likely mourns the fact that she had to have a c-section with breech twins who never engaged. A variation of normal, after all.

        I’ll admit that I mourned my c-section with my first. I didn’t understand why the doc wouldn’t attempt to turn my baby who was breech with a nuchal cord. I was vehement that I wanted a VBAC and thought the only way to do so was to get crunchy. I feared that one thing would lead to another … And we’d be in the OR again. I had my VBAC. Come to find out, vaginal deliveries are no walk in the park. I felt like I got run over by a truck. Every muscle hurt and my episiotomy took FOREVER to heal.

        Still, I had the best teams working to ensure a healthy baby. In retrospect, I wish I hadn’t spent much of my 2nd pregnancy fearing that my OBs would get in the way of my “birth story.” In retrospect, I also wish my OBs had taken the time to educate me. I had CNMs with my first until she required a c-section and I liked that they took the time to teach me. Just because I had one baby already doesn’t mean that I have all the answers. There’s certainly room for improvement in hospital births. But this would mean reform. Opting for a home birth because hospital births are not without their faults is throwing the baby out with the bath water.

    • Cobalt

      “21. Quit asking me, “Your doctor let you do that?”. First of all, where I birth is not my doctor’s decision and I did not ask him/her for permission. Second of all, I feel sorry for you if you ask this question. Because it means that you probably have authority-figure beliefs about doctors, and would base your decisions on what he/she says.”

      Because going to medical school and delivering a few thousand babies doesn’t make you an authority on anything. Certainly wouldn’t mean that I should base any of my decisions on your silly ‘opinions’.

      • anion

        Yes, I’m a fool for trusting the judgment of someone who underwent eight years of college and another four years of internship/residency (plus whatever else they may have done, if they’re specialists), and following their advice.

        I also do foolish things like hiring certified/licensed electricians to fix the wiring in my home rather than just wading in with some pliers, duct tape, and dishwashing gloves figuring hey, any idiot can figure out where wires go, it’s just logic, right?

        And of course there is also the very intelligent decision I made to get a bunch of people together and write our own class action lawsuit, because it’s just common sense and the Court will surely make allowances for us and understand what we mean and it’s not like legal terms have any sort of particular meanings specific to law alone or there are any nuances involved or we need to actually know what exact laws have been broken and on what specific basis we’re making a claim and about cases like ours in the past and what was decided in them.

        Nope, I don’t base any of my decisions on the stupid advice of people who’ve devoted years of their life to learning and practicing in an intricate subject. Obviously all those years means they’re morons, because I know just as much as they do after a week reading blogs and a couple of abstracts from medical studies (I didn’t understand the studies, but that’s okay, they’re not really important and nobody else does either, especially not those idiot “doctors” who probably have to mark their shoes to keep from putting them on the wrong feet and wasted all their money on some fancy meaningless degree when they could have just Googled some stuff.

        I listen to random bloggers instead. Because *I* am not a sheep!

        • Mishimoo

          My dad is both a qualified electrician and a qualified mechanic, and I spent a fair chunk of my weekends as a kid helping out. I have a fair idea of what I’m doing, so maybe I should hire out as a lay electrician or a lay mechanic. After all, electrical work isn’t that hard, there’s a little ditty that reminds you how to do it: “Red to red, black to black. Cut the others and turn ’em back.” As for mechanics? That’s just listening to what the car is trying to tell you is wrong and using a little intuition.

  • Zornorph

    The cultural belief in the ‘wise old woman of the woods’ runs strong, I see. It’s understandable but every time you see a scene in a movie where some (inevitably male) doctor is about to kill the patient by bleeding them or something and then the wise old woman comes in with some herbs and saves them, this just gets reinforced. I don’t actually know if this was the case in the middle ages or not – I mean, I know doctors bled patents and otherwise did stupid things with leeches, but I would assume most of them did want to help and wouldn’t have been stupid people. But this trope is what today’s ‘other ways of knowing’ midwives are tapping into.

    • The wise old woman killed a lot of people either actively by using herbs in poisonous amounts and combinations, or by simple neglect when the herbs had no more value than a placebo, that was the truth of it.

      It never fails to get me when a fictional character is the subject of a “prophecy”, in a novel, because the “prophecy” invariably comes true. In real life, prophecies often don’t. Ditto wise woman’s cures.

      Ever notice, also, how people in historical novels never die of appendicitis or other illnesses — it’s always poison?

      • Zornorph

        That was my first real clue that Game of Thrones was going to be a different type of fantasy story – when the boy who was prophesied to be ‘The Stallion Who Mounts The World’ died as an infant.
        I actually can think of a historical novel where a character died of appendicitis – Raptor by Gary Jennings – but it’s certainly rare.

        • Amazed

          The TV series or the books? I’ll admit I couldn’t suffer much of the TV series. But I enjoyed the moment in the second novel when Ser Jorah said, “Well, if he was The Prince Who Was Promised, the prophecy died with him the moment he had his head smashed in the wall.”

          • Zornorph

            Book. Though ‘The Stallion Who Mounts The World’ (Danny’s son with Drogo) was a different baby to ‘The Prince Who Was Promised’ (Danny’s nephew).

          • Amazed

            Exactly. A prophecy that failed and another one that, to my horror, will turn out to be just misinterpreted (making the Rhae-man the Savior of Mankind or at least, the Father of Said Savior. I don’t like Rhae-man.) We don’t see misinterpreted prophecies all that often in novels.

          • Haelmoon

            You guys rock!! That made my day to have a Game of Thrones discusion in the Skeptical OB threads. My two indulgences in one place. I needed that after a day of crappy consults (no, it is not a good idea to homebirth and not vaccinate a baby with trisomy 21). Thanks

          • Comrade X

            Let’s not be coy here. It’s pretty obvious Danny has another nephew.

          • Zornorph

            Not everybody has read the book. Let’s keep is spoiler free. And many question that, anyway.

          • anion

            So you’re a supporter of that theory, then? My husband and I just found out about it and think it’s very likely.

            Whee, excitement!! I can’t believe we have to wait so long for season 5.

          • Anna T

            I watch the TV series because I can’t help myself, but I’m really annoyed at how much they changed from the books.

          • Dr Kitty

            We live where they film a lot of it, and it has made my professional life more interesting when I’ve treated extras with armour related injuries.

      • Anna T

        What about “World Without End”? It describes the horrors of the Black Plague.

      • Amazed

        In truth, how were people supposed to know it WASN’T poison? With the level of medicine at the time and autopsies forbidden for a long time, I doubt there were many who knew how organs worked.

      • Sullivan ThePoop

        Charles Hamilton died of measles in gone with the wind

      • Trixie

        The wise old woman probably was right about a few simple ailments and treatments, though — enough to make her credible.

        • The Computer Ate My Nym

          Plus a lot of illnesses get better on their own. The old “if you take this pill (or herb or concoction) you’ll get better in just one week, if you don’t it’ll take a full seven days for you to recover” problem.

      • The Computer Ate My Nym

        Several people died of natural or semi-natural causes in War and Peace, including a death in childbirth, a stroke, and some rather gory wounds.

        • I was thinking more of contemporary historical fiction, written about periods far in the past, such as a tale about the Borgia, for example. Appendicitis doesn’t give the same frisson as having Lucretia slip someone the contents of a little vial…

    • Sue

      Such a misogynistic, old-fashioned view – based, I suspect, on the days when girls didn’t receive an education.

  • Alenushka

    OMG. This gave chills

  • The Bofa, Being of the Sofa

    manual palpation of fundal height and estimation (no actual measurement)

    Jeez, how hard is it to carry a tape measure and actually measure a fundal height?

    Then again, in order for this to be useful at all, you need to actually be comparing the results from week to week, so you can look for changes, right? Which she clearly is not going to waste any time doing.

    • Amy Tuteur, MD

      It’s not hard, but if you never measure you can never diagnose IUGR or macrosomia, and that’s why she never measures.

      • The Bofa, Being of the Sofa

        Yeah, that’s kind of what I said. The only reason to measure it is if you are going to use the information for something, and since she has no intention of doing so, why bother?

        What she is doing is all for show.

        • lilin

          I think sometimes midwifery are deliberately meant to keep people ignorant. Look at the fetal monitoring. If you listen to midwives, there’s a strange trend where, when the baby comes out, it’s mysteriously not breathing and its heart isn’t beating. It wouldn’t have been “mysterious” if they’d monitored the baby the way hospitals do. But if they did, they’d have to turn to parents at some point and say, “Your baby is in distress, and if you continue to labor at home, there’s a much higher chance that it will die or have brain damage.”

          It’s not that they can’t do anything about it. They can give the parents the choice to go to the hospital. But they don’t want to do that. They’d rather make sure they don’t know, and take the relatively likely probability that the baby will live, than make sure they know and be obligated to admit danger and give the parents the choice to respond to it.

        • fiftyfifty1

          “Yeah, that’s kind of what I said. ”

          Kind of, but not quite, and the distinction is important. It’s not that the midwife doesn’t want to “waste any time” as you stated. They have plenty of time to waste. It’s that they are being intentionally careful not to know information that might risk out a patient and lose her business.

      • Sue

        To quote Samuel Shem”: “If you don’t take a temperature, you don’t find a fever.”

  • Anna T

    My goodness, so many disasters waiting to happen. All through reading this, I was thinking, “how can clients not realize this kind of care is deficient”? It seems like only if you’re buried under some rock you might believe that no bloodwork, no ultrasounds, and no perineal repairs is OK. Then when the author mentioned most of this midwife’s clientele are Amish, this cleared things up a bit. Not to say that the Amish are unintelligent. But perhaps they don’t have access to the kind of information that is readily available to most people?

    I wonder, what happens if an Amish woman needs a C-section? How does she even find out something is wrong? How many of them actually receive professional care during their pregnancy and delivery?

    • Ash

      It’s not that hard to believe. The CPM spends a lot of time with you at every visit, becoming your “friend.” Every question you have has an easy answer. “We don’t need blood testing, a healthy diet is all that’s necessary. You are low risk” “We don’t use Pitocin, it can cause distress to the baby” “Instead of ultrasound, we use palpation, which is more accurate” “Perineal tears are natural. Arnica will help them heal. Breastfeeding also stimulates hormones which assists in healing” Everything has an easy answer, with anything “unnatural” deemed as “do your research, doctors just do this to make a buck off you”

      • Anna T

        I understand about wanting to avoid interventions. But what’s the problem with blood tests? You are low risk? Of course you are low risk if you never even got bloodwork done. Your fasting blood glucose might be high, your iron low, but it’s never known because it’s never tested… and so you remain “low risk”. And can anyone please explain how palpation is used to diagnose low amniotic fluid or placenta previa, or a myriad other issues? Or how breastfeeding can repair perineal tears? Sure, it helps the uterus contract, but what does one have to do with the other?

        Also, if avoiding interventions is the goal, why would a woman allow her midwife to inject illegally obtained drugs? Unless it’s done without her consent? I mean, if I had needed pitocin during labor, I’d much rather get it in a hospital, where it would be administered in a safe, well-monitored way.

        It’s mind-boggling, for me, that some women in the USA receive such substandard care, which is almost like no care at all. I’ve read that for some, it’s a matter of financial pressure, because their insurance doesn’t cover OB care and hospital birth. If someone is pressured to accept the “care” of an unprofessional midwife, because of money, then I can only pity them from the bottom of my heart. At such moments I’m glad I live in Israel. A lot can be said about our health care system, but we don’t have poor women rejecting OB care and hospitals because they can ill afford it. The poorest of the poor here receive better care than what is described in the article above.

        • The Bofa, Being of the Sofa

          Also, if avoiding interventions is the goal, why would a woman allow her midwife to inject illegally obtained drugs? Unless it’s done without her consent?

          I have no doubt that much of it is your second sentence, BUT ultimately, I think a lot of it is that your first question, in reality, is a false premise.

          They may CLAIM that it is about “avoiding interactions,” but the real reasons go astride of that.

          Remember, the definition of an “intervention that you want to avoid” is “something a midwife can’t do.” If a midwife can do it, even if she has to use illegally obtained drugs to do it, it’s not an unwanted intervention. It’s only medical intervention when doctors do it.

        • Guesteleh

          Pregnant women can always access some kind of medical care in the U.S. It’s almost unheard of to go without unless the mother has a substance abuse problem or has some other reason to avoid the hospital. Medicaid covers most indigent mothers and even if a woman has no coverage, if she shows up at the hospital in labor they are required by law to care for her.

          The cost of a homebirth is around $4,000 paid upfront out of pocket, so it’s not a low-cost option in most areas of the U.S. The homebirth trend is not being fueled by poor women but by women who can shell out thousands of dollars out of pocket.

          • Melissa

            I will disagree only in that even though there are programs that will cover pretty much all pregnant women, many of them are not aware of these programs. I’ve had to inform plenty of women who grew up solidly middle class but are now barley making it on their own that they qualify for different benefits. They have a mentality that those programs are for people who are lazy or destitute, and don’t recognize that they may qualify for them.

            There are plenty of people who think that homebirth is a better deal because they are comparing it to an out of pocket hospital birth. The fact that there are other options either don’t occur to them or are rejected because they’d rather pay for a homebirth than accept the stigma of being on assistance (this stigma many times may be from themselves).

    • Lena

      I wonder if it’s not so much lack of information as it is the fact that the Amish won’t seek better care unless it’s obviously and imminently life-threatening because of their beliefs, so it’s easier to go with the “practitioner” who rarely if ever suggests doctors and hospitals. They won’t sue no matter what happens, and while they might discuss it amongst themselves they’re not going to report a negligent midwife to anyone with any power. This midwife picked the perfect community for her.

      • Amy M

        Do the Amish truly not believe in getting appropriate medical care? (I don’t really know anything about the Amish)

        • Lena

          From what I know, they don’t refuse medical care out of hand, like, for example, Christian Scientists. But they prefer “natural” medical care as much as possible. And these things vary from one community to another. More conservative Amish are more reluctant.

        • The Bofa, Being of the Sofa

          I don’t know if it’s true, but I can understand the argument that, if crappy medical care is what you are used to, you don’t realize how crappy it is. Hey, this is normal, right?

        • Haelmoon

          I used to work in an area with lots of Amish. We would only see them in the high risk clinic or they had homebirths. However, we never had any problem convincing them when to come to hospital. We were lucky in that we had a group of high dedicated and well trained midwives helping to look after this group. They even drove the women to ultrasounds and labs to get all the appropriate testing done if that was a barrier for these women. They had a special newborn screening program, and all the babies had their blood drawn and tested for a variety of recessive traits. My experience wasnt that they refused medical care, but rather they were very accepting that they how little control in the outcome. They are not well educated and without some protection, they would be easily tricked into thinking they were having good medical care.
          Sure we did deliver more vaginal breeches in this population, but it wasn’t because they were reckless, but because they were planning large families and one vaginal breech may actually have been less risky that multiple VBACs at home or c-sections. However, they all came to hospital for their planned vaginal breeches, and there were very few surprise twins and breeches because they had good midwives. It makes a big difference.

        • Trixie

          No. There is no Ordnung against proper medical care. It’s up to every individual and family to decide for themselves. The Amish are open to scientific advancements in medical care.
          I’d recommend reading the blog of the Clinic for Special Children for more insight. https://clinicforspecialchildren.org

      • The Bofa, Being of the Sofa

        I am thinking the same thing.

        Unless you are carefully paying attention, there’s not a real noticeable difference between a 95% success rate and a 99% success rate. You need to be keeping tabs, because both of them are relatively rare and easily dismissed as “most of the time, things are good”

      • Trixie

        1) they aren’t litigious and 2) they pay cash under the table and have no health insurance.

    • Trixie

      It depends heavily on the local community. In the community where I live, there are real CNMs with hospital privileges who also do homebirth for Plain people. The hospitals accommodate Amish culture quite a bit. The Amish do have c-sections and standard care here for the most part, although they also pay out of pocket and so tend to avoid extras if they can help it. This depends heavily on decades of work between the local medical community and Plain leaders to build a working relationship of trust. The Amish are not opposed to modern medical care for religious reasons.

  • Therese

    It doesn’t seem like it follows to conclude that CPMs need to be abolished. Of course, I agree that they do, but any NCBer is going to look at this and say, “Well, most of the problems mentioned wouldn’t have occurred if the midwife had been a CPM instead of just a lay midwife.” And I would have to agree with them based on my experience with the CPMs I used. They were both dangerous and incompetent in their own ways, but nowhere near the level of medical ignorance that is described here.

    • Amy M

      What is the difference between lay midwives and CPMs, especially in a case like this where the lay midwife has had years of experience and seen hundreds of births?

      Will a CPM risk a client out based on obstetric history? Or current issues? (previous C section, twins, breech)

      Do CPMs know how to measure blood loss accurately, know when to get a woman help, and know what help needs to be administered? Do they have the skills/legal ability to administer that help?

      Can CPMs do perineal repairs correctly?

      How about prenatal visits? Do CPMs look for GD and pre-e? What about ultrasounds? If a CPM does these tests, or has someone who can do them for her, and things get complicated, will she risk the client out, or ignore the results? Can she even interpret the results?

      I’ll come back later (have a meeting) to finish addressing the other issues….

      • Therese

        Most CPMs don’t seem to risk out for twins, VBACs and breeches, but they definitely have more knowledge of these conditions than what is described here. I think most CPMs would at least have some understanding of chorioncity in the case of twins and I have heard of CPMs reviewing medical records for VBACs to check for incision type, etc.

        Also CPMs measure blood loss in terms of cc’s. I don’t know if they do this accurately or not, but no way would they measure in terms of “a little” or “a lot”. They can administer pitocin, methergine, cytotec to stop bleeding. They do a basic newborn exam which doesn’t seem to differ at all from what is done in the hospital (besides not discouraging you if you decline vitamin K/eye ointment).

        Perineal repairs are covered in CPM training. I have no idea what their success rate is of doing it correctly, my only anecdotal evidence is I had no issues from the tear that my CPM stitched up.

        Yes, checking for pre-e would be standard, urine is tested at every appointment. GD would be left up to the mother and many probably would discourage the test or encourage alternate testing like the jelly bean test or just checking blood sugar a few times. But they at least know what GD is!

        Ultrasounds, yes, at least in my state CPMs can order ultrasounds and most people seem to have them (just judging by the fact that everyone I knew who used a CPM still knew what the sex of the baby was). CPMs are, of course, notorious for not risking people out that should be, but my point wasn’t to prove that the CPM credential is adequate, just that it is light years above what is described here.

        • Guest

          Is perineal repairs something CPMs actually learn? My friend had a homebirth with a fairly significant tear, and in order to get it repaired, her CPM told her she would have to go to the hospital. Of course she just let it heal on it’s own….shudders.

          • Therese

            They only learn how to repair 1st and 2nd degree tears. They are supposed to transfer for anything more severe.

          • Ash
          • Therese

            Okay, that is disturbing. The midwives in my area have it listed in their transfer criteria that they transfer for 3rd or 4th degree tears. CPMs are legally regulated where I live, but I could see in states where there really isn’t any legal oversight you could have CPMs attempting crazy things like this (and not that CPMs don’t attempt crazy things even with legal oversight, but I think it has to cut down on it somewhat).

          • Sue

            As a junior doctor many years ago, one of my duties on night shift was to suture perineal tears on the delivery ward. I was no expert, but already knew how to suture wounds, and had done surgical rotations and assists in OR.Of course, I was also given specific instruction on what to do – though, at the time, it was relatively brief.

            I hate to think what the suturing skills of HB CPMs would be – especially with no oversight or audit.

          • Bombshellrisa

            It seems like all the homebirth stories talk about a tear being repaired as “getting a few stitches for cosmetic reasons” and they are always talked about as being small tears.

          • Siri

            Apart from when they ‘tear an artery’, causing the woman to nearly bleed to death, that is!

          • Medwife

            I would be surprised if they could truly identify third and fourth degree tears.

          • Stacy48918

            I’ve never had an episiotomy or tearing so I wouldn’t know – but do they really use unswaged needles???? That picture of the needle alone makes me say OW!

          • Durango

            From what we have seen in various birth stories, more than a few midwives have trouble correctly diagnosing tears, that is, they’ll call a 4th degree tear a 2nd degree. Or they will think it’s just a little tear that doesn’t need suturing, when it does. Clearly many midwives are terrible at simple assessment, let alone suturing.

        • Amy M

          Based on what you say, it sounds like the CPM could be better than what is described here, but that depends on the CPM. Here I am thinking of the Gavin Michael debacle, with CPMs suggesting all sorts of crazy things in response to an alarming BPP with low fluid. Or Caroline Lovell, whose CPMs couldn’t calculate blood loss accurately and killed her. Even if the CPM has some kind of training, if she chooses not to apply it (on the grounds of “trust birth!” or something like that), its worthless.

        • Therese

          So pointless anecdote time: With my first birth, I tore and the CPM told me that I could have it stitched or let it heal on its own, but if I chose to forgo stitches I would need to keep my legs together. I did not want to bother with keeping my legs together so I elected to get stitches. No problems. Then with my hospital birth, the OB told me he would stitch it up if it was up to him, but that it would heal fine on its own. So since I didn’t want to be tortured any longer, I elected to forgo stitching. It took months to heal! It occurred to me later that maybe I was supposed to have kept my legs together. I wish he had phrased his advice differently and I would have opted for stitches that time too! But all I heard was “will heal fine on its own” so at the time it seemed like the easy way out. I just find it kind of ironic that the CPM used language that encouraged me to accept an intervention while the OB’s language discouraged it, even though I’m sure that was not his intention.

        • moto_librarian

          This is similar to the “not all midwives” argument that is used whenever an incompetent CPM or DEM is exposed. There are some CPMs who do practice within scope and are better than their peers, but you will never convince me that anything short of the CNM or CM credential is adequate. The PEP process is a sham, and give the number of CPMs who have flat out ignored high risk situations with bad outcomes gives me no faith in the process.

          Dr. Amy did an extremely revealing post on diagnosing and repairing tears some time ago. I wouldn’t trust a CPM to be able to accurately diagnose the stage of tearing, let alone repair it. In the hospital, CNMs call in their obstetrician colleagues to repair anything more serious than a first or second degree tear.

        • Amazed

          “I think most CPMs would at least have some understanding of chorioncity
          in the case of twins and I have heard of CPMs reviewing medical records
          for VBACs to check for incision type, etc”

          I’d like to introduce you to mwherbs or something, a proud member of MDC where no one bats an eyelid that she, as a midwife, doesn’t distinguish between mono and di twins and instead whines that ALL hospital births of twins were done at 34 week, leaving those poor midwives to care for twins carried to term and shoulder the adverse outcomes.

          • Amy M

            So what is she complaining about? She shouldn’t be delivering twins at all, regardless of gestational age, but if she is, better they are term than preemie, no? Also, she has no idea what she’s talking about…OBs won’t routinely take twins at 34wk–only if there’s some reason to do so, like pre-e, or ptl, or TTTS.

          • Amazed

            That twins are included in homebirth death stats, of course! Far be it from me to suggest that she doesn’t want to attend them. Her problem is that these births are “skewing” the stats against homebirth.

          • Therese

            Do we know that mwherbs is a CPM?

          • Bombshellrisa

            She is a licensed midwife in Arizona (but not a nurse-midwife). She claims the only difference between a direct entry or certified professional midwife and a CNM is that you don’t have to be a nurse first to get your CPM.

          • Bombshellrisa

            She is also complains that non nurse midwives are being stripped of their autonomy because of new state laws being passé about who can administer meds during a homebirth (apparently Arizona doesn’t find her qualified to do so)

        • fiftyfifty1

          “They do a basic newborn exam which doesn’t seem to differ at all from what is done in the hospital ”

          Navelgazing Midwife wrote a post stating the exact opposite. After leaving her practice as a CPM she wrote a post about what a bad/inadequate newborn exam she did back when she practiced, but hey, that’s how her mentors taught her and she never bothered to read up on it even though she owned a medical textbook that explained in detail how to do it correctly because frankly the birth is what’s interesting, not the baby. Her expose on this was really scary.

          • Dr Kitty

            There are YouTube VIDEOS on the newborn and 8week exams, mostly designed for medical students.

            If you, as a CPM/DEM, haven’t ONCE thought “I wonder how the paediatricians do this” and checked via Google…well, it is no wonder that graduating High School was seen as optional for CPM qualification until recently.

      • Basically, “lay midwives” and CPMs are often very similar. Some CPMs are adequate, many are completely out of their depth. There’s no regulation or licensing standards.

        • Amy M

          I know, but Therese seems to think there’s a big difference.

        • guest

          And there are also many CNMs who are also practicing this irresponsibly. Check out Evelyn Muhlhan, CNM, of 26 years, who regularly administered Pitocin IM BEFORE delivery, did twins, postdates and VBACs at home, and did not treat GDM or GBS. Not to mention had NO idea how to do neonatal resuscitation and showed up at delivery with empty 02 tanks.

          • Guest

            Hey she’s a “doula” now! ;). She can still try to wreck people’s lives!

          • Guest

            Ugghh…I know. Disgusting :(:(:(

          • Young CC Prof

            Most CNMs would never attend home births. But according to CDC records, the small number who do are just as bad as the other midwives. They are just as likely to deliver preemies, twins, first babies, postdates babies. And, they have just as many neonatal deaths.

            I personally have a bigger issue with people who have real medical training and deliberately refuse to use it than I do with people who are just plain ignorant.

          • guest

            Absolutely agree with this. I work with many great CNMs IN THE HOSPITAL but they would never do a homebirth.

      • fiftyfifty1

        CPMs are nothing more than lay midwives who have banded together and printed out fake credentials for each other.

    • attitude devant

      Therese, how do you know that this lady wasn’t a CPM? What makes you think a CPM is any better? The vast majority of CPMs (about 90%) are certified through the PEP process (‘portfolio evaluation’), meaning they haven’t done any formal coursework; they just sit for the NARM exam and submit a list of cases (30 cases!). 30 cases and a test (that can’t be all that hard if Amy Medwin and Faith Beltz passed it), and they hold the lives of mothers and babies in their hands. What a crock!

      • Amazed

        Anyone remember the woman who sought to obtain a CPM qualification through ONLINE courses? And she was actually referred to schools that offered those, IRRC.

        • attitude devant

          EXACTLY. Even Bastyr, which offers a Masters degree in midwifery has a mostly online program. But no worries! Twice a year you go to Seattle for ‘intensive skills workshops.’ And Birthingway in Portland may require in-person courses, but many of them (e.g. the course where you learn to write a birth story) are of highly questionable worth.

          • theadequatemother

            birth story writing: because communicating the narrative of the beautiful home birth to the world is more important than what actually happened.

            birth story writing – because rewriting the events into a beautiful homebirth narrative allows you to gaslight your clients when things aren’t actually beautiful or they don’t end well.

          • attitude devant

            (have to admit it: that was exactly my thought)

          • Sue

            These days, they probably include a session on Blog Writing.

          • Bombshellrisa

            Not to mention that to get your “catches”, you are left to find midwives to take you as a student or you have to go overseas (on your own dime). Nobody has the same training and the clinicals vary, so a student may see only one or two complications or only homebirth or only birth center births.

      • Therese

        The writer described her as a self taught granny lay midwife. I don’t think a CPM would be described that way. If she is a CPM, the author should have come straight out and stated that, it would have helped strengthen her case. As for why I think a CPM is better, I already said, I have never encountered a CPM with the medical ignorance described here. Maybe you’ve had different experiences as an OB, I don’t know. Of course, CPMs are way too incompetent to be delivering babies but I couldn’t imagine your average CPM doing half the things listed that this granny midwife did (or failed to do).

        • attitude devant

          My point is that there is nothing to keep her from being a CPM. There is nothing in the very minimal requirements of the certification process that ensures that people actually know anything. 30 catches and you’re good!

          • Therese

            Would someone like this be able to pass the NARM exam though? I really don’t know as I haven’t looked into what’s covered on it, but it just seems like if it covered very much at all this granny midwife would be lost.

          • Bombshellrisa

            Some words of advice from one CPM to someone getting ready to answer those 300 multiple choice questions on the NARM (from mothering.com)”My advice would be to NOT study…..you should already know what you need to know to pass the exam. If you feel like you need to brush up, Heart and Hands is more than enough. The NARM is not horrible, it’s very basic knowledge.

            I think the main point you need to remember is the exam is not state law specific, so forget about state laws when answering the questions. The answers will apply to the LM, the CPM, and those who practice illegally.” So if those practicing illegally are passing this test, it’s probably with about the same or less knowledge then the granny midwife mentioned in the post.

          • Therese

            But surely there would be things on it about recognizing postpartum hemorrhage and newborn exams and pre-e and all the other things this granny midwife knows nothing about?? I mean, it has 350 questions on it, surely it has to cover basic things like that! (I hope.)

          • anion

            A few months ago I tried to find some sort of online study guide for the exam, without much luck at all; it’s all very secretive. The few things I was able to find were largely about prenatal nutrition.

          • anion

            Here’s a study guide/online flash cards, posted by an individual:

            http://quizlet.com/7248631/narm-study-cards-flash-cards/

          • Bombshellrisa

            There are questions about allopathic remedies for things on the test. From what I understand, it’s not a test that asks for specifics.there are plenty of flash cards online that are supposed to be used as study guides.

          • Bombshellrisa

            https://answers.yahoo.com/question/index?qid=20080326151046AAZE4so
            These show some sample questions for the NARM
            “COMPETENCY THREE
            A birth report describes a labor that was progressing
            steadily to 4 cm, but later required pitocin augmentation
            and a forceps delivery. Which of the following common
            practices is MOST likely to have contributed to the need
            for pitocin and a forceps delivery?
            A. Bedrest
            B. Use of epidural anesthesia
            C. Withholding of foods and fluids
            D. Continuous electronic fetal monitoring ”
            Also from a CPM test prep site:
            1. A client at 11 weeks’ gestation complains of severe and extreme nausea and vomiting. During history taking, the midwife learns that the client vomits at least three times a day. An ultrasound is performed and reveals that the client is negative for hydatidiform mole and multiple pregnancy. The midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client?
            A. Increase oral intake of fluids.
            B. Administer 3,000 mL of Ringer’s lactate.
            C. Administer metoclopramide.
            D. Monitor fluid intake and urinary output.
            – See more at: http://www.practicequiz.com/test_engine.php#sthash.SzDtOT8C.dpuf

          • Amy M

            Wow, based on my understanding of their philosophy, and some googling, I think I could pass this test. Which is, of course, a total sham and mockery of the medical establishment. I’m going to guess the answer to the pitocin/forceps question was B or D (tho wo/more info, its hard to say, since we don’t know that either was administered), but even I know (and I am not a medical person at all) that NONE of those answers are correct. That’s insane. Maybe D first, which led to B?

            How about E: baby was not in an optimal position? or F:labor went on so long, uterine atony set in, and contractions petered out. Again, making total layperson guesses here, but I think those sound more likely reasons for pit/forceps than any of the listed reasons. Of course, with no information beyond: something happened after 4cm, I suppose we can jump to any crazy conclusion we like. Like G: Putting a hospital bracelet on the mother, and checking it every time a nurse comes by to do anything. (since they asked which common practice). I bet that was it. Nosy nurses, always causing forceps births. What a poorly designed test.

          • The Bofa, Being of the Sofa

            For the first one, I was thinking, “Progressing steadily to 4 cm” tells me it didn’t actually progress all that far in the first place. 4 cm is not very advanced in labor, so if it only got to 4 cm before stalling, and needed intervention, I would be concerned.

          • Bombshellrisa

            Forceps-cause every to time labor stalls out, out come the forceps. I am with you, it’s the intervention of the hospital bracelet or even the hospital gown. Plus nobody was praising her sphincter.

          • Amy M

            Well, I totally failed the CPM quiz, but it was very hospital based—that doesn’t make sense, since the CPMs can’t get anywhere near hospitals. Do they really need to take a quiz based on a hospital scenarios? (They should of course, be able to pass it, but little of it was relevant to homebirth, with the questions about administering medications, and Csections, and some about non-pregnancy related care.)

          • The Bofa, Being of the Sofa

            This has got to be a joke, right?

            What in the world are these doing on a CPM exam? The second one, in particular, I don’t even get. “The client is admitted for monitoring.” Admitted WHERE? Can’t be at the hospital, because CPMs don’t have hospital privilege. In a birth center?

            Is metoclopromide available without prescription? For that matter, can a CPM prescribe a Ringer’s lactate?

          • Siri

            I hope they put ice in that lactate; 3000ml is a hella big amount to gulp down when you’re already feeling nauseated…

          • The Bofa, Being of the Sofa

            Yeah, I even have trouble drinking that 44 oz cup of Mountain Dew (and I like MD)

            Actually, I am thinking about the IV – isn’t the standard bag 500 ml? That’s like 6 bags? Jeez, my wife will give a big dog maybe 3 if they are very dehydrated, but 6?

            BTW, what are the clinical signs of dehydration on the patient? How can you know what to do about fluids without assessing that?

          • Dr Kitty

            Yeah, don’t give 3L of Ringers lactate IV.
            Sodium and potassium concentrations are too low for rehydration from vomiting, and the volume is too large for someone who is only mildly dehydrated and still able to take fluids orally.

            That question at least has a clear wrong answer. The other is more philosophical than evidence based.

          • sdsures

            “Is metoclopromide available without prescription?”

            Not that I’m aware of.

          • Bombshellrisa

            Some of the CPMs are also NPs and can write scrips in my state, also they can rely on the NPs they know to write scrips for them.
            Isn’t there a bit of black market for this stuff, since it’s supposed to help increase breast milk production?

          • Amy M

            Well—now I took the practice quiz for CNMs. I got all but 3 correct. You know why? They were the SAME exact questions as the CPM quiz, only in a different order, and I remembered the answers from earlier (and learned something from reading them too!) And one that I got wrong twice was actually wrong–it said they instill sperm for IUI one day after ovulation, but in my experience, having done ART, they aimed for the 24-36hr window BEFORE ovulation, since sperm live longer than eggs. Unless something has changed with protocols over the last 6yrs.

            I looked at the CM quiz—also exactly the same.

          • Therese

            I guess where I am coming from is that the CPMs I have used have not been exceptionally good CPMs. They both were responsible for the deaths of babies. One of them had her license suspended by the state due to completely negligent behavior. So probably pretty typical as far as CPMs go. Yet the care I received from them was still so much better than what is described in the article.

  • Guest

    The part about pitocin makes me angry. So it’s ok for a midwife to administer pitocin for stalled labor at home, but heaven forbid a doctor should do the same at the hospital where a patient can be properly monitored. The hypocrisy runs deep.

  • Amy M

    Wow. So does she generally only see first time mothers? Or if she has repeat customers, only ones who have seen her, or other lay midwives before? Even as a non-medical layperson, anyone who was pregnant and had a baby through the typical OB in America would notice the extreme lack of attention. Now, I guess, anyone who switched to a lay midwife from an OB might welcome that, to a point, but even homebirth advocates want to go home with a healthy baby, with most of their blood in their body and not all torn up in their nether regions. Did any of her clients with less than stellar outcomes notice? Did they seek better care next time, and/or demand to know why she wasn’t really addressing their issues?

    This is appalling. I mean, obviously as a regular reader here, lay midwifery in general is appalling, but you’ve really outlined the specific problems in such detail. It’s amazing that women are willing to put up with that kind of negligence. It’s hard to believe they think this is how doctors would or should treat their patients.

    Anyway, I’m glad that you went on to become a real medical professional and got out of that nightmare waiting to happen. Someone like this (the lay midwife, I mean) must have a dead or disabled baby or two on her hands if she has been practicing long, but she’s probably real good at sweeping that sort of thing under the rug. If not, she’s incredibly lucky.

    • Therese

      Did you miss the part of the post where she said her clients were almost exclusively Amish? (asking in a non-snarky way)

      • Amy M

        No, I saw that…even an Amish woman with little exposure to the modern world would notice a gaping perineal tear, or a disabled baby. Would the Amish be more likely to accept this kind of treatment? If they all go to her, and none of them ever get sewed up, and many suffer from the consequences of perineal damage, do they suppose that’s just normal?

        • Therese

          Yeah, they might just accept it as normal. I mean, lots of people accept having a weakened pelvic floor and leaking urine as just a normal part of having had children. So I could see someone with even less exposure to the world of medicine accepting even more severe problems as just one of those things that happen after you have kids. And a disabled baby would be accepted as God’s will, I am sure.

          • Haelmoon

            They are also a genetically high risk group. There is a high level of inbreding (genetically so) and increased risk due to founder effects. There are a lot of recessive genetic disorders causing developmental delays in these populations. True, they are unlikely to sue of poor care, but they are not “accepting” of poor obstetrical care. Unfortunately, they are not highly educated so they don’t always know that poor care played a role. Where i used to work, the midwives were great and the Amish (and Menonnites) had a high level of respect for obstetrical intervention.

        • guest

          They actually have a lot of disabled children, but their beliefs prevent them from suing. Many unscrupulous providers know this and take advantage.

  • wookie130

    Oh my goodness…

    Thank you for this piece. It’s horrifying, but every pregnant woman needs to see read it.

    • wookie130

      Sorry! Every pregnant woman needs to read it.