Midwife crowdsources life & death situation on Facebook; baby dies

I have gotten into quite a row here on the Dope about the role of paralegals. I was a paralegal for 15+ years, and by the end of it, I was basically practicing law while my lawyers went on vacation. Now, people were horrified that I suggested that paralegals be allowed to handle simple bankruptcy cases on their own - the concern was that a paralegal may think they can handle it, but can’t for whatever reason, or that they will miss something that a lawyer would catch, and the client would have their lives ruined, etc.

Why isn’t this argument applied to midwives? While your credit might be important, I can’t think if too many things that are more important than the birth of your child. You went to an OB because of risk factors, and presumably because the midwife told you you were high risk. What if he/she missed it? What if he/she thought they could handle it?

That appears to be what happened here - the midwife figured she had it under control, except for a few questions (which she posted on FB!) and now there’s a dead baby.

I don’t understand it.

Not quite a midwife but my first wife & I hired a doula to help us with both our children, born in hospitals with the help of Drs. My two were VBAC births, their older half brother being born by c-section. The assistance of a knowledgeable liaison between the hospital and parent was incredible and I highly recommend it. I am convinced both my children were born far healthier (and their mom less stressed) than they would have otherwise. Indeed my son (the first) was minutes from a c-section when the doula managed to talk my wife through and into childbirth.

Hell of a thing to see; the Dr had ordered the operating room prepared and said she had an hour before they went in for surgury. The doula got to work with her and minutes before they were to wheel her in he came back for a final check, reached in then yelled for a delivery tray and some help. My son was out 5 minutes later.

In short science can happily coexist with other practices if a careful balance is struck.

My mother-in-law is a certified nurse midwife. Her first response after emailed this story to her, “That’s got to be someone just calling herself a midwife with little or no training. A real midwife would get her license yanked for that kind stupidity.”

Simple wills, uncontested divorce with little in terms of assets and no children, power of attorney, etc. Maybe not a paralegal, but a paralegal+ who has had additional training and is certified…

I didn’t even stop for a CNM - my OB worked with my Reproductive Endocrinologist. I knew some of the issues - the only one that surprised me was the pre-eclampsia. I did talk to my family practice doctor after I made the OB appointment - he delivered babies - he said he would have referred me to an OB anyway.

That “significant minority” was amply heard from in this instance.

We’d have to define “significant minority” as it applies to obstetricians and compare that percentage to the proportion of midwives who are into snake oil. If this had been an OB who made very bad choices and received encouragement from similar dumbbells on Facebook, it’d be just as bad (well, worse actually). I have difficulty envisioning that scenario, though.

A BPP is a score out of 10 points that measures the fetus and amniotic fluid. From Wikipedia:

A “reassuring” score is 8-10 out of 10. The midwife said the amniotic fluid level was zero, so the best possible score there could have been was 8/10. Which is still reassuring right? Except no. The recommended management for a score of 8 is labor induction if oligohydramnios is present. Oligohydramnios is low amniotic fluid. And this baby didn’t have low fluid, it had NO fluid.

The combination of being more than two weeks overdue, and no fluid, means any midwife who is not a moron should have the mother transferred to a hospital. Not farting around for another day or two getting the mother to drink more water and crowd sourcing recommendations on Facebook for Stevia, a midwife friendly acupuncturist, etc.

And this was in Nevada, where they allow, but do not regulate, direct entry midwives, and they have no midwifery schools. (Direct entry being a woman who may have studied with another midwife, or may have read a couple of books…no way of knowing.) http://cfmidwifery.org/states/states.aspx?ST=NV

Especially in a place such as Nevada (although not so much Las Vegas) I understand the need for midwives and home births. Nevada has “66 primary medical care health professional shortage areas (HPSAs), 9 medically underserved areas (MUAs); and 4 medically underserved populations (MUPs).” There are lots of people who live more than an hour away from a hospital and/or don’t have the resources to get to a hospital when in labor. What the state desperately needs is a greater number of CNMs and to allow CNM’s to do homebirths for low risk pregnancies (which they currently do not; CNMs can only do hospital births) and to build more hospitals or free standing birth centers to serve the underserved populations out there. “Just use an OB” doesn’t work when you don’t have enough OBs to go around and more and more of them are fleeing the specialty every year.

(CNM’s insurance isn’t bad. They’re usually covered under the malpractice policy of the OB they work under, and their professional liability insurance, if they choose to carry a separate policy, is that of any Advanced Practice Nurse.)

But here’s the way I see it: if you become a Certified Nurse Midwife and you screw up, then you’re likely to be brought in front of the nursing board in your state. There your actions will be investigated by other nurses, other people who have your background and training and have been there themselves, and can make a pretty good determination if what you did was negligent and stupid, or if it was understandable given the circumstances, or if it was one of those unfortunate things that could have happened to anyone. Then they can act based on their decision. They may do nothing, they may suspend your license, they may tell you you have to practice under the direct visual supervision of another nurse for a while to learn more, or they may decide you are so fucking incompetent you can’t be a nurse anymore and revoke your license completely.

It’s fairly common, when stuff like this happens with a Medical Doctor or a Certified Nurse Midwife for law enforcement to stay out of it and let the professional board handle it. We police our own.

If you chose not to become a Certified Nurse Midwife, then our society doesn’t have that level of oversight and enforcement. All we can do is use the justice system. So you get brought up in front of a judge or a jury who don’t know nothin’ bout birthing no babies. There, the only penalities available are large sums of money or jail time.

So…sorry. I think unlicensed midwives deserve what they get. Not because I’m opposed to viewing natural childbirth as a natural event, or because I really think that nursing school is the only way to learn about pregnancy and childbirth (Ina May Gaskin is the best damn person out there with an exemplary success rate at birthin’ babies, but not from what she learned in school) but because they’ve chosen who they want to answer to in the event of a bad outcome, and it isn’t the nursing board. It’s the public media circus and the judicial system.

I didn’t go to nursing school to learn information. I already knew 90% of what they taught us in nursing school. I went to nursing school so that I could legitimize my practice with a license and I have a shot at presenting my case to a true jury of my peers if I screw up.

Since CNMs can’t do home birth in her state, she must be a direct entry midwife. And yeah, she screwed up. I’m not a CNM, but I know that much. A complete lack of amniotic fluid is not a low risk pregnancy anymore. Her doctor back up should have been called the first time she saw that, not the third.

I’d rather see hospitals within 30 minutes of any location. My sister is a nurse in a rural hospital - which won’t be closed because despite it losing money and not having a large population - the town is too far from any other hospital. So they need staff - mostly to stabilize patients until the helicopter arrives, but also because rural populations are often poor, and the hospital also functions as a medical and dental clinic. An orthopedist drives in once a week to do knees and such, there is an active surgery center. If the people nearby don’t come there, they aren’t likely to drive an hour to see a doctor. There are lots of reasons rural residents need medical care - homebirth is filling a very small portion of that need.

The hospital does very few births now - labor lasts long enough to drive 45 minutes to a better hospital - and with higher risk women, they schedule and induce or do a c-section (or if the woman is opposed to that, they recommend she spends the last few weeks of her pregnancy closer to Fargo - most people have friends or relatives in Fargo to stay with - the arrangement isn’t unusual). My sister gave birth to both her boys at the local hospital - both ended up with transport to Fargo’s NICU - my understanding is that they can handle the birth, but since they don’t have anything more complicated than a 1980s era incubator in the nursery, its the health of the newborn and the rate of transport after the birth that made them switch.