# Phlosphr, you are a fucking idiot (re: home birth) **URL:** \ **Category:** The BBQ Pit\ **Created:** [June 17, 2011, 2:43am UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786 "2011-06-17T02:43:34Z")\ **Posts on this page:** 20\ **Page:** 23
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 20, 2011, 8:19pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/441 "2011-06-20T20:19:28Z")
> [@Diogenes\_the\_Cynic](#): > > I know they’re not doctors. That’s all I NEED to know. Can you cite any hospital where midwives are allowed to override doctors? A nurse (regular ol’ RN) not only may but MUST refuse to carry out any order that he or she has good reason to think is unsafe. (Good reasons include textbooks, scientific studies, drug books, etc.) If he or she does not refuse and harm comes to the patient, his or her own license is forfeit. Nurses are legally and ethically responsible for their own actions - you can not get out of a malpractice suit by saying that the doctor told you to administer 200mg of morphine and you checked the number with him twice. Even if that’s what was prescribed, you as the nurse are responsible for only administering SAFE medications (or other nursing interventions.) In the real world, this first means questioning the order, explaining why you do not feel it is a safe order and documenting your concerns and the physician’s response. If you are threatened (as sometimes happens) or told you MUST comply, you go to the charge nurse or nursing supervisor. They may disagree with you and agree with the doctor, in which case they may fulfill the order, or they may agree with you, in which case the doctor’s supervisor will be called. There’s a chain of command, both for the nursing profession and the physician profession, and a doctor may not ever force a nurse to carry out any order\* because the nurse is not the doctor’s subordinate\*. I’ve already done this twice, as a student. They weren’t very happy with me, but did eventually concede that there was a slipped decimal point that somehow wasn’t noticed by the doctor, pharmacy or my teacher, so I refused to give the med until the order was corrected. The second time, a patient was scheduled for a procedure where he needed IV dye, and I was the only one who noticed he’d been given a medication an hour before my shift that made that life-threatening, so I refused to give his chart to Transport when they came to take him for his test (when I explained what happened to the Charge Nurse, he rescheduled the test and thanked me). Sometimes even very well educated people make mistakes. And even “just” a student has a legal and ethical responsibility for not blindly carrying out orders, but using her burgeoning professional judgement and refusing when appropriate. So yeah, not only a nurse, but a lowly nursing student can “override” a doctor’s orders. As can a Respiratory Therapist, a Physical Therapist, a Nursing Assistant or even a housekeeper. The only person a doctor can order around is himself. ---
**Author:** ![Zeriel](https://avatars.discourse-cdn.com/v4/letter/z/58956e/32.png) [@Zeriel](https://boards.straightdope.com/u/Zeriel)\ **Post date:** [June 20, 2011, 8:23pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/442 "2011-06-20T20:23:40Z")
> [@Diogenes\_the\_Cynic](#): > > Go ahead and cite them. I’m particularly interested in seeing a cite that a nurse or a midwife can override a doctor on a matter of pure opinion. My aunt is my cite. At minimum, if she overrides an order on a chart, it gets a second look by the doctor. Funny how she complains on a regular basis about having to override doctor’s orders that eventually get changed, and has for decades, and yet she got promoted repeatedly. Not all hospitals work like this, granted. Just the good ones, that recognize that nursing vs. doctoring is not a difference of rank, but one of specialization. Or, as much more eloquently phrased by WhyNot: > [@WhyNot](#): > > In the real world, this first means questioning the order, explaining why you do not feel it is a safe order and documenting your concerns and the physician’s response. If you are threatened (as sometimes happens) or told you MUST comply, you go to the charge nurse or nursing supervisor. They may disagree with you and agree with the doctor, in which case they may fulfill the order, or they may agree with you, in which case the doctor’s supervisor will be called. There’s a chain of command, both for the nursing profession and the physician profession, and a doctor may not ever force a nurse to carry out any order\* because the nurse is not the doctor’s subordinate\*. ---
**Author:** ![raspberry\_hunter](https://avatars.discourse-cdn.com/v4/letter/r/b19c9b/32.png) [@raspberry\_hunter](https://boards.straightdope.com/u/raspberry_hunter)\ **Post date:** [June 20, 2011, 8:54pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/443 "2011-06-20T20:54:32Z")
> [@sugaree](#): > > Competent, well-trained midwives, particularly CNMs, know a hell of a lot, and I wager they know more about pregnancy and labor than doctors that do not specialize in OB/GYN. > [@Diogenes\_the\_Cynic](#): > > I doubt that very much. I used to think this way too, until my sister and my best friend from college became doctors (peds and onc respectively). Both of them would MUCH rather have a midwife or ob nurse deliver their kid than an MD who wasn’t ob/gyn, and counseled me the same way. (Though they did both still recommend hospital births with an ob/gyn.) ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [June 20, 2011, 9:02pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/444 "2011-06-20T21:02:53Z")
> [@MandaJo](#): > > Dio, I am honestly curious. If your wife were in labor and the only medical professionals on the plane were a CNM and an oncologist, who would you want delivering the baby? I would choose the one who was actually a doctor. I don’t see this as even being a tough question. ---
**Author:** ![DianaG](https://avatars.discourse-cdn.com/v4/letter/d/7ab992/32.png) [@DianaG](https://boards.straightdope.com/u/DianaG)\ **Post date:** [June 20, 2011, 9:08pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/445 "2011-06-20T21:08:03Z")
And so ironically, Dio would endanger his wife and child for the sake of his stubborn pride. Seriously dude… WHY are you so dug in? Homebirth can still be stupid even if midwives aren’t. Stop undermining your larger point (which is correct) by being ridiculous about this. ---
**Author:** ![sugaree](https://avatars.discourse-cdn.com/v4/letter/s/cc9497/32.png) [@sugaree](https://boards.straightdope.com/u/sugaree)\ **Post date:** [June 20, 2011, 9:11pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/446 "2011-06-20T21:11:04Z")
**Dio** would, but the oncologist wouldn’t. Knowing more about medicine than **Dio** , he or she would defer to the CNM. You know why I’m pro-homebirth (in some circumstances)? Because hospital birth is fucked (in some hospitals). It’s totally documented that moving around is good for the progression of labor, yet some women in some hospitals are still tethered to IVs and that restrictive type of fetal monitor. So labor stalls. And then the woman is in worse pain then she would have been if she could switch positions or stretch out or get into a nice warm tub of water, so the epidural is administered. So labor stalls even more. Don’t forget that she’s weak and dehydrated from being forbidden to eat and drink. Hours of this mess, and eventually there’s nothing to do but a c-section. Get hospital birth uniformly to the point where women don’t have to worry that they’ll have a million interventions pushed on them or that their wishes concerning birth and infant care will be disregarded\*, and nobody will want to give birth at home, and all these women will be conveniently at the hospital if an emergency arises. With their OB, or with their midwife and the OB only a quick page away. Bam. Solution to the problem. \*Yes, I realize that many hospitals are totally progressive and awesome and supportive and family-friendly, but this is not universal. ---
**Author:** ![Shayna](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/shayna/32/17976_2.png) [@Shayna](https://boards.straightdope.com/u/Shayna)\ **Post date:** [June 20, 2011, 9:15pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/447 "2011-06-20T21:15:19Z")
> [@Phlosphr](#): > > No worries at all 🙂 And thank you for being a friend. We were at the BC this morning, it’s a beautiful place and has tons of benefits. I’ll email with the details … Thank you! I can’t wait to read more about it. From the review I found by one new father online, it sounds really awesome, with birthing rooms that are “bedroom-like”, queen beds so you can be lying with her, views that make you feel like you’re on an exotic vacation (and I’m sure they’ll let you keep the lights down low). {{Phil}} ---
**Author:** ![Sarahfeena](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sarahfeena/32/519_2.png) [@Sarahfeena](https://boards.straightdope.com/u/Sarahfeena)\ **Post date:** [June 20, 2011, 9:16pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/448 "2011-06-20T21:16:25Z")
> [@Phlosphr](#): > > No worries at all 🙂 And thank you for being a friend. We were at the BC this morning, it’s a beautiful place and has tons of benefits. I’ll email with the details … Yes, yes, yes, please listen to your friend Shayna. Of course problems are rare, but when they do happen they can be catastrophic. You are lucky to have such a nice birthing center right adjacent to a hospital, take advantage of it, I’m sure you will not be sorry. ---
**Author:** ![Erdosain](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/erdosain/32/7284_2.png) [@Erdosain](https://boards.straightdope.com/u/Erdosain)\ **Post date:** [June 20, 2011, 9:30pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/449 "2011-06-20T21:30:49Z")
> [@Zeriel](#): > > 1. Not actually necessarily true. > 2. In many states, midwives are required to be certified as RN/APNs, which means a residency and postgraduate work. How many times do we have to do this? CNM =/= midwife. Some states refuse to license midwives that aren’t CNMs, but that just means the midwives operate without a license or as doulas. According to the Slate article I linked to, almost no CNMs will preside over homebirths. I’ve yet to see anyone contradict this. Quotes like yours above lull people into a false sense of security. “Oh, well most midwives are CNMs and have postgraduate work” when in fact the exact opposite is true. Also, I’d like to disassociate myself from any of Dio’s typical tired lunacy. I think women should be free to do whatever they want at home, I just want them to have access to a real medical professional, not pseudomedical midwives. ---
**Author:** ![Erdosain](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/erdosain/32/7284_2.png) [@Erdosain](https://boards.straightdope.com/u/Erdosain)\ **Post date:** [June 20, 2011, 9:40pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/450 "2011-06-20T21:40:42Z")
I should say, I don’t know why CNMs don’t do home births. It could be they make more money working at a hospital or birthing center, or it could be that they think regular, barely regulated midwives are good enough to get the job done. Or they could think home births are hippy-dippy. It’d be nice if we could get an actual CNM and OB to discuss these issues, since most of us are in the dark about all these factual points. ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [June 20, 2011, 9:55pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/451 "2011-06-20T21:55:09Z")
Just thought I’d share that this thread is currently the #5 Google hit for “Nigerian woman forced C-section.” What this means, I have no clue. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [June 20, 2011, 10:05pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/452 "2011-06-20T22:05:48Z")
> [@Diogenes\_the\_Cynic](#): > > I would choose the one who was actually a doctor. I don’t see this as even being a tough question. I think you _vastly_ overestimate the amount of training a doctor has in areas outside his/her specialty. This is like saying an electrical engineer is more qualified than a mechanic to change your transmission because they’ve had more education. ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [June 20, 2011, 10:09pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/453 "2011-06-20T22:09:37Z")
It’s not like that at all. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [June 20, 2011, 10:22pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/454 "2011-06-20T22:22:21Z")
> [@Zeriel](#): > > I can cite several places (including the hospital where my sister-in-law works as a PA-C, and the hospital where my aunt works as Nurse Supervisor, and the hospital where my grandmother worked as a trauma/ER nurse) where RNs, APNs, and PA-Cs can override a doctor’s order when that order is clearly wrong–usually in cases where the patient would be endangered by the order, but in some cases where the patient had expressed a preference of care that the doctor didn’t know about or ignored. My father the pharmacist overruled doctors several times in his career and other doctors vindicated his action every time. Why? Because as a pharmacist he’s a specialist in medications and how they can interact. He can’t diagnose or prescribe, but he sure as hell can note overdoses or potentially fatal interactions ordered through ignorance (multiple doctor prescribing without being aware of each other, for instance) or potentially serious or fatal interactions between various drugs, or other possible problems, and not only does a pharmacist have an \*ethical \*duty to challenge such prescriptions but a \*legal \*one as well. It’s not that pharmacists “know more” than doctors, it’s that in their particular area of expertise they are, in fact, the experts. That’s just one more example where the person without the MD can have a valid and valuable contribution to medical care. Nurses aren’t “doctors lite”, they’re nurses. As noted, it’s a collaboration (ideally) and not a matter of dominance. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [June 20, 2011, 10:22pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/455 "2011-06-20T22:22:32Z")
Dio, you’re doing the thing again. Some supporting detail beyond “nuh-uh” would be appreciated. ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [June 20, 2011, 10:24pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/456 "2011-06-20T22:24:12Z")
I need to provide a cite that doctors outrank nurses on matters of medical opinion? ---
**Author:** ![Sateryn76](https://avatars.discourse-cdn.com/v4/letter/s/a88e4f/32.png) [@Sateryn76](https://boards.straightdope.com/u/Sateryn76)\ **Post date:** [June 20, 2011, 10:25pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/457 "2011-06-20T22:25:15Z")
> [@Diogenes\_the\_Cynic](#): > > It’s not like that at all. What it’s like is a lawyer - same type of professional with many different areas of expertise. I’ve worked with bankruptcy as a paralegal for almost 15 years. I know a ton about it. My lawyers know much, much more than me. Snidley Cheatam is a lawyer specializing in anti-trust. Some other guy works with worker’s compensation cases. If you wanted an instant opinion about a credit card company that is suing you, who would you call? I’d call the BK paralegal, since they’ve had day to day experience with the nuts and bolts for years. Snidley or the other guy will only know the basics about a lawsuit - say, what timelines you have to follow - and may know nothing at all, since they practice in county court, and bankruptcy is Federal. Same with doctors - they may all know how to stop the bleeding, but in terms of birthing a baby, your mid-wife/whatever the acronym is, is going to do a better job, if for no other reason than they’ve caught a ton more babies than the oncologist, who may have done an OB rotation during their training. FWIW, I would always have a baby with an OB at a hospital, but if I was at the side of the road and could only pick one, I’d probably pick the midwife. ---
**Author:** ![sugaree](https://avatars.discourse-cdn.com/v4/letter/s/cc9497/32.png) [@sugaree](https://boards.straightdope.com/u/sugaree)\ **Post date:** [June 20, 2011, 10:27pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/458 "2011-06-20T22:27:41Z")
> [@Eva\_Luna](#): > > Just thought I’d share that this thread is currently the #5 Google hit for “Nigerian woman forced C-section.” What this means, I have no clue. I saw that earlier while searching “nigeria ‘court order’ ‘caesarian section’” Awesome. > [@Erdosain](#): > > How many times do we have to do this? > > CNM =/= midwife. > > Some states refuse to license midwives that aren’t CNMs, but that just means the midwives operate without a license or as doulas. According to the Slate article I linked to, almost no CNMs will preside over homebirths. I’ve yet to see anyone contradict this. > > Quotes like yours above lull people into a false sense of security. “Oh, well most midwives are CNMs and have postgraduate work” when in fact the exact opposite is true. > > Also, I’d like to disassociate myself from any of Dio’s typical tired lunacy. I think women should be free to do whatever they want at home, I just want them to have access to a real medical professional, not pseudomedical midwives. I have nothing against licensed direct entry midwives myself, but I thought too much emphasis on the different levels of midwifery might totally blow the discussion off course when one participant was still struggling with the concept of midwife as a modern-day career choice. Baby steps; baby steps. My guess is that most CNMs don’t do homebirths for the same reason that most doctors don’t do house calls. But there are a handful. [Short list here](http://www.birthlink.com/directory/homebirth.html). I also found more doing a Google search. They are out there. ---
**Author:** ![tnetennba](https://avatars.discourse-cdn.com/v4/letter/t/7993a0/32.png) [@tnetennba](https://boards.straightdope.com/u/tnetennba)\ **Post date:** [June 20, 2011, 10:31pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/459 "2011-06-20T22:31:17Z")
[I’m hearing you guys, ok. I’m going to try.](http://boards.straightdope.com/sdmb/showpost.php?p=13683688&postcount=291) ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 20, 2011, 10:37pm UTC](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786/460 "2011-06-20T22:37:46Z")
> [@Erdosain](#): > > I should say, I don’t know why CNMs don’t do home births. It could be they make more money working at a hospital or birthing center, or it could be that they think regular, barely regulated midwives are good enough to get the job done. Or they could think home births are hippy-dippy. > > It’d be nice if we could get an actual CNM and OB to discuss these issues, since most of us are in the dark about all these factual points. Most of them can’t get malpractice insurance that covers homebirths, or they work for groups that only elect to buy coverage which specifically excludes homebirths, or they work in states where homebirth is or was until recently illegal (which may also influence malpractice rates and availability) like Illinois. There are a lot of people who go into midwifery \*wanting \*to do homebirths (my best friend is in UIC’s Midwifery program, and at least half her class wants to do homebirths) but most of the actual jobs are in hospital based group practice in my state. My friend intends to do her first years at such a group, and homebirths when she has appropriate experience, but is well aware that the financial reality may make that impossible. [Previous page](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786.md?page=22) [Next page](https://boards.straightdope.com/t/phlosphr-you-are-a-fucking-idiot-re-home-birth/585786.md?page=24)