Midwives think it is more important to rescue women from technology than to rescue babies from death

Got ethics?  Vintage wood type.

I don’t think I’ve ever read anything as heartless, coldblooded and self-interested as this anywhere else in the scientific literature.

Midwives have a pesky problem. Many people think that having a live baby is more important than having an unhindered birth. That’s especially true for the medical professional that has the thoroughly annoying habit of insisting that dead babies are unacceptable.

Never fear. Marie Hastings-Tolsma, PhD, CNM, FACNM, Professor, Nurse Midwifery, and Anna G.W. Nolte, PhD, RMc, Professor, Midwifery have come to their rescue with a philosophical “justification” for letting babies die in childbirth. Their piece in the journal Midwifery, Reconceptualising failure to rescue in midwifery: A concept analysis is a paean to the moral bankruptcy of contemporary midwifery in placing the avoidance of technology ABOVE saving babies’ lives.

The authors lay out the problem:

Obstetricians rescue women from dead babies and midwives rescue women from interference in the birth process.

Failure to rescue was developed by Silber et al. (1992) who suggested the term as an indicator of quality of care with focus on surgical patients in the inpatient setting though others have since suggested including medical patients. Failure to rescue was originally conceptualised as management of complications or preventing death after a complication and was operationalised to mean the number of patients that health care providers failed to save after developing surgical complications that were life-threatening. The original concept focused on recognition of unexpected though preventable events that influenced mortality. Subsequent effort has centred on the identification of interventions to reduce events through early recognition and the skills required to do so.

Therefore, the concept of “failure to rescue” in midwifery OUGHT to mean failure to prevent death after a complication, employing early recognition of complications and the technology to treat them. But midwives don’t like technology. That leaves them open to the charge of letting babies die by refusing to use the technology that would save their lives. You or I might imagine that dead babies would cause midwives to reassess their aversion to technology. Instead it has caused them to reassess their aversion to dead babies.

How? By insisting that failure to rescue women from technology is a greater calamity than failure to rescue babies from death, or even worse:

Failure to rescue as applied to labouring women likely undermines confidence in the ability to birth spontaneously and denies women access to normal birth. Such values have been purported to be of central concern to midwives worldwide

What’s a pile of tiny dead bodies compared to women’s confidence in their ability to birth spontaneously? Not worthy of concern, apparently.

Environments with high intensity of services may have short-term value for decreasing mortality for select patients with medical complication but at what cost when applied to those who are not with risk requiring continuous monitoring?

Sure, modern obstetrics may have short term value in preventing dead babies, but at what cost to unhindered birth?

Midwives believe that there is much more at stake than the lives of a bunch of babies. They can “rescue” women from technology! They offer:

…the unique contribution of midwifery surveillance in prevention of failure to rescue from unnecessary interventions during childbirth …

See! They’ve squared the circle! Midwives rescue, too. They just rescue women from different things. Obstetricians rescue women from dead babies and midwives rescue women from interference in the birth process.

Several organisations have been instrumental in calling attention to the quality and safety of hospitalised patients (e.g., Institute of Medicine, Agency for Healthcare Policy and Research and National Quality Forum) and concerns about iatrogenic harm as a result of care processes. For the perinatal patient, such harm has centred primarily on mortality, surgical intervention rates, admission to the intensive care unit, length of stay, readmissions, and trauma (Mann et al., 2006). Midwifery data for these quality indicators is often absent or data are provided for the same outcome measures, failing to differentiate them from physician-led care. Although midwifery data for these outcomes are crucial in detailing the quality, safety and cost of care, what is conspicuously absent are data which provide support for how the midwife has maintained normative birth processes.

But the Institute of Medicine, the Agency for Healthcare Policy and the National Quality Forum naively imagine that mortality is an indicator of quality and safety. Midwives know better:

Patients may need to be rescued from the health care system and midwives are challenged to so do. The importance of addressing maternal psychosocial and physical needs during birth is crucial, potentially preventing unnecessary physical and emotional suffering where birth is perceived as traumatic.

Because everyone knows that a dead baby is less traumatic that failing to prevent emotional suffering!

But wait! There’s more!

For conceptual fit with the midwifery philosophy of care, failure to rescue needs to be refocused as not only an outcome measure, but also as a process measure.

It’s almost as if they read my writing on midwives privileging process over outcome (a deep ethical and legal failure for any healthcare provider) and embraced it.

The process involved in midwifery care is the important phenomenon when assessing promotion of normal physiologic birth rather than the actual outcome… A successful rescue process means rescue from unnecessary interventions.

I couldn’t have said it better myself. There’s no truer evidence of the chilling moral bankruptcy of contemporary midwifery than that statement.

The authors recommend their reconceptualization:

Failure to rescue is a crucial phenomenon in midwifery care and is central in the protection and promotion of normal birth. At a time when few experience totally physiologic birth and with evidence that interference with normal processes increases the risk for complication, midwives are challenged to consider the need to rescue women from the health care system.

I’m prepared to go one step further:

Failure to rescue babies and mothers from death is an immoral, unethical phenomenon in contemporary midwifery and is central in the protection and promotion of THEMSELVES. Going forward, obstetricians are challenged to rescue women from MIDWIVES who place their professional concerns above the lives and health of babies and mothers.

  • Amy

    I’m wondering what “midwives” you are getting this information from as the basis of this artical? Have you actually had a real conversation with a midwife CPM or CNM? Besides reading articals and sensational new stories? Have you looked over the educational requirements for these midwives? I understand that the experience doesn’t compare to yours but to make these blanket statements about all midwives is extremely false and misleading. It really seems like it you have been hurt by someone in this field I hope one day you will find peace and not continue with all the negativity. If someone with you passion and knowledge worked together in a peaceful colaboration with the midwives you constantly put down imagine what change and impact you would create.

    • Who?

      I find articles an excellent source of information.

      Do tell us more about these articals of which you speak.

      • Amy

        For example This article that this post is written about. I find it interesting that she would state “Midwives think it is more important to rescue woman from technology than it is to rescue babies from death” I might have missed that quote in the article, but I didn’t read anything that says let the babies die so mom can have a wonderful intervention free birth. When the term “Midwives” is used I would also assume it would be in reference to more than one person who wrote a article, so who are the other midwives that think this?
        When blanket statements like these are made it puts all midwives in the same category.

    • Bombshellrisa

      Have you been reading here long enough to have seen how many midwives come here to “set us straight”? They have yet to vary in their responses, it all boils down to the same thing. Some of them have been so callous that they describe agony in getting an IV but refuse to admit that a laboring woman needs more than “support” to endure the pain of labor. There are also regulars here who are midwives (antigones CNM, medwife, crowned medwife).

      • Amy

        I actually just stumbled on this blog when I was searching for something else. Not all women need something more than “support” to endure labor, I’m not sure what you are referring to but not all woman want or need to be drugged either. I know in some cases an epidural was needed in labor to help an exhausted mom but that isn’t the case for everyone.

        • Bombshellrisa

          There have been midwives who are well educated, work in systems where midwifery is the default mode of care for low risk women and actually teach at university level who have come here and insisted that women need “support” NOT offers of epidurals or the choice to have a maternal request c-section. I don’t know what support is either, although I believe doulas can be helpful and can be an example of support. There are CNMs who believe maternal request c-sections are “moral quagmires” and still more who encourage women to do things “all naturally” even when they are going post dates.

        • Charybdis

          True. Not all women want or need to be *drugged* as you put it. You can get an epidural, which is targeted to the nerves of the uterus and as a local, regional analgesic (pain relieving) has very little to no effect on the baby. The medications involved in an epidural vary, often a local anesthetic coupled with a painkiller like fentanyl which reduces the amount of “caine” anesthetic needed. Then there are the opioid painkillers: morphine, demerol, stadol, fentanyl and the like. These can affect the baby, but are given IM or IV, if I remember correctly.

          There are a number of effective pain relief options available for a woman who desires it. And that should be the end of the discussion. She asks for pain relief, she gets it. Period. End of story. None of this wheedling, persuading, cajoling and bullying her into not getting any pain relief, nor should the midwife “forget” to pass the message along, or simply out and out ignore the request. Suggesting a position change or other coping mechanism until the pain relief arrives is okay, but don’t lie to or otherwise mislead a woman about pain relief when it has been requested or demanded.

        • Amazed

          “Drugged”. Another subtle dig, eh?

          Not all heartless idiots need to set people who know more than them straight but you do. All in the name of collecting nice income pretending to be a medical professional… unless shit starts flying around at which point you’ll throw your hands dramatically in the air and cry out, “Not a medical professional! Didn’t you do your homework before hiring ignorant me? You could have checked me, just like you would check a doctor!”

          Again, unfuckingbelievable. I don’t know of a doctor who can run away from a bad outcome and set up shop elsewhere, without any information about their failure ever reaching a place where prospective clients can find it. It’s “midwives'” territory.

    • PrimaryCareDoc

      Have YOU actually looked at the educational requirements for a CPM? And if so, do you find them to be adequate?

      • Amy

        I have looked at the requirements for CPMs. To my understanding it is an entry level certification. I also believe that when many midwives receive the certification they then work closely with an experienced midwife for a while before venturing out solo. I know this isn’t the case with everyone. I also think it is important for the people using CPMs to know what their experience as a CPM entails. It is poor judgement on the people using CPMs to not do their homework. I also think it is important for people to look into hospitals track records and what is the intervention and c-section rate is with the hospital/ob that they choose.

        • Roadstergal

          The question was, do you consider the educational requirements of a CPM to be adequate for primary care for pregnant and delivering women? Yes or no?

          • Amy

            Yes and no I think it depends on the person. Do newly graduated CNMs deliver babies by themselves?

          • attitude devant

            Amy, do you realize that over 90% of CPMs are certified through the PEP process, which is an online test plus being present at 30 births (which may include the births of their own children)? Can you seriously view this as adequate training for caring for pregnant women and newborns?

          • Amy

            That is not accurate of the needed requirements of a CPM candidate through the PEP process. I’m not sure where you are getting your information from. Have you looked at the NARM website?

          • attitude devant

            Yes, I have. And I just looked again. It’s fifty births, so I’ll grant you that I was wrong on that detail, although I’ve been told that some count double. And until recently they didn’t even require a high school diploma. I know this because one of our local CPMs doesn’t have one.

          • Roadstergal

            I do have to wonder how many New York city cabdrivers would be eligible to be CPMs…

          • Roadstergal

            “Yes and no I think it depends on the person”

            Requirements don’t depend on the person. Requirements are what we use to determine the standards of a given profession, the things we can be sure of when we are looking at a provider of a service. So do you consider the standards required to be a CPM adequate for primary care for pregnant and delivering women?

          • Squillo

            Sometimes. But the difference is that they have had more relevant didactic hours and more clinical hours of practice with a generally more diverse patient load (in terms of risk levels) than CPMs, meaning they are better trained to recognize and manage unexpected complications that can occur even in low-risk pregnancies and births. Moreover, no CNM has been educated and supervised by a single solo practitioner; they have been exposed to a variety of teachers and preceptors, unlike the >50% of CPMs credentialed through the PEP process.

            The vast majority of CNMs practice in hospitals, where there is additional trained help if needed in an emergency. A CPM attends home births with, at most, one more CPM, and often just an apprentice midwife. Meaning that, in the event of an emergency (one she has likely never even observed during training), she is the only practitioner with any skill at all; the life of the baby and, sometimes, the mother are in the hands of a single, entry-level practitioner and at least an ambulance or car ride and triage away from more skilled help.

            It isn’t a question of whether a single practitioner is qualified or not; it’s a question of whether the baseline educational, ethical, and oversight requirements of the profession are adequate.

          • The Bofa on the Sofa

            Yes and no I think it depends on the person.

            So you are saying that whether the CPM requirements are sufficient is independent of the actual requirements themselves? Doesn’t that tell your that the requirements are actually INSUFFICIENT?

          • Bombshellrisa

            Most CNMs have been RNs for years and have labor and delivery experience. If they are delivering babies just out of graduate school, odds are they will have been to more than 50 births. If you train to be a CPM, you observe five, act as assistant for 20 and be a primary (deliver the baby and do all labor care and after labor care) for 25 births. The training even through an accredited school isn’t that intense and a lot of it (at least through the really well known schools) is distance learning with a few on campus classes for most of the three years.

          • Amazed

            Yes? Then why did you roar like a lioness on CNMs behalf and was indignant that Dr Amy blended them with CPMs if CPMs were competent enough?

            Of course, that was just another tactic in your battle, so I am not surprised that the truth came out. CNMs have prominent presence on this board – Crowned Medwife, Medwife, Antigonos CNM. And they wholeheartedly support Dr Amy, despair in CPMs incompetence and take insult at being likened to them. But it doesn’t matter, does it? You already knew it since you replied to CrownedMedwife.

            It depends on the person? Bullshit. In my language school, we had a girl who was bad with languages. It just wasn’t her thing. She put forth more effort than any of us, yet her results were worse. But even she graduated with the minumal competence required and expected by the school. I would not hesitate to trust her with anything demanding this competence.

            But it’s different for your precious CPMs. Tell me, what’s so damned special about you (I guess you’re one. No one can play the fool for so long unless they have a vested interest) that you deserve to be thoroughly examined on one to one basis, losing people’s precious time and risking their babies’ very LIVES? And their own, of course,

          • Amy

            Wow! First it would be so nice to have an intellectual conversation with people here without all the profanity. Please expand your vocabulary or learn manners.
            The point that I was making and you stated it yourself is that two people can go through a program CNMs, CPMs, language classes, Dentist or anything and produce vastly different outcomes. One that is great and one that just meets minimum standards.
            I’m not sure where I roared and on anyone’s behalf? I’m just trying to point out flawed thinking when blanket statements are made that all Midwives think one way or another or practice one way or another.
            It seems like you feel all CPMs are baby killers when you have no idea that some may also be RNs. There is a lot of grey are in things and I’m sorry that you are so easily offended.

          • Amazed

            It would be nice, I agree. But I am not here to make it nice for you. You’ve made it nice enough for yourself already by pretending competence and collecting money for that. Money from people who don’t know you’re a scam artist.

            You whined that Dr Amy didn’t distinguish between CNMs and CPMs, more than once and pretended to be offended on CNMs behalf.

            Minumum standards ensure competence that’s enough to do a decent job. For CNMs, that’s enough to handle uncomplicated labours and deliveries. But MANA embraces “different roads of learning”, or some other nonsence like this. And you insist that CPM competence varying from person to person is a good thing. It isn’t and you acknlowledge it by insisting that parents should do their homework.

            Yes, I feel all CPMs are either babykillers or babykillers in waiting. That’s what lack of knowledge does.

            Again, nice try for a subtle attack. I am easily offended? You’re appallingly callous to life and death. Sadly, I am not even easily shocked. I’ve come to know your ilk by now. You all utilize the same talking points.

          • Amy

            What money am I collecting? What are you talking about? You know absolutely nothing about me.
            “Enough competence” to do a decent job now that is really scary thinking. Educate yourself, if people are ok without researching, asking others about the quality of care from any provider they are crazy. I would not put my care of my child’s care into someone just because they have certain letters after their name. MD, CNM or CPM.
            Sadly you utilize all the same talking points too.

          • Amazed

            Sorry. I thought you were protecting your outcome. So, you aren’t even a CPM? Why, then, are you such a heartless monster?

            If “enough competence” is so scary for your tender soul, you must be terrified by the fact that there’s no tiny requirements about CPMs, yet it’s all peachy with you.

            Please, make yourself useful and enlighten us: how does one do “research”, “ask others” and so on about a midwife who has been sheltered and protected by her “colleagues” after devastating a family and who ever so often moves shop and starts working under a different name?

          • DelphiniumFalcon

            Except those letters after an actual health care professional means something.

            If I see DDS after a practitioner’s name, I can reasonably assume they have completed schooling with hands on practice regarding human teeth and surrounding tissues. If a person has CNM after their name, I know they only have basic healthcare training for cleaning and moving patients so they’re not a doctor. A person with CRT after their name I can safely assume has completed additional training related to respitory therapy to a certain knowledge standard.

            What does CPM mean? Well they can catch a baby and I don’t know anything else. Have they studied female anatomy and physiology in depth? Do they understand chemistry and drug interactions? I don’t know what they studied or where they studied and not all programs are open about their training practices. Midwives in my state don’t even need to be registered so when I see “Healing Apothecary” on a building, what does that mean?

            With standard medical abbreviations, if I know what they mean I can make a pretty good guess right off the bat the kind of education they’ve received and had to show at least a passing level of competence with. I don’t know what CPM means from state to state. I do know what an OD and an MD are and their specific areas of practice. I at least know what a CNM has been educated in.

          • Azuran

            We are ok without researching because we know the letters after their name are proof that they went through a regulated and recognised education. They were then often selected by the hospital where they work and they are required to keep up to date with continuous education
            Also, all records of sanction against doctor and nurses (either following a lawsuit or some malpractice issue) are public.
            What more do you want? The result of all their tests during medical school? What high school they went to?
            Asking other people about the quality of care they received is also super biased and often the people you ask will not have the medical knowledge to actually understand what happened and will often remember things wrong or accuse doctors of things that were actually not their fault.
            I live in a small community, Whenever someone complains about our service on facebook or other social media, we end up seeing it somehow. And 99% of the time, their claim of wrongdoing on our part is total bull**** We get accused of the weirdest things and people get insulted at the smallest of things.

          • MaineJen

            I find it interesting that it’s the *profanity* that offends you. Not the fact that there is a second, woefully uneducated class of midwives who are passing themselves off as “certified professional midwives” and killing people with their ignorance. (Yes they are passing themselves off as healthcare providers. Look at the words.)

            And no, I’m not impressed that some RNs hold the CPM credential. Becoming a real midwife involves years of training ON TOP OF the RN. It doesn’t make the CPM credential any less bullshit.

          • rosewater7

            There’s a term for what you are saying…it’s called tone troll. PLEASE don’t focus on the profanity and the sometimes abrasive, aggressive attitudes. Read what they are talking about. Read what they are saying about how truly unsafe CPMs doing home birth are. NO ONE is saying that all CPMS are evil baby killing monsters. No one! What we are saying is that CPMs are sadly lacking in the skills needed to attend home births. And because of that, women and babies are suffering. And dying. Why is that so hard to understand? They may not MEAN to do what they are doing. BUT they are still doing it. And for that they bear responsibility. Why is this so confusing???

          • Bombshellrisa

            Oh we know that there are RNs who get their CPM. Valerie Runes is a good example of why that hardly makes a difference.

        • Ash

          So the blame is upon the prospective parents then?

          Tell me, when you are cared for by a physician, nurse, physical therapist, pharmacist, do you “do your homework”? If it turned out that a nurse at a hospital was a “certified professional nurse” with a high school degree and had done an “apprenticeship” instead of a Registered Nurse, would you consider it your fault that you didn’t do your homework?

          Ah, the old attitude of “YOU didn’t work hard enough on your birth”

          • Amy

            I never said the blame was on the parents. Why would you put your life and unborn child’s life in “inexperienced” hands. When I do go to a doctor yes I research about them and find out what their experience is and track record. If I am being cared for by a nurse yes I want to know if they are a student.
            If you are choosing to have your care with a CPM you know you are choosing someone without a “medical” background.
            How can you not work hard enough at your own birth? In my experience giving birth is hard work I never said it wasn’t. I am saying that parents need to be educated in whatever situation they choose.

          • Ash

            “Why would you put your life and unborn child’s life in “inexperienced” hands.” Good point! That’s why the the term “midwife” should be regulated so that CPMs aren’t allowed to call themselves “midwife”, just as you aren’t allowed to call yourself a nurse if you are not a Registered Nurse. These laws are in effect to protect people. We don’t allow people in certain professions to call themselves whatever title they want and then blame it on “lack of doing research” when uncredentialed people cause harm.

          • moto_librarian

            Because the “certified” in CPM implies a level of professionalization and competency. CPMs trade on the good reputation of CNMs. I didn’t even know that there was more than one kind of midwife until after I had given birth for the first time with a CNM in the hospital. It’s ridiculous.

        • PrimaryCareDoc

          CPMs are holding themselves out to be licensed, certified medical professionals. That ought to mean something. It shouldn’t mean that parents need to “do their homework” to see if the person claiming to be qualified to provide care actually has any qualifications.

          • Amy

            I do not see on the NARM or CPM credentials that they are claiming to be certified medical professionals. Please show me where it says that. The CPMs that I know specifically state that they are not medical professionals.

          • attitude devant

            The main page says “autonomous healthcare professionals” What does that mean to you, Amy?

          • The Bofa on the Sofa

            The main page says “autonomous healthcare professionals” What does that mean to you, Amy?

            It means she has to ignore it.

            And for pete’s sake, ok, let’s grant the premise that CPMs do not hold themselves up to be medical professionals.

            Are you fucking kidding me? Then what in the blazes are they doing selling their services as a primary attendant in childbirth?

            I don’t know what I find more appalling – the fact that Amy would deny that CPMs are claiming to be medical professionals, or that she thinks that it’s OK that they AREN’T medical professionals, as if that makes them acceptable? The thought horrifies me.

          • Roadstergal

            But Bofa, birth is a normal physiological process, not a medical condition. Deaths and damage to women and babies are just a normal physiological part of it all.

            Which brings us back to the article, which is all about how the ‘normal physiological’ part is the most important part. It definitely shows how even CNMs are jumping into the ‘sisterhood’ with both feet. I feel sorry for Crowned and Medwife, grouped in with the rest.

          • Amy

            So this is the point that I have been trying to make the whole time. This blog article groups all midwives together. CPMs and CNMs and you just said it yourself they are not the same. I would even push it further and say not all CNMs or OBs are educated, safe and professional similar to what is being said about CPMs.

          • The Bofa on the Sofa

            Hey Amy, tell us again about how CPMS don’t claim to be professional medical providers. That was really stupid, wasn’t it?

          • Amy

            So you are calling yourself stupid because you are the one calling a CPM a medical provider.

          • Bombshellrisa

            “CPMs practice as autonomous health professionals working within a network of relationships with other maternity care professionals who can provide consultation and collaboration when needed.”
            http://mana.org/pdfs/CPMIssueBrief.pdf
            Midwives of North America’s website describes Certified Professional Midwives as health care professionals.

          • The Bofa on the Sofa

            THEY are the ones calling themselves medical providers (“health care professionals”) and you are the one twisting yourself all over the place trying to make them NOT as an attempt to defend their lack of education and training.

            It would be funny if it weren’t lives that were in the balance.

            If they aren’t medical providers, what are they? Baby catchers? That’s all?

          • Bombshellrisa

            Space holders? Birth workers (as long as we don’t have to hear that woman talk about being a birth worker in a miniskirt again)? Birth keepers?

          • Roadstergal

            Placenta encapsulation?

          • Bombshellrisa

            Oh that is right, Wendy Gordon is a “placenta encapsulation specialist”!

          • Bombshellrisa

            It’s not the title that does that, it’s the unity in the belief that natural is best. Dr Amy has written many times about how she worked with CNMs and found them to be professional and well trained. The problem we are seeing is that midwives in countries where the education, training and licensure is extensive are not practicing in a way that differentiates them from CPMs and they are having the same bad outcomes.

          • Amy

            My understanding of a “health care professionals” is an umbrella term that is used for a group of workers that work together to improve human health. Health Care workers have obtained a liscense in a specific are of expertise. For example a health care worker is a doctor, nurse, midwife, dentist, chiropractor, and mental health professionals. So I would consider not all health care workers “medical”.
            The point that I am trying to make is that you are the ones falsely labelling CPMs as medical providers when it does not say that they are. I also believe that it is the responsibility of the CPM to explain exactly what their education and experience is and that they are not, most if not all do. It seems like your experience with CPMs are limited to the ones that just have negative outcomes.

            I am appalled that you can’t have a conversation without using profanities.

          • Bombshellrisa

            It’s confusing, if a CPM had LM after their name, then they usually are licensed in the state that they are practicing in. Some practice midwifery as Christian scientists, Native American medicine practitioners or along with a naturopathic doctor degree if the CPM is not a recognized title where they practice .

          • Amy

            Typically if a CPM is also a LM they are also abiding by the rules and regulations of the state the are practicing in. Typically there are other tests, skills and educational requirements needed to also be a LM.

          • Bombshellrisa

            To get a license in states that recognize the CPM as a licenced midwife you apply by submitting the form with your personal info and the fee, proof of CPM certification and of passing the NARM, documentation stating you have attended births and proof of AIDs education. You also have to submit your plan of transfer (means nothing without admitting privileges). If you are lacking any of those qualifications, you can still applyi for special licensure that allows you to work under supervision until you can complete all qualifications. Some states require proof that you took an obstetrical medication class, which most midwifery schools teach using herbs and homeopathic remedies.

          • Monkey Professor for a Head

            I’m a little confused by what you are saying. What’s the difference between medicine and healthcare. Is it that medicine is evidence based? Are medical professionals limited to doctors, or do nurses and CNMs also come under that umbrella? If a CPM administers a medication like pitocin then would that make them a medical professional?

          • The Bofa on the Sofa

            Your admission that CPMs are a bunch of amateur hacks and somehow that is OK with you IS APPALLING, and DOES drive me to profanities.

            It’s absofuckingly mind-blowing stupidity. I’ve never heard such awful callousness.

            I always say, I’ve been around internet discussions for more than 20 years, I’ve heard it all. But you have brought something new. Something so low that I couldn’t imagine it.

          • PrimaryCareDoc

            Sorry if my profanity offends your tender ears… but Holy shit. You have got to be fucking kidding me. This is a fucking joke, isn’t it? You don’t consider all those professions you listed to be “medical?”

            We are not the ones falsely labeling CPMs as medical providers. THEIR OWN FUCKING WEBSITE describes them as “autonomous healthcare professionals.” That is is not a fucking medical provider?

            You are fucking delusional.

            Fuck off.

          • The Bofa on the Sofa

            You don’t consider all those professions you listed to be “medical?”

            This is what she has to do in order to maintain her position. She has to twist herself completely in knots to the level of absurdity.

            All to avoid admitting she was wrong.

          • Roadstergal

            “You don’t consider all those professions you listed to be “medical?””

            To be fair, she did list chiropractors… but I certainly wouldn’t call them ‘health care providers.’

          • moto_librarian

            It’s quite simple, really. No other developed nation would allow CPMs to practice as midwives. The CPM is a vanity credential, yet it is used to lend a sense of legitimacy to people who want to deliver babies without actually getting the education and clinical experience required of CPMs. They have proven time and again that they have no interest in improving themselves as a profession, so it’s time to quit the charade and ban them from practicing.

            But hey, thanks for playing!

          • Roadstergal

            “They have proven time and again that they have no interest in improving themselves as a profession”

            Each individual CPM proved that by getting a CPM in the first place instead of a CNM, and all of the bullshit since then is just then hammering that point home (and presiding over preventable deaths in the process).

          • Valerie

            This discussion remind me of the laws for food labeling- there are specific legal differences between “beef dinner,” “with beef,” and “beef flavor” when you are buying dog food, but the majority of consumers don’t know the difference.

          • Roadstergal

            Another parallel to food labeling is that ‘natural’ is a meaningless term.

          • The Bofa on the Sofa

            The CPMs that I know specifically state that they are not medical professionals.

            So the implication, then, is that the midwife is not a medical role at all? Because “professional” is right there in their name, so they are professional somethings.

            What in the hell are they, then? Baby catchers? That’s all? Why do you even need a license, then?

          • Ash

            http://i.imgur.com/PEgNeWu.png

            From NARM’s webpage today. Do I need to add arrows too?

          • Roadstergal

            “We’re not certified medical professionals. We just call ourselves ‘autonomous health professionals’ and lead with a picture of one of us putting a stethoscope on a newborn.”

            Tangentially, the phrase ‘guardian of normal birth’ needs to die in a fire. And I’m calling bullshit on ‘competency-based certification.’

          • PrimaryCareDoc

            Are you serious? CPM stands for Certified Professional Midwife. I think it’s reasonable to call a midwife a medical professional. They are providing medical services for which they are charging money, are they not?

          • The Bofa on the Sofa

            See my comment below. They implication is that midwives don’t provide medical services

          • Bombshellrisa

            They can bill insurance, including Medicaid, in many states. They are listed as midwives and often mislabeled as CNMs in insurance provider booklets. I asked about that and the CPM I talked to said that they have told the insurance companies time and again that they are a different level of midwife and that the fault for listing them as something they are not lies with insurance company and how they code things.

          • Charybdis

            Then why the bloody hell are they involved in medical issues? Assuring pregnant women that they can do all the prenatal care, attend the birth and *prescribe*, sorry, RECOMMEND numerous herbs and castor oil and often carry pitocin and oxygen, the former for slipping unnoticed and unannounced to a hemorrhaging mother, the latter to have to blow by a newborn struggling to breathe or to give to the mother for “relaxation”?

            lt seems as if all they do is lie, mislead and misinform and then when called on it they do a mighty fine impression of a whiny toddler.

          • Amazed

            That’s… a… new… high. Fucking unbelievable. Even for a midwife clown. Just how cynical can you be in defense of your bloodied outcome made up from deluded women?

          • Nick Sanders

            Then what the hell does the C stand for?

          • DaisyGrrl

            Crazy. But don’t forget, #notallmidwives are crazy and dangerous so we should be cool with them and stop being meeeen.

          • fiftyfifty1

            “Sure my title is Certified Professional MIdwife, but I’ve NEVER claimed to be a certified medical professional. Where would you have gotten that silly idea?”

          • MaineJen

            CERTIFIED PROFESSIONAL MIDWIFE

        • rosewater7

          If the homework can be done. Bad homebirth outcomes don’t play well with NCBrs. Often mothers who don’t homebirth are blamed, shamed, put down and it is made to seem to be their fault. Look at Gavin Michael’s case. If CPMs don’t allow themselves to be held accountable publicly how is anyone else supposed to know about what they have done?

          • Amy

            I agree with you on that. But not all CPMs are crazy, uneducated risk takers wanting to put moms and babies at risk.

          • The Bofa on the Sofa

            But not all CPMs are crazy, uneducated risk takers wanting to put moms and babies at risk.

            ALL CPMs have chosen to forego the proper training needed to be a competent healthcare provider. If they did, they would not be CPMs.

          • Karen in SC

            cpms don’t know what they don’t know. that is how poorly they are trained for childbirth. Glaringly apparent when I attending the inquest for a lost baby at a birthing center. The cpms testified that they used the doppler, all was fine. It was the MDs that described in tragic detail how the baby died while they were using the doppler.

          • rosewater7

            Okay. I’ll buy that. But what far too many of them are, from what I’ve read, is woefully unprepared to handle complications. Over and over I’ve read stories of homebirths where mom has a PPH, shoulder dystocia, arrest of labor, arrest of descent. And on and on. And for whatever reason, the CPM doesn’t pull the trigger and insist on transfer. WHY? If CPMs want respect, they need to train and educate and admit that not every woman can home birth. That not every home birth ends in rosepetals and bubbles and butterflies. Look at Hurt by Homebirth. Look at #notburiedtwice. To get respect, CPMs need to prove themselves respectable. A homebirth where the baby is in NICU for preventable complications is NOT a success. A mom transported for PPH is NOT a success. A protracted painful labor is NOT a success. And I really wonder about CPMs-and their supporters-who insist that these things don’t matter. At least you had a vaginal home birth!

          • Bombshellrisa

            I don’t think any CPMs want to put babies and pregnant women at risk, they just don’t know enough to understand that they are.

          • Charybdis

            Then how exactly would you characterize them? Naive? Delusional? Misguided? Blinded by ignorance? Willfully ignorant? Unwilling to consider an opinion that doesn’t agree with their worldview? All of the above?

          • momofone

            I wouldn’t stake my baby’s life–or mine–on wondering whether I got one who wasn’t, and they certainly aren’t sharing that information.

          • Who?

            But if some are, why bother with any? Why wouldn’t the ‘good’ CPMs-if such a thing can be imagined-be drumming out the bad ones?

        • Amazed

          “It is poor judgement on the people using CPMs to not do their homework”

          Really? I, for one, wouldn’t expect anyone to have to learn how-any-years of medical textbooks just to know if the loon they want to hire and PAY to is bulshitting them, playing with their lives and their children’s lives.

          The fact that you think close work with a single midwife, no matter how “experienced” (howling with laugher at THIS idiocy. Birth complications happen in the digits of hundred and thousand and CPMs with about 300 births under their belts fancy themselves so knowledgeable and experienced! What? You didn’t know this? You didn’t do your homework? You know, it’s poor judgment on people whiteknighting fucking baby murderers and maimers to not do their homework.) the “midwife” is can be enough is telling me all I need about you. You’re an uneducated clown. But then, I already knew it before I reached this paragraph of victim-blaming.

        • SporkParade

          Ignoring how disgusted I am by natural childbirth advocates treating C-section as a negative outcome as opposed to just another way to deliver a baby, the C-section rate of an individual doctor or hospital is totally meaningless. Maybe the hospital or the OB specialize in high-risk cases, which would drive the rate up. Maybe the OB has a reputation of being friendly towards women who prefer C-section by maternal request, and so they form a disproportionately large part of their practice. In any event, we know that drives to reduce the C-section rate increase the rate of forceps and vacuum delivery, which are far more damaging to women and babies than C-sections.

    • CrownedMedwife

      Not speaking for Dr. Amy, but I’ve had my own ‘real’ conversations with CPMs. It always seems those conversations precede catastrophes such as the fetal heart tones were fine up until transfer for arrest of descent, followed by the birth of a macerated fetus of a mother with multiple comorbidities that would have prompted delivery of a live baby weeks earlier under the care of CNM or OB. Let’s see, there’s always the classic case of the uterine atony of a grandmultiparous women with a history of PPH, followed shortly by the initiation of the massive transfusion protocol within minutes of admission. Yeah, I’ve had conversations with CPMs. Again, not speaking for Dr. Amy, but I’ve had more conversations with CPMs than I could ever want.

      As a CNM, I find your statement placing CPMs and CNMs in the same midwife category offensive. My education, practice, experience, objectives and outcomes are a world away from a CPM. Just because CNMs and CPMs are at the receiving end of a birth does not mean we are anything alike.

      We are not ‘sisters’. I have no intention of a peaceful collaboration with CPMs. Their willful ignorance at the risk they place on women and babies is appalling. Do low risk homebirths with positive outcomes occur in the hands of CPMs? I suppose so, but it most certainly isn’t due to the CPM skill set. Birth happens and sometimes it doesn’t need a damn thing to help it, which is good because that’s about all CPMs have to offer. The frightening truth is that their ignorance to the identification and realities of risk over the process is a threat to public health. Those that choose, at an individual or organizational level, to recognize CPMs as actual providers, is just as much at fault.

      As for CNMs having a ‘real’ conversation with Dr. Amy, I’m sure there have been many. For my own n=1, I’ve had the opportunity and I’ve thoroughly enjoyed it. Lovely woman. If you can’t interpret her objective from negativity, then it is likely you may be a part of the problem. Actual health care providers strive for high standards and good outcomes. When poorly educated people give themselves a title with little standards and variable outcomes, it tends to cause some negativity to those of us who really know what we are doing.

      • Dr Kitty

        How do you break it to someone that their baby, who the CPMs were apparently monitoring throughout labour, actually died days ago?

        That is just awful, but not entirely unexpected.

      • Amy

        I wasn’t the one putting CPMs and CNMs in the same category. I believe Dr. Amy was by using an article that was written by a CNM and also just using the term “Midwives”. Unless as a CNM you don’t refer to yourself as a midwife? I’m sorry that I offended you it wasn’t my intent.
        I know that your training as a CNM is totally different than a CPM. It is also extremely ignorant of you to think that all CPMs are ignorant and not trained or educated. This makes you part of the problem. No one wants a baby or mother to die. If there was more openness in working together maybe there wouldn’t be transfers in a dire emergency situations. I know working in a hospital setting you are the ones to pick up the train wreck situations but there has to be a better solution than belittling each other.
        There are always going to be women who want an out of hospital birth. So how do you provide care for them? Let them just birth without anyone there?

        • theNormalDistribution

          It is also extremely ignorant of you to think that all CPMs are ignorant and not trained or educated.

          Feel free to enlighten us as to the years of training and stringent requirements for CPM designation. I’m sure it will be the first time ever we’ve heard about it.

        • The Bofa on the Sofa

          It is also extremely ignorant of you to think that all CPMs are ignorant and not trained or educated.

          Bofa’s Law: if your defense of a group consists of “not all of them are bad” then that group has a serious problem.

          • attitude devant

            I think the “not all CPMs” defense is HILARIOUS. If a credential does not certify that you are well-trained and competent, then why have the credential at all?

          • Amy

            So you are saying all CNMs and OBs are adequately trained and make no mistakes, and OBs or CNMs have never killed a mom and/or baby by being inexperienced or using/abusing their medical interventions. According to Bofas Law of not all of them are bad it would apply to this group of professionals too.
            I have met some really bad, inexperienced and unprofessional OBs and CNMs so for me to say they are all like that is wrong of me. Just because you have experience with unprofessional,or uneducated CPMs to say they are all like that is wrong of you.

          • The Bofa on the Sofa

            There is a world of difference between “there are some bad eggs in the basket” and “not all of the eggs are bad”

            If you can’t tell the difference, you are not looking

          • The Bofa on the Sofa

            OK, so I went to bed thinking about my “some bad eggs” analogy. And I realized how apt it is.

            When we buy eggs from the store, we always open them up to make sure there are no obviously bad ones. No cracks, for example.

            The reason we do that is because, although the eggs are generally ok, there are occasional bad ones.

            Now, suppose there were a store down the road that also sells eggs, but in that store, the eggs are mostly cracked, and instead of opening the box to make sure there weren’t any bad ones, you have to open the boxes to try to find the occasional good one, and if you open enough of the boxes, you might be able to get enough to fill a dozen.

            So in store 1, we might find a bad egg once every 10 dozen we buy, maybe. In store two, we have to open 10 boxes to find a dozen good ones.

            Now Amy thinks those two stores are equal. At the second store, not all the eggs are bad. And there are broken eggs at the first store.

            Meanwhile, Bofa’s Law says that store 2 has a problem. BTW, notice that no one says “All the store 1 are good,” so making that accusation is just a strawman. But then again, no one describes store 1 as “not all the eggs are bad,” either.

            This is the difference between “there are a few bad eggs” and “the eggs aren’t all bad.”

            I’m sure Amy shops at a store where the eggs aren’t all bad…

          • Squillo

            Given how little actual information is available on non-nurse midwives in some states, it’s more like selecting your eggs when the box is cemented closed.

          • rosewater7

            If a CNM or an OB commits the kind of gross medical malpractice and/or negligence that some CPMs have, there is a system in place that holds them accountable. Licenses being pulled, suspension, censures. They can be sued for damages. Their wrongdoings are often public knowledge that anyone can access.

            No one here is saying that CNMs/OBs are beyond reproach. No one is saying that they have never killed a mom or a baby. Look for the Morecombe Bay posts. Everyone posting excoriated those midwives.

            There are CPMs and lay midwives who have killed again and again and again. Google Lisa Barrett. Faith Beltz. Brenda Scarpino. Valerie El Halta. Christy Collins. They made the same mistakes again and again. The babies they delivered are in cemeteries.

            Google Liz Paparella. Sara Snyder. See what happened to them when they tried to seek justice for their children who died at the hands of incompetent midwives. And they are just 2 mothers. How many more are unknown because they had NO legal recourse?

            Childbirth is not like a hand of blackjack. If you pull bad cards, you may not be able to get a better hand dealt to you.

            How big a gamble do you want to take? Yes, in a hospital you may get a crappy doctor or CNM. But the chances of NOT getting one-or of another part of the system working to keep you and your baby alive even if that happens-are far better than the odds of what will happen if a CPM ends up over her head.

            PLEASE don’t drag that tired old adage “Babies die in hospitals too!” Yes…they do. But far more often than at home…THEY LIVE.

          • Bombshellrisa

            #GavinMichael #notburiedtwice
            And the midwives you mentioned are just the ones that have known losses. There are plenty of midwives who injure and kill and the families never try to hold them accountable because they either are brainwashed (the midwife used all the From Calling to Courtroom tactics early and often) or have hit a dead end and there is nothing that can be done.

          • Azuran

            They are all, actually, adequately trained. Some of them might be better than other, and experience is of course important, but all of them will have a guaranteed standard formation.
            When you see a Doctor or CNM, you don’t have to ‘do your homework’ and check out how she was trained to find out if she is properly qualified. And you shouldn’t have to, because the Dr. or CNM credential have actual value.

            Then there is accountability, which rosewater7 explained so I’m not going to repeat that.

          • PrimaryCareDoc

            Yes, they are all adequately trained. That’s not to say that some of them are not incompetent, as there are always people who slip through the cracks, and people certainly make mistakes. But yes, they are all adequately trained.

          • CrownedMedwife

            By what standard are YOU qualified to have deemed those OBs and CNMs as “really bad, inexperienced and unprofessional”? Perhaps you could also provide examples. It’s fairly difficult to complete a residency or internship and remain inexperienced. There’s also a difference between an OB being “unprofessional” and stating the facts that may be contrary to what someone wants to hear.

        • CrownedMedwife

          Dr. Amy’s post references a dangerous concept of a Midwifery tenet as it prioritizes the Midwife as the Protector and Obstetrics as the threat. It does not reference a specific type of Midwife. I find it shameful to have been written by a CNM and concur with Dr. Amy’s sentiments as to its message as immoral and unethical. Any CNM worth his or her title, knows her abilities and outcomes are only as optimal or futile as the physicians and interventions available when they are needed.

          It is not ignorant of me to think all CPMs are ignorant, untrained or uneducated. A midwife cannot be expected or capable of identifying or mitigating risk without a thorough concept of biology, chemistry, anatomy or physiology in order to grasp the reality of pathophysiology. We do have midwives with that knowledge and experience, they’re called CNMs. We don’t need an inferior level of midwives to sully the midwife title with their ignorance. That ignorance is precisely what allows a CPMs conscience to attend mothers with a plethora of risk factors or markedly remote from resources. They just don’t get it. What’s worse is their ability to market themselves as safe and professional, instilling fear and distrust of the medical model, all the while displaying their martyrdom complex with a claim to protect birth in the unmet need of homebirth attendants.

          Part of the problem? Openness in working together? You’re barking up the wrong tree. Not a chance in hell. CPMs want to be integrated into the system, respected as providers and develop a collaborative process? CPMs don’t get to stomp their feet and demand those opportunities. They haven’t earned it and if they had, they’d hold the title CNM.

          As for out of hospital births, CNMs can attend homebirths in most states. The majority CHOOSE not to attend homebirths. They have the experience and knowledge to identify risk, value resources and a professional expectation to provide an optimal outcome. I am thoroughly disgusted by the martyrdom of CPMs that clammors to serve an unmet need as homebirth attendants. It makes no sense to give an uneducated person a title in a resource poor environment and expect it to meet a need.

          All that said, do not mistake my message as unwavering support of CNMs. I believe CNMs are the minimal standard of educated provider women should be ensured, but nonetheless there are CNMs ignorant to risk, placing value on process over outcome and practicing distant from the resources and physicians capable of keeping birth as safe as it should be. While those CNMs may be the minority, the lack of integrity of their professional organization permits and promotes that practice with its misplaced objective of process and is in dire need of an overhaul.

          • Roadstergal

            Beautifully put, comprehensive answer.

      • The Bofa on the Sofa

        If I get permission from my wife, will you marry me?

  • Anna

    Technology is the product of human intelligence and it is a blessing.Western women should feel lucky to have access to epidurals and to have the possibility of a life saving emergency c section.My two youngest boys were born via c section and I can t imagine the pain of not having them with me.It is OK that I wasn t “saved” from painful surgeries,I don t care as I was saved from losing my sons.
    Putting à baby s life in danger for thé saké of natural birth or homebirth is not ” saving ” women,it is taking the risk of them knowing the worst emotional pain that exists: losing a baby and being the one to blame for the loss.
    The only acceptable outcome is the birth of a live healthy baby and yes in some cases the only way to achieve this is to undergo medical procedures that require anesthesia and can be scary ,it is a reality but a newborn baby is worth every second of fear.Accepting the help of technology is just accepting what could make the différence between life and death for your child,it is mature and responsible.

  • Elaine

    “[…there is] evidence that interference with normal processes increases the risk for complication”

    The authors are NOT suggesting that babies be left to die. They are saying that some interventions in low risk births actually increase risk to both mother and baby and that the concept of “failure to rescue” can be a useful way of thinking about these situations.

    An analogy might be the old practice of removing a healthy appendix “just in case”–while an untreated ruptured appendix is fatal, that does NOT mean that people without appendicitis are well served by prophylactic appendectomies.

    Perhaps a course in remedial reading comprehension would be useful. At any rate, perhaps in the future you could discuss your positions without ad hominem attacks and out of context quotes.

    • Nick Sanders

      Except it’s been shown that midwives’ definition of “normal” extends well beyond low risk births.

    • Azuran

      To push your appendix analogy.
      Doctors will monitor your appendix and if anything seems to be going wrong and they fear a risk of rupture, they will do an appendectomy.
      With CPM they will not monitor your appendix and will only notice that something is wrong until you rupture and end up in septic chock. Then they rush you to the hospital for an emergency appendectomy with an unstable patient. Which is more risky.

      The midwife will probably have a lower rate of ‘appendectomy’ than the doctor. But is it really the best way to go? Should we wait until people have ruptured appendix to go to surgery?

      Doctor practice preventive medecine. They monitor the birth to ensure that they can act BEFORE anything serious happen.
      They do know the risk and benefits of the interventions they propose. If they propose it, it’s because doing it is less risky than not doing it.
      Sure, you can have a totally intervention free labour. But the only thing it means is that you have no idea how the birth affected your baby. Just because you didn’t monitor him didn’t mean he didn’t have decels or other problems. It just means you didn’t see them.

    • Linden

      So, with the choice between “interference” (actually, that should be observation) and ignorance, midwives should choose ignorance, so that interventions don’t happen. And when something horrible happens, they should be the objects of pity, because the trauma of “failing to rescue”.
      I’d feel immense sympathy for a carer that did their best and still couldn’t save their charges. These women are talking about witholding care, because giving it might cause “complications”. They can pound sand. Cpms can’t fix any complication more urgent than, “i’m thirsty and would like a cup of tea.”

      • Linden

        But feel free to carry on defending the indefensible, Elaine.

    • Karen in SC

      No one is having prophylactic appendectomies as a stand alone surgery. What you are referring to is the practice of removing the appendix during another abdominal surgery. I know of a women who had her ovaries removed and also her appendix. Little or no extra risk. Sounds like a good idea – and one could always say no.

    • Dr Kitty

      I had what we thought was appendicitis.
      When they opened me up it turned out to be a massive ovarian cyst which had ruptured. As well as sucking out all the blood and fluid floating about, the surgeons also took my appendix.
      Which is very sensible.

      The next time I have right iliac fossa pain, I know it can’t be appendicitis. If I collapse on the street with evidence of abdominal sepsis and can’t speak, the surgeons will see my scars and know I don’t have an appendix.

      If you leave healthy appendices behind, you have people with scars that look as if they have had an apendicectomy, but who haven’t. This has led to deaths in the past when they have developed appendicitis, but nobody thinks it is possible, because everyone thinks the appendix was removed.

      Nobody removes a healthy appendix “just in case”, they open you up believing it is appendicitis, and take the appendix out, no matter what it looks like, because it makes more sense than leaving it behind. Bad analogy.

  • Staceyjw

    Thats some scary stuff. I cannot believe they actually think that “physiologic birth” (because it could be non physiological??) aka “normal birth” is more important that LIFE. Women don’t generally have babies for the process; all but the most far out of NCBers have a baby so they can have a baby, not a birth!

    I also don’t have any idea why they think “normal” birth is at once so rare, and also that something so rare could even be considered “normal”. Normal means the norm, and if NCB is son rare, its NOT normal. Sigh. They are idiots. Dangerous idiots.

  • Bugsy

    OT: is intermittent light bleeding at 17 days postpartum a sign of too much activity?

    #2 was born 17 days ago, a quick vaginal delivery w/ an episiotomy. He weighed in at 8 lbs, 8 oz. The bleeding has been steadily declining so that generally there’s barely any discolouration throughout the day, but each day I’ve had one small gush of bright red blood. I generally feel great and I think I’ve been healing pretty well.

    I have an appt with my family doc tomorrow, but put in a call to my public health nurse on Friday at 14 days postpartum. She mentioned that the gushes signify too much activity, and that the scab where the placenta attached isn’t healing properly.

    I took her advice and spent the weekend pretty much dormant, yet went to the bathroom in the middle of the night to find another small gush. Frankly, it’s causing me to feel a bit like a failure: physically I feel great and emotionally am ready for light activity (mild walks, shopping), but worry it will cause another bleed. So I feel like I’m failing because I’m not listening to my body’s wanting a bit more activity. I feel like a failure as a mom because I can’t take care of my toddler – he loves being held and chased around. And despite my best efforts to take it easy all weekend, I feel like a failure because my body is still producing these random bleeds.

    Is the public health nurse correct that these types of bleeds are a sign of too much activity? The amount of blood being produced doesn’t seem to be a concern – from what I can gather, it’s somewhere around a teaspoon at most.

    Thanks.

    • Dr Kitty

      Not my area of expertise, but if you feel well, there is no pain or fever or odour and the bleeding isn’t excessive, I wouldn’t worry.
      Some people bleed for longer. Some people, because of quirks of anatomy, rather than constant loss seem to have gushes, maybe because the blood pools in the uterus or upper vagina.

      If you are becoming miserable doing nothing, go ahead and do what you feel comfortable with, if the bleeding gets markedly worse, dial it back.

      Clots, pain, fever, odour or very heavy bleeding, see your Dr.
      Oh, and don’t forget that if you’re not exclusively BF your period might come back in the next 2-4 weeks…

      • Bugsy

        Thanks, Dr. Kitty. It is a challenge between wanting to stay emotionally happy and being 100% as cautious as possible. I am going to try upping my activity to more normal levels to see how my body reacts. So far, I’ve none of the other concerns you mention…just the occasional and random bleed (and feeling great physically otherwise). Thanks for your take on it. 🙂

        • Kelly

          I bleed for six weeks with my second and three to four weeks with my first and third. It can go on even longer. My doctor told me that it can take longer to finish up bleeding with each child because your uterus is being stretched out more and more. I had big clots with my first and third child and it seemed to make me bleed for less time.

          • Bugsy

            Thanks – that makes a lot of sense. The bleeding w #1 stopped after 10 days – I remember trying to convince my OB at the time to let me.go swimming in the ocean – so its lasting longer is definitely new to me.

    • Chant de la Mer

      I had bleeding, red blood, for 4 weeks with my last one. It wasn’t heavy and would come and go. I took it pretty easy at first because I was sore but after 2 weeks I was active again and it didn’t seem to be related to activity.

      • Bugsy

        Thanks – it sounds very similar to what I’m experiencing!

  • yentavegan

    Are you by any chance a parent- to- be searching the internet for information about labor and birth? Are you being psychologically charmed, groomed and courted by the natural birth industry ? Are you being told that birth is an emotionally empowering experience and that the medical establishment is designed to rob you of that experience because medicine is a patriarchal and oppressive to women? It is easy to be swayed by seductive speech when facing the unknown
    . Birth is a process you can prepare for by learning about the stages of labor and you can hedge your chances of coming through the process alive, unscathed, fertile and with a thriving infant. Take your prenatal vitamins, don’t smoke, use recreational drugs, or have unprotected intercourse with anyone who is not 100% monogamous. Watch your caloric intake ,try not to gain excessive weight and most importantly see your ob/gyn and follow their recommendations.
    Do not belittle your self worth focusing on the function of your uterus, cervix, perineum etc…. you are not the sum total of your body parts although the Natural Birth industry needs you to believe that you are, and that you can be in control of the birth process.
    Your reproductive system is like every other organ in your body. Even really intuitive healthy moms sometimes need glasses, have diabetes, a heart murmur, hearing loss , dental cavities, asthma, herpes etc… some of these conditions are genetic and some are environmental. If it were not for advances in science and medicine these conditions are life threatening and/or fatal. On the day that it matters most, do not fall victim to the misogynist eugenics of the Natural Birth Industry. Science has so much to offer to make available to you and your fetus the best possible outcomes. You can burn candles, beat drums, soak in a tub of elixirs and listen to whale mating calls on the day after.

    • Who?

      Vote up.

  • nomofear

    OT – the anti-GMO crowd is working hard to silence science: http://gmofaq.blogspot.com/2015/11/nicholas-taleb-used-his-doomsday-cult.html?m=1

    • Nick Sanders

      I hate that he shares my name.

  • Susan

    Forgive me if this is already discussed… I browsed through the comments and I don’t see it.
    https://www.yahoo.com/parenting/woman-sues-hospital-for-traumatic-birth-that-201605478.html

    • Paloma

      She doesn’t really say what happened to her, it’s hard to really give an opinion with so little information. From what I gather, she is having pelvic floor related problems, but a woman with 3 previous vaginal births (4 counting this one), it isn’t all that difficult to imagine her having any number of problems, even if it had been 4 uneventful normal births.

      • Kelly

        I agree. There were not enough specifics to the story and or course we can’t get the hospital’s side in this either. I hope that the courts will sort it out and not give in to the women if they are being a bit whiny.

  • Taysha

    …why are they still using computers?

    Or phones? Or Facebook, twitter, online journals and email?

    • Chi

      Because if you have a baby unassisted in the woods and there’s no one around to brag to about it, it doesn’t count.

      • Who?

        This is so perfectly accurate. It’s all about the show.

        • Chi

          I was being a smart-ass and parodying the “If a tree falls in the woods” metaphor, but yeah, it is surprising how apt it actually wound up being.

          Because truly, homebirth is ALL about the mother’s narcissism. It’s all about THEIR experience. Healthy baby? Oh that’s just a bonus to them. They just want to brag about how beautiful and empowering it was.

          And of course midwives just egg them on to protect their income.

          Someone referred to NCBers as ‘spoiled’. And I would have to agree. They’re spoiled because in our society, they can take all the risks they like and when it all goes to shit, they can go to a hospital and have them clean up the mess. And if it ends badly, well it was probably the evil hospital’s fault.

          What really sickens me are the midwives responsible for dead babies turning around and blaming the mothers they duped into NEEDING that wonderful, beautiful empowering experience because they didn’t ‘trust’ birth enough.

          This is WHY we have modern obstetrics. Yes, it seems cold in comparison to the (fake) warmth of these (fake) midwives, but their focus is where it should be, ON THE OUTCOME. Which is a healthy baby and a healthy mum. All those interventions are a means to that end. All those women who scream about them being unnecessary have obviously never had a birth where they were and where they saved baby/mum’s life.

          • Who?

            I think there are a lot of women who truly don’t get it-for whatever reason they have fallen under the NCB spell.

            Some are control freaks who think they always make the best and most informed choice, and who seek certainty the medical profession won’t offer; some maybe lacking social or family support they feel okay about relying on; some with anxiety about hospitals, doctors, medical procedures.

            Not that any of that matters when there is a death or serious injury, but nuances around how we discuss these issues might well make a chink in various pieces of armour.

            But yes, the midwives, particularly those with some actual education, who should know better, are a disgrace.

          • Chi

            Exactly. And as has been stated before, if midwives REALLY wanted to help, they’d work WITH the doctors to help alleviate some of the distrust and fear people associate with hospitals.

            They’d work with doctors to see where the system is letting people down and figure out how to, if not fix, then make it better, make it easier, and above all, make it safer.

            Rather that sequestering women at home and terrifying them with lies about the big bad evil hospital and the evil doctors who only want to cut you for profit.

            Which is also the biggest load of hypocrisy EVER. I don’t know how it works in the states, but here in NZ, midwives get a BONUS for attending a home birth. They get a smaller bonus for a freestanding birth clinic birth.

            So who’s in it for the profit?

  • She

    Rescue women from the health care system? The health care system rescued me and my baby. The only ‘traumatic’ part of it was the pain of being in transition labor for 6 hours or so with a failed epidural, and not understanding why I was having so much difficulty. The c-section was my favorite part of the whole deal. Nobody died or even had any lasting injuries.

  • Adelaide GP

    Wow, that scientific journal manner of writing almost has an Orwellian doublespeak quality to it. Their real meaning is opaque on just casual reading, blah blah blah, interventions, blah blah blah, science blah blah blah evidence blah blah blah interventions blah blah blah physiological. Love the juxtaposition of Dr Amy’s punchy straight talking translation , keep them honest lol

    • Who?

      I’m just blown away by what they are happy to write down. Either they are entirely unaware of the impression their words might make outside their immediate world, or don’t care.

      • Mishimoo

        I’d go with the latter. It also rather reminds me of the attitudes found in the antivax movement. “We’re right, and anyone who disagrees with us is either just not enlightened yet or a tool of Big Pharma. Let us help you mamas, we just want what’s best!”

  • KarenJJ

    Newly pregnant woman: “I’m having a baby!”.
    Midwife: “You’re having a birth!”

    • lilin

      Perfect.

  • WordSpinner

    My, uh, favorite part was the phrase “normative birth process”. Normative is not, in fact, a fancy way of saying “normal”. In actual academic parlance (sociology and philosophy) it means “how things should be”, or more precisely “how this value system/culture has defined how things should be”.

    Which is exactly what vaginal birth is for NCBers: normative, not normal, not safest, but what Should Be because Reasons.

    (Cite on how normative is used: https://en.wikipedia.org/wiki/Normative)

    • Valerie

      I liked the assertion that women giving birth is “the fundamentally most normal event of all.” What definition of “normal” could they possibly be using here? I just scrolled through Dictionary.com and didn’t find one that made much sense.

      • Who?

        ‘Normal’ has become a word that carries good deal of judgment with it. This is one of those occasions. The assertion describes how birth, according to the speaker, ‘should’ go, another v judgmental word.

        • Valerie

          Yes, but even in that context, the “fundamentally most normal event of all” is quite a claim. I mean, they are saying it’s more normal than breastfeeding.

          • Sarah

            Or death.

          • Who?

            I think they are riffing not trying to communicate anything meaningful. Apparently if you string together enough buzzwords you occasionally get a sentence, even if the words the sentence comprises make no actual sense.

      • demodocus

        I’m pretty “the fundamentally most normal event of all” is sleeping. Everyone on the planet needs to sleep, preferably every night. More than half the planet never give birth, and even that Duggar woman has probably not spent a whole month (cumulatively) in labor.

        • Roadstergal

          Sleeping or urination.

    • SarahSD

      YES.

    • Sue

      I love to see take-downs by people who actually know what they are talking about.

  • monojo

    OT-ish:
    http://vitals.lifehacker.com/why-i-had-my-babies-with-a-midwife-instead-of-a-doctor-1743669422

    A lot of drivel about how doctors don’t practice evidence based medicine, and don’t respect your autonomy. Ugh.
    This woman has also written a piece about how you shouldn’t give up on breastfeeding just because of a silly issue like low supply, and how bottles/formula can destroy the breastfeeding relationship. It sucks to have this crunchy NCB crap infiltrate Lifehacker, which tends to be a pretty helpful and rational site. I don’t know what to do about it- I feel like this person is spreading a lot of misinformation, under the guise of “it’s just my opinion!” But an incorrect fact is not an opinion- it’s just wrong!

    • crazy grad mama

      I saw this, and drivel is right. Doctor don’t practice EBM, and yet midwives do, by giving you the option to refuse a bunch of things that are, in fact, evidence-based?

      The worst part is that women are going to read this and believe it.

      • monojo

        There is a regular commenter over there who is a doctor, and who is taking the author to task for her claims. The author says she is surprised that she is getting so much push back! That’s what happens when you lock yourself in an echo chamber- you don’t see your own biases.

        Head-freaking-desk.

    • Chione

      As they say, you are entitled to your own opinions but not your own facts. There are plenty of woo-peddlers who don’t quite grasp that.

    • LaMont

      I love how hospital policy informed by science, and doctors recommending things rather than asking the patient if they’d like to do them (it’s almost as if they’ve been to school for years to learn what best practices should be), is depicted as taking away autonomy. How is it oppressive for a doctor to say “we recommend such a procedure at this time” rather than *ask* the patient? I’d find the latter remarkably unprofessional – but I guess these women believe that birth is just part of parenting, something that Mama Goddess should always be in charge of (like vaccines!). Ugh. I mean, I like to be informed and go to my doctors with questions so I can follow along as much as possible (when a test is ordered and they don’t tell me explicitly what they’re looking for/ruling out I get annoyed), but damn.

      • nomofear

        St. Vincent’s, a hospital in my hometown, has a new campaign that’s plastered on billboards all over town. I can’t remember the exact terms, but it basically promises that you get to choose how you birth. Whaaaaaat. Ok, if I’m a crunchy woo mama, I’m not going to believe you. If I’m a normal ass person, I don’t know nothin bout birthin no babies, which is why I brought my pregnant butt to you. So why? I don’t get it. I just hope it nets some of the women who might otherwise drive the six hours to see Ina May.

  • Krista

    Wow, she thinks I should have been rescued from technology such as continuous EFM? Without this my daughter’s sudden distress in the final stages of labor (when the knot in her umbilical cord pulled tight) would have been missed. They wouldn’t have gotten her out quickly (with vacuum assist), and she could have been injured or worse. But that’s just the cost of doing business, and somehow worth it? Um, no. I don’t consider my daughter’s life an acceptable loss, but I guess that’s just me.

    • lilin

      I doubt any woman does. What she thinks is that it’s always going to be somebody else’s loss. Oh, sure, sometimes babies die during home birth, but clearly her baby won’t.

      • Krista

        You’re right of course, but I could have been that statistic, if I had leaned that way. Obviously, I am not okay with that, but I feel a little ragey at the idea that someone else might suggest that it would okay (for me or anyone else for that matter).

        • Amazed

          Read Brooke’s input in the Birthzilla post. You thought your okaying it matters? Umm, no. Brooke knows what uou need – NO epidural because you said so beforehand and you aren’t allowed to change your mind, ever, so she’ll encourage you and give you water instead.

          Think such a provider would care about you okaying interventions they deem unnecessary? Think again.

    • Chant de la Mer

      CEFM is of the devil I tell you. Why I could have kept laboring on my back if it hadn’t been for the monitor showing a heart rate that meant a compressed cord. They had the gall to make me roll into different positions until baby’s heart rate came back up. Just because my water had broken early and something about there not being enough to keep that baby from compressing his own cord, BAH what do they know!

  • DelphiniumFalcon

    Damn technology! Next thing you know if we don’t get a handle on this technological intervention stuff is they’re going to pop out of the womb with iPhones already in hand!

    That would be a severe disappointment to me…

    …because I mean an iPhone? What you doin’ bring that Apple shit in here?! Any children of mine will know it’s Android or bust!

    Other than that they can get their hands on nearly any technology they want. Their familiarity with tech and being able to keep up with it is probably going to be a defining factor of their success in life the way the world is going.

  • Sue

    Here’s something I don’t understand.

    In Australia, hospital midwives (who have traditionally been specialist nurses, with post-grad training) were amongst the first nurses to take on advanced practice roles – prescribing medications, suturing. Much of modern obstetric practice is actually implemented by midwives – collaborating within a health care team.

    How did it come about that we have hosptial midwives implementing life-saving “iinterventions”, but a different population, also called “midwives”, rejecting life-saving interventions?

    ANd why, oh why, don’t the trained, professional midwives’ organisations and regulators call out the untrained ones?

    • Chi

      Because in the states you have those completely under-qualified lay midwives who tout themselves as the ‘natural birth experts’ who promise home births without that ebil, ebil technology. As such, they only see the inside of a hospital when shit hits the fan and any thought of ‘rescuing’ the mother from intervention is well and truly out the window.

      I don’t know why actual qualified midwives AREN’T speaking up. Surely the actions of these lay midwives reflects badly on ALL of them? Especially since the qualified ones actually put in the effort to become a CNM and the lay ones are basically cheating the system.

      But then, here in NZ we don’t get a choice. Unless you’re considered a high risk pregnancy, the government pays for a midwife, NOT an OB. If you want an OB you pay yourself. Though, our midwives are CNMs for the most part and have hospital privileges. It’s not a perfect system by any means.

      • crazy grad mama

        Unfortunately, I think there’s a fair amount of woo among CNMs here in the U.S., which may explain why they don’t speak up. (Not all CNMs, for sure, but a sizable fraction.) The CNM-run birthing center in my town is very woo-forward, recommends reading Ina May, etc. Even the CNM working with my OB suggested a Spinning Babies-type exercises to try and turn my breech baby.

      • Margo

        And if you need an ob as pregnancy unfolds then you are referred to an ob and that is free.

        • Bombshellrisa

          Exactly, it’s not if you WANT OB led care, there must be a medical need to be able to be referred to an OB and get your care paid for.

          • Chi

            Exactly. Which sucks because while I managed to get an awesome midwife who was really helpful and knowledgeable and really worked with me through the entire pregnancy and beyond, it would have been nice to have an OB as an option.

  • Gatita
    • SarahSD

      Exactly. Cute “outcome”, though.

  • yugaya

    That was a sickening read. Words like *psychopaths* and *sadists* spring to mind.

    • Melissaxxxx

      How in hell do they both have phd’s?! Fucking hell. You’d think that would entail some BASIC ability to analyse data and not be totally loopy about it. But I guess here they aren’t even PRETENDING to care about live babies and mums

  • Amazed

    I can’t believe that one of the authors actually TEACHES students this crap.

    Nurse midwifery seems to have a serious problem. I’m leaning more and more in Bofa’s direction of not being thrilled with them. Until their leadership tolerates and actually extolls such inhuman views, what do we expect?

    Were they priestess of Baal in some past life, perhaps? Sacrificing children at someone’s altar isn’t something that comes naturally to most people.

  • MaineJen

    Such values have been purported to be of central concern to midwives worldwide

    …notice that the whole paper focuses on what *midwives* want, what *midwives* think is of concern. I cannot believe these two women came right out and said they value the concept of physiologic birth over the OUTCOME of birth. Are they insane?

    No really. Are they?

    • Amazed

      No. They’re just doing business.

      The women who seek them out because they thing this philosophy rocks, on the other hand… Sure, hormones and all. My SIL just kindly offered to kill a publisher for me and then say, “I’m pregnant, I cannot be hold responsible!” (Strongly tempted to take her to it!) but I don’t really think it’s gonna work. Surely hormones cannot be used to justufy ALL insanity under the sun?

  • Daleth

    That is flat-out psychopathic. WTF is WRONG with them?!?!

  • SarahSD

    I can understand it when it’s about believing a lie, the lie that natural is safer and that the cause of most complications is intervention. How can they say this out of one side of their mouths, while from the other side they acknowledge that they don’t care about “outcomes”?

    MW: It’s safer and better to have a natural birth.

    Mom: Is it really?

    MW: Well we think so and our clients like it better

    Mom: But is it actually safer?

    MW: If you focus too much on outcome, you risk losing control of the process

    Mom: But statistically, is my baby likelier to die with you as my care provider?

    MW: …

    • SarahSD

      Unfortunately, it often goes like this:

      MW/natural birth community: It’s safer and better to have a natural birth.

      Mom: That sounds good. I want to believe it. Birth seems scary and hospitals and the idea of surgery are also scary, so it makes sense to me that the medical model is what makes birth dangerous. I am scared for myself, and also I care about my baby, so I will choose what is best for them and go for a natural birth. Whew, I’m so glad I did my research! Really dodged a bullet there.

  • namaste863

    What the ever loving FUCK? Can someone tell me, doesn’t a dead baby and/or a dead mum defeat the whole point of the process? If sending both parties home in one piece isn’t the primary goal, isn’t it a lot of bother for no payoff?

    • FrequentFlyer

      I guess the midwife collecting her fee is the only payoff that matters to them.

  • lilin

    That is truly horrifying. On the plus side, I have something I can link to whenever people talk about how midwifery is safe. Even midwives admit it isn’t, and have publicly declared that in this effort at spin.

  • mostlyclueless

    Wow.

  • Madtowngirl

    Please don’t “rescue” me from life-saving technology.

    Maybe I should put that in my next birth plan.

  • FrequentFlyer

    My sister and our entire family are happy and grateful today that she had medical interventions. She developed pre-eclampsia and had an induction yesterday. New niece arrived safe and healthy. Sister is safe and healthy. She is not complaining at all about this change in her plans. She would probably have hurt anyone who tried to “rescue” her from her doctor’s care.

    • Amazed

      You have a new addition to the family? Congratulations! Happy that everyone is fine.

      • FrequentFlyer

        Thanks!

    • Mishimoo

      Congratulations! Good to hear that they’re both safe.

      • FrequentFlyer

        Thanks. Little Sister’s case shows that doing everything right as far as diet and exercise are concrrned does not guarantee you won’t have a complication. So glad she isn’t woo prone!

  • demodocus

    Process matters. This is why finding an approachable and professional ob is important to me. However, they’re missing an important detail; most journeys in life have a destination, a goal in mind. I like to go for walks but if I just keep walking, I’m eventually going to fall off the cliff.

    • kilda

      yes, but as long as it’s a good natural walk that’s all that matters. Trust gravity!

      • demodocus

        The local cliffs are only like 20 feet! That’s like a breech birth. or something

        • Amazed

          You win the internet today!

        • Roadstergal

          20 feet is a variation of a normal step.

      • KarenJJ

        Gravity is natural!

        • DelphiniumFalcon

          The body knows how to impact.

  • theadequatemother

    I can’t think of any reasonable rationale why patient outcomes under midwifery care should be subjected to different outcomes measures than for patients under OB care. A patient is a patient and an admission to ICU is an admission to ICU regardless of primary provider. What is so wrong about keeping tabs on these outcomes for midwifery patients:

    “…surgical intervention rates, admission to the intensive care unit, length of stay, readmissions, and trauma?'”

    • The Bofa on the Sofa

      I can’t think of any reasonable rationale why patient outcomes under midwifery care should be subjected to different outcomes measures than for patients under OB care.

      The problem is that, being held to the standards of the rest of the medical field puts midwives at a disadvantage. Therefore, the solution is obvious: create different standards.

      • SarahSD

        You said it more clearly than I did.

    • PrimaryCareDoc

      It reminds of a “study” that Dr. Amy posted about, where the midwives talked about how maybe PPH should be redefined to be a higher amount of blood loss for a home birth than for a hospital birth.

    • SarahSD

      Because if you compare the outcomes on the same terms, it becomes impossible to continue upholding the fallacy that being “rescued” from technology has any value, that it is “as safe or safer than” being “rescued” from complications using technology.

  • Nick Sanders

    Semi-OT:

    I know HuffPo isn’t the best of sources, but still, if this is even remotely true, it’s obscene, refusing to save a woman’s life if it means performing an abortion:
    http://www.huffingtonpost.com/brigitte-amiri/trinity-catholic-hospitals-_b_8592560.html

    • DaisyGrrl

      I have no doubt it’s true. The article mentions Savita Halappanavar, whose death was discussed extensively on this site at the time. She knew her baby was doomed and begged the doctors to complete the miscarriage and save her life (ie: perform an abortion). This was in Ireland, and the doctors told her they would only intervene once the baby’s heart had stopped beating because, “this is a Catholic country.” By the time the fetus had finished dying, Savita was too sick to save and died from the resulting infection.

      While I can accept that Catholic hospitals will not perform abortions without medical indication, it is obscene that women’s lives are at risk from such a medieval and antiquated view. It is especially obscene when a pregnant woman has no other care option available and must obtain her care from one of these places.

      • Roadstergal

        I don’t accept it, myself. It’s a hospital, not a church. A legal medical procedure should not be 100% of the table.

        • EmbraceYourInnerCrone

          Its worse than that a lot of hospitals are being taken over by Catholic hospitals making them the only game in the local area for some people. If you call 911 because you are pregnant and hemorrhaging and they take you to the Catholic hospital, because its closest getting the care you need should not depend on if the hospitals religious beliefs allow it, if you have a DNR ,whether it is honored should not depend on the religious beliefs of the hospital you end up at

          • Roadstergal

            Exactly. Medical decisions should be based on medical knowledge and patient needs and values. If a patient is Catholic, that can influence their decision to have an abortion or not. It should not influence anyone else’s.

          • Nick Sanders

            I’m reminded of Sandra Fluke, and her being denied insurance coverage for her treatment because it happened to be a birth control pill.

          • PeggySue

            Well, see, you’re thinking logically. In the US, Catholic health care providers have gotten exemptions from the laws that allow them to provide only a subset of the options that are legal, no matter if the patient is Catholic, no matter if the patient has any alternative provider. It would be disingenuous to see the expansion of Catholic health care as wholly altruistic–they want to make money AND limit access to procedures to which they are opposed, IMHO.

      • attitude devant

        Try Michigan. Google Tamesha Means.

        • DaisyGrrl

          Ugh. Yup, Catholic hospitals’ approach to women’s health is disgusting.

        • fiftyfifty1

          Where are the guts of the doctors who tend these cases? If the doctors stuck together and insisted on professional autonomy, the bishops would have to give in. They can’t fire them all.

          • An Actual Attorney

            I don’t know, but it terrifies me that the nicu in my city is at a Catholic hospital. It’s where you get sent if something is going wrong, which is exactly when I don’t want the Pope weighing in.

          • Medwife

            That is a real concern. My hospital has the highest level NICU in the county, and is the only trauma center. To get somewhere else you’d have to be flown out, which is a practical and financial nightmare.

          • PeggySue

            Some of the doctors hold the same theology. For one thing. And the bishops could shut the whole unit down. Don’t underestimate the attachment to this theology. It’s simplistic and hideously misogynistic, and its very simplicity makes it appealing to some.

      • LizzieSt

        I remember the Halappanavar case. What a horror! An Indian newspaper at the time ran the story under the headline “Ireland Murders Pregnant Indian Dentist.” Tough, but fair.

      • PeggySue

        Was she given antibiotics before the fetus died? Would it have made any difference at all? Might not have, given that the source of infection was left alone.

    • attitude devant

      Believe it. I heard the author speak at a medical meeting last week, and the cases reviewed included:

      A woman who was not told her baby had a lethal anomaly until 26 weeks.

      A woman with a twin pregnancy, but one was a mole (which is never viable and can be life-threatening, or even progress to cancerous behavior) but wasn’t told of her prognosis. She wound up losing her uterus because her treatment was far delayed.

      A woman who, like poor Dr. Halappanavar, ruptured membranes in the second trimester and was repeatedly sent home from the ER (the last time with a fever) with NO TREATMENT or referral because the baby had a heartbeat.

      A woman who was bleeding out from a non-viable pregnancy (baby wasn’t growing but there was still a heartbeat) and who was transferred 90 miles away to get a 10 minute D&E.

      I don’t care if you’re prolife or not, but these cases NEVER held any good outcome for babies, and the mother’s life was put at risk from some reductio ad absurdum of prolife philosophies. And it’s disgusting. All American hospitals receive beaucoup federal dollars (sorry, Ron Paul!) and they should not be allowed to refuse care to women who happen to be pregnant.

      • Roadstergal

        If you’re not competent to provide proper care to all patients, for religious reasons or any other, you shouldn’t be in the hospital business. Similarly, if you don’t like birth control, find a job other than “pharmacist.” Ffs.

      • Nick Sanders

        Please, don’t get me started on Ron Paul. I will rant about his awfulness until the cows come home, and SkepOB isn’t really the place for political discussions about things other than maternity and childcare issues.

        • Roadstergal

          He thinks children are the property (not the wards) of parents, and that vaccines aren’t so great. That’s all pretty barfingly on-topic.

        • attitude devant

          I mention Dr. Paul only because he makes a big deal of saying that he doesn’t accept federal dollars (via Medicare and Medicaid) so he keeps his ideological purity as a libertarian. Except that’s bullshit because every doctor in this country was trained by Medicare/Medicaid dollars and every hospital is heavily supported by those same federal dollars. And for him to claim otherwise is LYING.

      • Melissaxxxx

        These are HORRIFFIC

      • Azuran

        I just can’t wrap my head around the twisted mental gymnastic it takes to refuse a life saving pregnancy termination.
        That baby is never gonna make it no matter what you do. You can either take it out and make sure the mother is fine or leave it there and risk the mother’s life. How can that even be up for debate?

        • fiftyfifty1

          “I just can’t wrap my head around the twisted mental gymnastic it takes to refuse a life saving pregnancy termination.”

          Oh I can. It goes something like this:
          Terminating a pregnancy before the heart has stopped beating would be “playing God” which in our omniscience we have decided is Wrong. Therefore we will play God by risking YOUR life, which must be Right, because we said so.

          • PeggySue

            It is enormously frustrating to argue these points because the theology goes along with a staunch rejection of science. For instance, an understanding of how many fertilized ova do NOT survive to become term pregnancies might temper the certainty that EVERY SINGLE fertilized ovum is a complete human being. I’ve tried arguing about this and it simply makes me crazy.

          • Who?

            I think risking mother’s life is actually allowing God’s will to play out, whereas interfering, and preferring one life over another, is in defiance of God’s will.

            It’s no wonder I’m an atheist.

          • fiftyfifty1

            “It’s no wonder I’m an atheist.”

            Agreed. And if God were provably real (so I wouldn’t be an atheist), I would still feel morally obligated to defy a theology that preferred the death of both mother and fetus over the death of fetus alone. It’s so obviously cruel and wasteful. Where are the guts of these people? It’s like they just roll over and say “God says I have to let both of them suffer and die horrible deaths because it’s His will. Sure it’s a total asshole move, but I wanna stay on his good side, and I’m scared he’ll send me to hell, so I’ll do whatever the Big Mob Boss in the Sky says.

          • MaineJen

            “It’s no wonder I’m an atheist.”
            A freaking men. It’s crappy, ass-backwards policies like this, church doctrine carried to its logical (and absurd!) conclusion, that began chasing me away from organized religion in the first place. That, and the whole thing being disgustingly anti-woman. You can bet that if a man were lying there dying of sepsis, Catholic doctrine would allow the doctors to move heaven and earth to save him.

          • Roadstergal

            Absolutely this. If there is a god, and if that god thinks it’s better for a woman and a fetus to die than just a fetus, I’m totally cool with defying his will.

          • Azuran

            It’s not even ‘preferring one life over another’
            That foetus is going to die either way. One life is sure to be lost. It’s putting a second life at risk for no benefit.
            Anyone who would think that this is god’s will is an idiot.

    • Medwife

      Believe it. I deliver in a Catholic hospital. Disasters are just waiting to happen.

    • Ash

      I have no doubts that these events happened (such as waiting for fetal heartbeat to cease prior to termination), but I thought that Catholic scholars had already determined that beneficience allowed an abortion to be done so a woman could live when otherwise the woman and fetus would die. So even a Catholic hospital should have allowed the physician to do the termination for the woman miscarrying in the case study by Lori Freedman. Crazy stuff.

      • The Bofa on the Sofa

        I thought that Catholic scholars had already determined that beneficience allowed an abortion to be done

        No offense, but who gives a shit what “Catholic scholars” have said if it isn’t put into practice?

        Don’t tell US about these determinations, tell the people in charge who are killing women.

        • Ash

          Agreed.

        • LizzieSt

          AMEN.

      • Valerie

        I just looked that up and quoted the policies in a comment above. In short, there directives are not to perform abortions, ever, even when some good can come out of it (eg, probably saving the mother’s life). The Scandal (in the Catholic sense- spiritual ruin) caused by an abortion trumps everything. If anybody here is Catholic and reading this, I suggest you talk to your church leadership about why you find this morally reprehensible (if you do). The current Pope is relatively liberal, so perhaps you could get a clarification on doctrine. The rest of us can complain to our governments.

        • DelphiniumFalcon

          It’d probably be a better idea to do what other religions that have owned hospitals have done and get out of the business by donating all their facilities to the states/communities they’re in. Preferably with the stipulation of being run as not for profit. Then help support them through donations to the facilities for what’s needed to keep them running.

          Most other religions I know of that once owned medical.facilities got out of that game a long time ago and the communities benefitted in more ways than one.

          If a doctor is morally against something like an elective abortion they should at the very least have a colleague available to do the procedure with no moral quandry to complicate it. At the very least.

          But at the same time… A live mother saved from a life threatening situation that resulted in a terminated pregnancy can (hopefully) have more children in the future. A dead mother and dead embryo/fetus can’t. So if it’s to follow the be fruitful and multiply commandment then one is much more likely to have a better outcome than the other.

          • Valerie

            Yeah, I’m not that familiar with the system enough to suppose what the best solution is to make sure that people receive ethical care. What we have now is unacceptable- religious doctrine should not be enforced on anybody while they are making medical decisions. Honestly, I was pretty shocked that the Catholic Church’s official stance is to prevent abortion at all costs. I knew that women have died (or almost died) because hospitals refuse to abort, but I thought it was an unintended consequence- that the law or rule was to save the mother, but, for example, somebody on the ethics committee wasn’t convinced it was that urgent. It turns out that, nope, that is the rule: the evilness of abortion automatically overrides any good that may come of saving the mother’s life. I don’t think the majority of Catholics feel this way.

          • Roadstergal

            “I don’t think the majority of Catholics feel this way.”

            In the US, at least, the majority of Catholics have used birth control. But Catholicism might be the most hierarchical religion currently out there, and the uppers don’t care what the majority think.

    • KeeperOfTheBooks

      If I may step in to explain for a moment? Lay Catholic here who is fairly familiar with doctrine–bit of a nerdy hobby for me. 🙂
      There is a moral principle in Catholic theology called the principle of double effect. The idea is that if something bad comes out of something where the primary intention is good and the bad thing wasn’t intended but was a direct consequence of the action, it’s okay to perform the action even if you know that something bad might come of it.
      As an example, I can’t walk up to an elderly person and smash her chest with a baseball bat. That would be both morally and legally wrong. However, if I see her keel over at the grocery store, check for a pulse and breathing, find none, start CPR, and in the process break a few of her ribs (an unpleasant and not uncommon consequence of performing CPR on the elderly), I wouldn’t be morally or legally responsible for that even though the same thing ended up happening–i.e., I used force which fractured her ribs. The reason for that is that my intention was to save her life by getting oxygen into her and getting it circulating by compressing her chest, not to break her ribs, although I knew as I knelt down to do CPR that there was a good chance I’d break a rib or two.
      Similarly, in the case of a woman with broken water at 18 weeks, an abortion per se (abortion used in this case as “a medical action performed deliberately to kill the baby”) would be morally wrong in Catholic teaching. However, at 18 weeks there really isn’t anything you can physically do for a baby; they’re just too small. Furthermore, mom’s health is also a consideration. There is absolutely NO excuse for not starting her on antibiotics at that point, and similarly, no excuse for not having her miscarry (stillbear? I think it’s considered a miscarriage before 20 weeks, but could be wrong.) the baby in a safe, clean environment, or, should labor not commence, for not instigating labor in order to keep her safe from infection. The baby will inevitably die if it’s born, but that’s not the primary intent: the primary intent is “at a certain point, mom is going to develop a very nasty infection from walking around with her water broken, and we need to take care of mom.”
      There is, however, a *lot* of miseducation out there on this stuff. Wouldn’t be shocked if we’re not hearing the full story, either–leaving aside anything else, there is NOTHING in Catholic teaching that would say not to give mom antibiotics, at a bare MINIMUM, in this situation, even if they didn’t understand the finer point of theology I listed above. Sounds like shoddy care all around.

      • dulcythefrog

        This is also why a very religious friend (with 3 prior kids and one since) is still around after an ectopic pregnancy. Of course, the theologians believe that you must excise the whole tube as a workaround, because it’s the *rupturing tube* that is dangerous to mom, not the zygote (an innocent bystander.) Still, I think it shows that the Church is not 100% blind to the nuance of circumstance.

        • The Bofa on the Sofa

          Which I’m sure is a great consolation for those that are dying as a result of those times when they are blind

          • dulcythefrog

            A fair point. There are numerous Catholic pharmacists in my family and I’m glad I stayed away from the “family business” and went into research instead, because there was a time in my life when I may have felt obligated to exercise my beliefs in a manner that I now see as abhorrent.

        • Dr Kitty

          If you catch a tubal ectopic before it ruptures you have three choices:
          1) remove the tube, with the pregnancy in it.
          2) open the tube, remove the pregnancy and leave the tube behind
          3) use drugs like Methotrexate to end the pregnancy, avoiding surgery and preserving the tube.

          Personally, I’d choose option 3.
          The Catholic Church would limit the options to number 1 if there was a detectable foetal heartbeat, in fact, in countries like Chile, if there is a foetal heartbeat, you might have to wait until the tube ruptures before you can get lifesaving surgery….

          • MaineJen

            Holy hell. Every time I catch myself thinking that the Catholic church might not be so bad after all, I’m going to remind myself of that last sentence.

      • Nick Sanders

        One of my friends is a lay Catholic in med school. I’m curious what his take on it would be, but there is no way to ask him that wouldn’t be just astoundingly awkward.

      • The Bofa on the Sofa

        Again, don’t tell us this shit. Apparently the asshiles letting women die missed the message. Unless they are getting the message, none of this theology matters.

        • LizzieSt

          I am completely with you on this. A few years ago, a strictly Catholic friend of mine had a miscarriage about 10 weeks. The hospital normally would have performed a suction D&C in such a case. But oh no: Her priest told her that she might go to hell for that. So she waited in the hospital to expel the fetus “naturally” (this was deeply emotionally and physically painful for her). And then the priest advised her to contact the Sisters of Life (anti-abortion order of nuns) so that they could pray for her soul. (!!!!!!!!!!!!!!!!!!!!!!!!)

          Forgive my language and intolerance, but the hell with all of it. It makes the Greek Orthodox Church of my childhood look like the Feminist Consciousness-Raising Club and Reproductive Freedom Brigade, and that is quite an accomplishment.

          It’s one thing for my friend to go through all of this by her own choice. But the very thought of a woman being forced to go through it because a church that is not her own runs the hospital………..no, no, no. I cannot excuse or condone it.

          • This is a case where the priest would have been served well by having a modern Catholic bioethics book at hand. Or a dictionary that defines the word “miscarriage.”

            The Sisters of Life should be praying for the baby’s soul, not the mother’s. What did the mother do wrong? Ask about having some potentially dangerous tissue removed along with her dead child?

          • LizzieSt

            She goes to a church that leans very far to the right, theologically speaking. Latin mass and everything. She did nothing wrong, but this church wanted her to believe that she did for some reason. It hurt so much to see her suffer.

          • An Actual Attorney

            I don’t understand. What is wrong with a post miscarriage d&c?

          • Azuran

            There is abdolutely nothing wrong with it.
            But there are apparently some people out there who thinks that even if a foetus is 100% certain of dying, you cannot take it out until it is dead. Even if leaving it inside could potentially kill the mother.

          • Dr Kitty

            The difference between a “threatened” miscarriage and an “inevitable” miscarriage is whether the cervix is open or not.
            I was taught to check the cervix before going to ultrasound.

            Because, even if you see a foetus with a heartbeat, if the cervix is open, you know it is only ending one way, and if there are products stuck in the cervix you can make your patient feel better immediately by removing them.

            If you start with ultrasound and see a foetus with a heartbeat it is very difficult to then find an open cervix, but if you find an open cervix you can at least warn them that whatever the scan shows, unfortunately the pregnancy isn’t viable.

          • Grace Adieu

            Is that strictly correct? I don’t know all the details, but I have a friend who had a cerclage placed at around 13 weeks – she described her cervix as being “wide open” – and after a difficult pregnancy with lots of premature contractions, bed rest and son on, her daughter was born at around 34 weeks.

          • araikwao

            A rescue cerclage at 13 weeks?? Yikes, I don’t know that that would even get done here..so glad she made it to late prematurity though, that’s amazing!;

          • attitude devant

            It’s a matter of timing. An open cervix in the first 12 weeks is a different story from an incompetent cervix.

          • LizzieSt

            I don’t know the theological reasoning. I just know that my friend and her priest were dead-set against it.

      • Roadstergal

        It’s fine to have that morality – but the problem comes when care providers put their morality onto patients. There are religions that find abortion immoral, birth control immoral, circumcision immoral, blood transfusions immoral. Those are all fine things for a person to believe and to abide by, but a HCP should not be deciding matters of morality for their patients.

        In a case like the one linked, it’s fine for the woman in question to say “An abortion is the clinically recommended course, but I am not okay with that, so I will not have one.” It’s not okay for a hospital to tell her “An abortion is the clinically recommended course, but I am not okay with that, so you will not have one.”

        • FrequentFlyer

          Oh no! You used the dreaded c word. I hope you haven’t summoned the troll.

        • Medwife

          The care providers on the ground are being coerced, too. I think if push came to shove our OBs would administer a life saving abortion against hospital policy, but they would be fired.

          • fiftyfifty1

            “I think if push came to shove our OBs would administer a life saving abortion against hospital policy”

            Ouch, that’s painful! You *think* that if *push came to shove* your OBs would do abortion if otherwise I would *die*. I’m not exactly feeling reassured here.

          • Dr Kitty

            But what if it isn’t life saving?
            What if it just saved you from blindness and daily lumbar punctures and postpartum psychosis?

            That was a patient I saw in Ireland as a student. She’d had BIH in her first pregnancy and required frequent lumbar punctures, suffering temporary visual loss and terrible headaches from the raised intracranial pressure. Then she had postpartum psychosis requiring ECT and serious medication and nearly lost her relationship with her partner and custody of her child.

            When she fell pregnant again (despite using reliable non hormonal contraception) and almost immediately began suffering from BIH and low mood her partner, neurologists, obstetrician, social worker and psychiatrist were all in agreement that it was in her best interest that the pregnancy not proceed.

            But she wasn’t dying, so she had to travel to England, because it wasn’t legal to end it in Ireland.

            Or the triplet pregnancy with PPROM in the lowest sac in the late second trimester, where a reduction of that non viable foetus would have given the other two babies the best chance at remaining in utero to a viable gestation, and reduced the mother’s chance of getting chorioamnionitis.
            But, no, the hospital ethics committee would only approve once she had life threatening chorio, by which time it was too late and all three babies died, and their mother almost died too.

            I have NO time for the Irish interpretation on Catholic doctrine as it applies to abortion law. It kills and maims and ties itself into knots avoiding the simple answer that sometimes a therapeutic abortion is the least bad option.

          • demodocus

            Terrible all around. Anti-abortionists seem to have a remarkably black-and-white view of the world, and apparently some difficulty seeing all the possible complications.
            Reasons why I love my minister #47. She considers abortion a tragedy but agrees with you that it can be the least bad option, and that it isn’t her place to tell anyone whether she thinks it was appropriate.

          • The Computer Ate My Nym

            The hospital ethics committee wouldn’t approve a termination on a non-viable fetus to give the other two fetuses a chance to survive? How very pro-life of them! Could it be any clearer that the intent is to hurt the woman for being pregnant, not to save any babies?

          • Who?

            It’s all about the will of their skyfriend, not the sanctity of life or anything else.

            We’re hearing a lot about skyfriends at the moment, I’m sincerely very relieved to be an atheist, since I don’t have the moral energy to pick and choose which bits of their grotesque belief systems I’ll fall in with.

          • Dr Kitty

            Here, if a provider performed an abortion not covered by current legislation, but arguably in their patient’s best interest (fatal foetal abnormality, rape, incest) they face a prison sentence.

            A few years ago what happened in Northern Ireland was that those kind of abortion were happening, quietly, in Northern Irisih hospitals, and everyone looked the other way. This was as recently as 2008, to my certain knowledge.

            Then formal legal guidance came out (the first draft of which referred to the foetus as ” unborn baby” throughout, so clearly driven by an agenda) and it was in black and white that such abortions were illegal with potential prosecutions, and hospitals had to deliver data on the numbers of abortions and legal justifications for them to the department of health.

            One hospital trust has since stopped offering quadruple screening and Nuchal fold measurements. You can have an amnio, or you can pay OOP for quad screen or harmony at a private clinic, but you can’t get it done on the NHS, because it isn’t like they can offer you a termination anyway…

          • Dr Kitty

            Also, you know what else sucks?
            Worrying that your patient doesn’t have the means to travel for a legal termination, will take matters into her own hands and that your notes could be used as evidence against her if something goes wrong.

            My notes tend to be very brief.
            “Unplanned pregnancy, not sure how to proceed, advised of legal situation, including need to travel for legal termination. Advised of further sources of advice and support, will go away and consider her options”.

            I’ve already had one patient phone up and ask how to take abortion pills, because the instructions for the ones she got online were in Chinese (my patients are not exactly criminal masterminds).
            My advice, of course, was to dispose of the illegal, unknown and potentially dangerous tablets immediately.

            This is not hypothetical for me. This is real.
            There was a recent case where a prosecution was brought against a woman who obtained abortion pills for her daughter.

      • Valerie

        I had to look it up. Here is the official wording from the Ethical and Religious Directives for Catholic Health Care Services available here:

        http://www.usccb.org/about/doctrine/ethical-and-religious-directives/

        “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.”

        There is no consideration in there about the life of the mother or whether the fetus is nonviable (but still has a heartbeat). I think it might be difficult to prove that the beneficial effect of an abortion is “immediate” in the case of sepsis prevention until it’s too late.

        I think you, or anybody convinced that Catholic doctrine allows doctors to perform abortions to protect the life and wellbeing of the mother (even when the benefit is not certain or demonstrably “immediate”), should take it up with the Pope.

        • Who?

          Which is really not the situation KoTB is describing.

          The catholic church’s doctrine is one thing, its meddling ways are another.

          In a world where ‘danger of scandal’ is the most pressing matter for consideration, bad outcomes are likely to ensue. Interestingly I think they mean ‘ending a pregnancy too soon’ as giving rise to scandal; whereas many others see letting a woman become seriously ill or die while trying to protect a doomed pregnancy as the scandal.

          Lack of attention to perspective can lead to tunnel vision.

          • Valerie

            I also had to look up exactly what is meant by “material cooperation.” Here is what I came up with:

            http://fmmh.ycdsb.ca/teachers/fmmh_mcmanaman/pages/formco.html

            Material Cooperation: Material cooperation is a type of cooperation in which one does not intend the evil that others are doing but only permits or tolerates this evil for the sake of avoiding even more serious evils. Such cooperation can be either immediate or mediate. Immediate material cooperation is the actual doing of the evil one disapproves of and is thus morally equivalent to formal cooperation. Such material cooperation is never permitted. But mediate material cooperation in the evil of others is permissible on the basis of the principle of double effect. Thus a Catholic and a Catholic hospital may at times materially cooperate in the evil of others (only permitting or tolerating and not directly intending the evil done) when only in this way can a great harm be prevented.

            So, this is where the “principle of double effect,” the situation KOTB was describing, would come in and allow a life-saving abortion, but the Religious Directives quoted in my previous comment expressly state that material cooperation does not ever apply to abortion.

            Also, “Scandal” has another Catholic-specific meaning here, so at least they aren’t just talking about keeping it out of the papers.

            So, yes, in short, denying a woman a life-saving abortion (while the fetus is still alive, even if it is an inviable pregnancy) is their official policy, and consistent with their doctrine (presumably just by declaring that the “scandal” of the abortion is always greater than harm to the mother).

      • I knew all that. That’s completely unacceptable.

        Why? Because I get to choose what is morally acceptable for me. My doctor and my hospital do not get to impose their religious standards on my body. I am a Jewish secular humanist. The Jewish tradition is extremely clear that the life of the mother comes before any fetal life, and that if an abortion is medically indicated then that is what must be done if the woman wants it (she is, of course, not forced to do so). This is because in the Jewish tradition, the fetus is not a person until it takes its first breath, but the woman is unquestionably a person, so saving her life (and health, and mental health) takes priority.

        The secular humanist position is that consent and bodily autonomy are crucial values, and thus if a woman wants an abortion for any reason or none at all, she gets one. Period.

        So both my religious tradition and my secular philosophy are in agreement on this particular issue. Why can a hospital take that decision away from me and force its religion upon me?

        EDIT: When it comes to Savita Halappanavar, yes, she had shoddy care. However, she requested an abortion and she was denied it. There is no world in which this is ethical or moral, and it really shouldn’t be legal either.

    • Dr Kitty

      Savita Halapanavar.

      She went to an Irish hospital at 18 weeks pregnant with ruptured membranes.
      Her foetus still had a heartbeat and she was not at imminent risk of death, so labour was not induced and she did not have a D&E.

      When her baby died she was immediately taken to theatre for a D&E, despite that she died from sepsis.

      That was Ireland, where you literally have to be dying in front of your doctors before they can end your pregnancy.

      I went to medical school in Ireland. I have other stories.

  • PrimaryCareDoc

    What the fuck? I can’t even.

    • attitude devant

      LOL! I was about to post the EXACT SAME comment

  • Amy M

    Maybe these midwives ought to interview patients before they publish such offensive drivel. If patient satisfaction and emotional well being is so important, find out from the women themselves, what they value most. I’m sure that a number of them value an intervention free birth, but I doubt many would value that over a dead or injured baby (or mother).

    No one is challenging midwives to preserve unhindered birth. Their challenges should be more like helping low risk women safely give birth. Each woman is a new challenge, after all. How can anyone see this and think its ok? It seems like this woman is shooting herself and her profession in the foot.

    • FrequentFlyer

      Re: “I doubt many would value that over a dead or injured baby (or mother).” If they did interview patients and that was the result, wouldn’t they claim it was proof of women being brainwashed by the medical establishment (or some such nonsense)? They would just decide they have to try even harder to “rescue” the poor, deluded women. They can twist anything to suit their purposes.

      • Amy M

        True. 🙁

    • MaineJen

      It’s clear they don’t care what their patients prefer. The article only addresses what the *midwives* prefer. Disgusting.

  • somethingobscure

    I’m sure there are plenty of horror stories, but are birth interventions really so horrific that someone would need to be rescued from them?? I just don’t get it. I had a failed vacuum extraction (with no epidural or pain meds) and it really wasn’t that bad except that it didn’t work. Then I had an emergency c section. Also not that bad. I actually liked it because I wS so excited to have my baby finally out safely. Then with my second I had a planned c section. Again: pretty much fine overall. Was there pain? Sure. Did I take medication for said pain? Yes. But I can’t comprehend a world in which I would possibly trade medical and surgical procedures being done on me for my safe, happy baby’s precious life. Who are these people who would put their own avoidance of medical procedures — that are often lifesaving in and of themselves — over the lives of their children??? I truly don’t get it. It sounds like child abuse to me. Parents convenience and preference shouldn’t be prized over the child’s life and health. I mean for fucks sake!

    • Bombshellrisa

      You don’t understand it because you viewed delivery as when you got to meet your baby, not a process that defined YOU and possibly gave YOU another reason to feel superior to someone else.

    • DaisyGrrl

      I think it’s important to acknowledge that some women can have horrific experiences in hospital. Some of these experiences will drive women into the arms of the NCB movement and CPMs who tell them what they want to hear. Trauma can come in many forms, and depending on a person’s perspective and experience, something that you or I find okay might cause PTSD in a woman with a different set of experiences. It is possible to be both traumatised and grateful for the outcome at the same time (if I ever require manual examination of my uterus without pain meds, that would fit my criteria for horrific but ultimately a good thing).

      Hopsitals and medical providers have a responsibility to provide ethical patient care, including obtaining informed consent to interventions (whenever possible). Those that don’t should be held to task and generally are.

      The most horrifying thing about this paper is that these midwives clearly value the process of natural childbirth above the outcome of a healthy, living baby. This is almost certainly not communicated to the women in their care. I suspect at least 90% of women who have home births haven’t actually provided true informed consent that explains the elevated risks due to the place of birth, the provider’s lack of training, and the provider’s philosophy on interventions. That is horrifying.

      • The Bofa on the Sofa

        I think it’s important to acknowledge that some women can have horrific experiences in hospital. Some of these experiences will drive women into the arms of the NCB movement and CPMs who tell them what they want to hear.

        As somethingobscure concedes, there are true horror stories. But then there are also the “I was ok with my c-section until afterward when people I started talking to on-line told me that it was an awful thing to happen to me” stories.

        The NCB industry is the one selling the “if you had a c-section it means your body failed” message. Doctors, on the otherhand, view a c-section as a “variation of normal”

        • DaisyGrrl

          Sure, there are the people who become convinced that their c-section was traumatic and unnecessary after the fact, but there are interventions that I think fit the bill for being traumatising in and of themselves. It’s not a reason to avoid the intervention and risk the baby’s life, but it’s okay to acknowledge that some interventions totally suck and that different women will have different reactions to the same intervention.

          • The Bofa on the Sofa

            Yeah, but the greater the suckiness of the intervention, the greater the need, typically. If you have to go through an awful intervention, there is usually a damn good reason.

            So yeah, the intervention is awful. But that means nothing without considering the alternative.

          • Sue

            Of course it’s OK to acknowledge, but it’s not OK to “protect” those women and their babies from the interventions that can save their lives or outcomes, and their babies’ lives or outcomes.

            I look at it this way: If these so-called MWs were serious about preventing trauma, they would collaborate with science-based MWs and OBs to improve communication and support for the women who are suffering.

            Why not dedicate their time and energy to improving communication rather than worsening outcomes?

        • Madtowngirl

          I was pretty shocked the first time I heard the “c-section is not a real birth” crap. My sister and I were both born via c-section. I’m pretty confident that we were both born.

          Also, I’m very glad no one tried to rescue my mother from technology. I would be dead, and she probably would be, as well.

          • Mel

            OMG, YES! That’s the best comeback line ever!

          • StephanieA

            Right? I was born via c section after my mom attempted 4 hours of pushing. I could care less whether I came out of her vagina or not, I’m just happy she didn’t refuse.

      • Blue Chocobo

        My unmedicated manual examination was indeed very painful, but not traumatic (at least not psychologically, by the strict definition it was a physical trauma). Needing it was scary, not being able to have the need addressed and the resulting extended hemorrhaging would have been traumatic.

        My trusted OB very quickly explained it was manual exam RIGHT NOW with attendant pain or surgery later without pain and with increased risk. Informed consent and prioritizing our safety for the win!

        • AirPlant

          My IUD placement was extremely painful. The OB was a harsh, cold woman and was openly fighting with the nurse about the details of the procedure. The literal first thing she said to me was “You understand that if I place this IUD there is a risk of perforation which will be painful and complicated and could lead to the loss of your uterus and any future fertility. During the insertion itself the pain was so bad that my mind started kind of drifting off into a nonverbal place and the OB kept pulling me out of it and making me answer questions and give consent each time she enacted part of the placement and talking through the pain made it feel like my coping mechanisms were being purposefully dismantles and it was probably the worst thing that has happened to me in a clinical setting.
          I did not find the experience traumatic however, because I was safe and even if my OB was mean, she was competent and professional and three years later I remain neither knocked up nor perforated so she got the job done that needed doing.
          I feel like the difference is that I never expected my IUD placement to be a transcendent joyful moment of emotional resonance.

          • Blue Chocobo

            It’s amazing what psychological traumas the realistic expectations gained from informed consent can prevent.

          • AirPlant

            Maybe the fact that I am moderately annoyed three years later is a kind of trauma, but that doesn’t even rank in the top ten for my life.
            And in the OBs defense when I started crying midway through the procedure she stopped and held my hand and gave a really nice speech about how I had nothing to fear, it would be over soon, and she was chosen to do insertions because she was fast and competent and had never had a single rupture.

          • Melissaxxxx

            Sigh. Having mine inserted wasn’t a “trauma” as such either but i did feel some of the wafts of poor listening and rudeness etc that NCB people dramatise. I wanted a copper IUD given my history of mental illness and poor response to progesterone in contraceptives, the OB just kept saying “well the mirena has a very low dose of hormone” repeatedly and finally “yes well mirena is standard practice” before sending me back into the waiting room. I felt angry and frustrated with myself for not advocating more for what i wanted (especially because i was hungover and that was one of the reasons i wasn’t able to keep asking questions, ha)

            Then just before getting it inserted the nurse asked if i had had children previously (no) then exasperatedly muttered “oh great, you’ll be fun then”
            Because obviously its a more difficult insertion. It made me feel pretty humiliated and like she didn’t care about my needs for wanting one. Sigh. Even though it was agonising i didn’t scream or cry, after which the same nurse became quite friendly and warm to me… Ugh. Old school nursing mentality where you only get “respect” if you’re an easy patient.

            Two years later im still annoyed about these. But oh well.

          • Sue

            “Informed consent” can, however, be in the eyes of the beholder.

            For some people, informed consent means an explanation that things can go horribly wrong at any stage, and the provider might have to act with haste to intervene.

            For others, permission and an explanation, with pros, cons and all potential risks, have to be offered for each therapeutic manoeuver.

            Most people sit somewhere in between, but there is certainly no single standard for what constitutes sufficient information. ANd often, dissatisfaction occurs with hindsight – in the setting of an adverse event.

          • Sue

            I wonder whether than OB had had her fingers burnt in relation to explaining potential complications.

            That’s no excuse for bad behaviour, but it might be in the background.

      • Michelle

        “Hopsitals and medical providers have a responsibility to provide ethical patient care, including obtaining informed consent to interventions (whenever possible). Those that don’t should be held to task and generally are.”

        Not in my experience. As long as the hospital has the patient’s written consent, no one seems to care if the patient was informed about what they were consenting to, or even if the doctor flat-out lied to the patient to get that consent. (I’m not saying midwives are any better. But in general, I don’t feel like I can trust either one.)

        • Dr Kitty

          Cite specific examples please. Thank you.

          • Michelle

            My husband went to our local hospital for a blood transfusion, something they are well equipped to handle, but the doctor saw my husband as a liability and wanted him OUT of that hospital. So he lied to my husband in order to get him to sign consent to transfer by ambulance to another hospital. It was really frustrating when we found out he lied. We tried to contest the ambulance bill, but the hospital said my husband had consented to it. We argued that it was misinformed consent, but the hospital ignored us and just kept repeating that he had consented. They sent the ambulance bill to collections and we were completely powerless to fight it. It was a very frustrating experience and it resulted in us having to pay two months’ income on an ambulance bill that wasn’t covered by insurance, just because my husband had trusted his doctor.

          • fiftyfifty1

            What was their reason for feeling that your husband was too high risk (i.e. a liability) to transfuse on site? The reason I ask is because I did some rotations in a smallish hospital that was equipped to do some transfusions, but not others. Higher risk transfusions (previous history of reactions, unstable patients, rarer blood types etc) were sent out. ETA: if by “liability” you mean that it was just that he lacked insurance, then that wasn’t ethical.

          • Michelle

            He has a rare blood disorder (hence the need for the transfusion) that most doctors aren’t familiar with, but it doesn’t complicate the transfusion. He’s had dozens of transfusions at our local hospital since then. We would have handled the situation a lot differently if the doctor was honest with him and said “I’m scared because I don’t know anything about your condition, so I want you to go to a different hospital.”

        • the wingless one

          I think that without this blog I could have easily become one of those women bleating on about how I was given no choice in my “unnecessarean” blah blah blah.

          My doctors held my hand through every step of a medically complicated pregnancy and when the time came for my c/s (it was unexpected for me at 34w but not so much from their perspective) I was told I couldn’t have a TOL and needed a c/s. A nurse came in with a consent form, I don’t believe anything was explained to me, and a little while later I had an apparently healthy baby who was rushed off to the NICU for observation.

          With only those details alone I could have allowed myself to become bitter and angry, wondering why I wasn’t given at least a TOL since baby came out screaming and I was told he was healthy.

          Luckily, through reading this blog and reading a few of the horror stories about babies with “no variability” NSTs and 100% failed BPPs (exactly what happened with my son), I realized that indeed, my providers did the right thing. My baby came out screaming BECAUSE they didn’t mess around and did what they knew was best. It also helped that I had a LOT of trust in my MFM and OB and was at peace knowing that if they felt it was necessary then it probably wasn’t worth the risk to fight. This is why I tell all of my friends who are having babies that the #1 thing is to find an OB you can trust and then listen to what they’re telling you.

          My best friend’s son passed away last year, not a stillbirth because they did a crash c/s at 29w, but he passed away several days later because of placental insufficiency. With me, they were aware that my placenta likely wouldn’t make it til 40w and were monitoring me very closely and that’s how they knew he needed to come out at 34w. Especially after seeing what she has had to go through (still is going through and will be for the rest of her life) I can only feel gratitude towards my providers. My c-section was not unecessary although to untrained eyes it may have appeared that way. My c-section very likely saved me from having to live with the pain of a much-wanted but stillborn baby.

          Anyway, I guess this was very long, but it is my explanation of why sometimes “informed consent” doesn’t always happen but maybe it’s because it can’t in every case. I’m glad my doctors didn’t spend extra time talking to me about the research on consecutive failed NSTs and BPPs or pay attention to my request to have a TOL which I now understand would not have been good for my son. They have the medical knowledge, gained over years and years of practice and study. Sometimes there isn’t time in a semi-emergent situation for them to sit down with a patient and go over all of it in the detail that a patient might need to feel 100% informed.

          • Sue

            I think of it like this: I can, and will, negotiate with providers where I have equal knowledge and experience in an area of skill – which happens to be emergency medicine (thankfully I haven;t been a customer, but have negotiated for others). If I am in this situation, however, I do my best not to be invasive, and to remember my role as patient advocate, not provider.

            Outside my area of expertise, though, I can only do myself more harm than good. Let’s take financial advice. I;ll choose the provider, but I won’t tell them what to do, because they know better than me, and I’ve hired them for their advice. Of course, they have to get my permission and assess my risk tolerance, but they know what to do better than I do. I choose them, they set the direction. It might be my money, but I’ve entrusted it to someone who knows how to manage it better than I do.

            I don’t feel any “loss of autonomy” over this – on the contrary. I am empowered by engaging an expert.

          • Hilary

            My story is similar to yours, although I went through labor (also at 34 weeks). I signed the consent forms for the c-section in the OR, while getting a spinal block between contractions. “You won’t be able to have a VBAC” was sort of casually tossed in there and I could not even process it at the time. Technically it was an elective c-section but I did not feel prepared or well informed at the time of the reasons, I just trusted the doctors in what they thought was safest. I had to do my research afterwards and determined then that it was the right decision.

            Could they have done a better job of preparing me? Probably not. I was in labor and on narcotics. It’s not like I would have really paid attention if they had sat down with me to go over a handful of case studies.

          • Sarah (a different one!)

            I think about this when I had an anaphylactic reaction- no time to consent, got to the hospital and was pumped full of adrenaline and steroids. I didn’t care because it saved my life! I know it’s different in labour but I think in emergency situations it’s impossible to consent people- you just have to trust the medial professionals know what they are doing

      • Star

        Define “horrific.” Because I have been told by women that their “birth trauma” was not allowing candles to be lit, music to be played or the lights to be dimmed. So excuse me when I will be doubtful of actual birth trauma until I hear the whole story.

        • Lizzie Dee

          Trauma does indeed come in different forms, and it is possible to be traumatised by the wrong candles if you have no idea at all of the horrors you might have missed.

          The lovely story of women being empowered by making daft choices is very seductive – and while midwives go on telling it like it isn;t, they are increasing trauma not reducing it.

      • Roadstergal

        This is exactly where midwives could be of huge help – in preparing women, informing women, setting up collaborative atmospheres with various providers. Even giving ‘no fear’ hospital tours! If they really cared about birth trauma, they would do these things. But they clearly don’t care about anything other than maintaining their fiefdom.

        • KarenJJ

          The midwife that did the hospital tour for myself and my husband told us all quietly how to circumvent the visitor paid parking and get cheaper onsite parking. It was probably the single most useful thing we learnt.

          • Sue

            Now THAT’s patient-centred care!

    • Bugsy

      I can describe one such parent – as my old friend Crazy Lactivist descended into the NCB world, one of the first clues was the birth of her first son. She was intending for a birth centre birth, but the little guy interfered w her plans by having frequent decels – significant enough so that she was transferred to the hospital across the street. However, even with the decels she pushed for an unmedicated natural delivery at the hospital (which she did get, many hours later). After the fact, the focus of her birth story wasn’t on her son’s health or the medical team that kept them safe, but on how awesome she was for fighting through the pain and problems, how she was able to have the unmedicated birth of her dreams. She was clearly the star of her son’s birth story.

      Even before being a parent, I couldn’t understand the rationale of prioritizing birth type over the potential well-being of one’s child. Now that I have kids, the logic (or lack thereof) simply astounds me.

      Anyway, don’t even get me started on the NCB woo she bought into for #2…

      • DelphiniumFalcon

        No, no. Please get started on what happened with #2.

        • Bugsy

          Heh, let’s just say that by the time #2 rolled around, the family was already allergic to GMOs. She believed ultrasounds would irreparably damage her fetus and, despite having had GD in her previous pregnancy, was cleared by her midwives to use an all-natural glucola substitute for her GTT.

          I have no idea what happened after that, just that the kid was incredibly big and that he wasn’t born at the birth centre.

          • Amazed

            Big is normal! Nature won’t let you make a too big little one!

            Really, I can’t believe how stupid people can be. Not too big, they claim. Once upon a time, women give birth to big babies all naturally!

            Don’t I know this! 29 years ago, the Intruder was the biggest baby they had in the unit. All glorious 10 pounds of him. Now, it barely scratches the surface of “umm, perhaps we need to rethink this whole low-risk thing”. The thing is. they KNEW he was enormous! Now, it’s considered cute and normal cause humanity develops and so on. Guess what? Pregnant women I see today are NOT taller than my mom. Broader, yes. But not taller.

            I go with the suggestion that their lady parts aren’t bigger than hers and generally aren’t better equipped to push out baby elephants swiftly, gloriously and most importantly. WITH NO COMPLICATIONS.

          • If only having broader bodies gave us broader pelvises and vaginas. We could birth toddlers.

          • PeggySue

            I might could birth a lawn tractor.

  • Blue Chocobo

    “The importance of addressing maternal psychosocial and physical needs during birth is crucial, potentially preventing unnecessary physical and emotional suffering where birth is perceived as traumatic.”

    This is true, but the midwives’ response (“promotion of normal physiologic birth rather than the actual outcome”) is impossible to reconcile with it.

    Treating women with respect and dignity is important. Hence: informed consent, patient rights, amoral access to pain relief, safe accommodation of requests to satisfy psychosocial and physical needs, and prioritizing prevention of harm (trauma) and subsequent suffering to the woman and her child.

    • Roadstergal

      By demonizing hospitals and interventions, and setting up an adversarial relationship with OBGYNs, midwives do exactly the opposite of “preventing unnecessary physical and emotional suffering where birth is perceived as traumatic.”

      They are in a position to do much good there, explaining interventions and liaising with the woman. But they do the opposite.

      • Blue Chocobo

        They CREATE trauma by perverting informed consent, falsifying risks, misrepresenting interventions, normalizing process-over-outcome, and isolating women from real help.

        • The Bofa on the Sofa

          As I mentioned above, the NCB industry are the ones who are selling crap like “if you have a c-section, it means your body has failed.” You don’t hear that from doctors.

      • Dr Kitty

        I had a great NHS midwife in my most recent pregnancy, who was totally on board with my no VBAC plan.
        Maybe it was because she’s had two CS herself and her midwife daughter had just had an emergency CS after hours of unproductive labour ( yes, we got quite close), who knows.

        Her advice to me was very straightforward.
        “Any twinges after 37 weeks that don’t go away with position changes, you go up the road like a rocket girl, and make a fuss until you get your section! Don’t you be waiting around until contractions are two minutes apart. UP THE ROAD LIKE A ROCKET”.

        I didn’t need or want protecting from intervention, I wanted someone on my side who knew that I didn’t want to VBAC.

        Thankfully my son stuck around and I got my ERCS at 39w.

  • Valerie

    Figure 1 in the article: is that supposed to look like a birth canal?

    • DelphiniumFalcon

      Oh good I’m not the only one who saw that! I feel less weird now.

    • Sue

      I don;t know about the symbolism, but the content doesn’t make any sense.

      • Valerie

        Right? It’s laughably bad. Here are some of my observations. I’m still pretty stumped as to the difference between “Midwife as Monitor” and “Midwifery Surveillance.” They appear to be used interchangeably in the article. I get the impression that these midwives want to put themselves as a tri-layer barrier between the woman and and interventions. Think a C-section is needed? You will have to cut through three of us before you get to the mother! Also, “prompt recognition and correct management” of what? An imminent intervention? And how does that lead to normal processes? Is that, for example, recognizing the signs that a woman is going to ask for an epidural and intervene by insisting she try alternative pain management strategies first?

        I think it would make more sense, based on the text, if they put “Unmedicated Vaginal Birth” in the middle instead of “woman,” but I think they were correct to have “midwife” or “midwifery” on there six times but leave the infant off of the chart altogether. Outcomes for babies and mothers aren’t important, and don’t factor much into their model of care.

  • moto_librarian

    I don’t know what to say. This is just stunningly cold on so many levels. Plenty of women achieve physiologic birth in the developing world because they HAVE NO CHOICE. Funny how privileged bullshit like this totally negates their outcomes. I find it utterly repulsive for a midwife to condone this viewpoint at all. The goal of childbirth is a healthy mother and child. Period. If someone with an endowed chair who teaches CNMs is espousing this, I am beginning to believe that midwifery is indeed representative of Bofa’s Law.

    • Roadstergal

      “Plenty of women achieve physiologic birth in the developing world because they HAVE NO CHOICE”

      And women and babies in the developing world die thanks to being ‘rescued from the health care system.’

      • DelphiniumFalcon

        Maybe these people need to trade places.

        Send those that need to be “rescued” from interventions to the developing world and let the woman from the developing world take the woman who’s afraid of tech’s place in the hospital.

        Everyone gets what they want!

        Developing world woman gets first world health care and actually wants to be there!

        And the other one gets to have their NCB experience without the temptation of technological intervention! I mean, that’s the reasoning behind not having painkillers on site, right? Remove the temptation? Same principle!

        You could make a TV Show out of it like Wife Swap and we’d have more mindless reality TV for the masses!

        • Liz Leyden

          Would it be on Lifetime, The Discovery Channel, or TLC?

          • Bugsy

            I think TLC is looking for something to fill the recurring 19 Kids time slot…

          • DelphiniumFalcon

            Allll of theemmmm.

    • Ash

      If this is the attitude of leadership in midwifery in the USA (both lay midwives and CNMs) this bodes very poorly for the profession. Excellent healthcare providers, like Medwife and Crowned Hamster Wife on this site will become an increasing minority.

  • Ash

    Marie Hastings-Tolsma, PhD, is a professor a U of Colorado. Anna G.W. Nolte, PhD was teaching at university in South Africa, I’m not sure if she is still employed there.

    It is appalling that they have this philosophy…AND they are teaching countless students this drivel as well!

    I can’t imagine other midlevel providers, such as Physician Assistants and Nurse Practitioners issuing a paper like this.

    • The Bofa on the Sofa

      And remember, Hasting-Tolsma is a CNM – supposedly, one of the GOOD ones, right? Now you can see why I continue to be skeptical of CNMs.