Phlosphr, you are a fucking idiot (re: home birth)

[WhyNot]

@Diogenes_the_Cynic

I’ve answered questions about this scenario before. First of all, the abortion issue does not have anything to do with full term pregnancies, so the dilemma is essentially bogus, but my position is, and has been, that the woman has a right to have the babies removed from her body. If the state wants to keep them alive once they’re out, the state may do so. Her right is to terminate the pregnancy. Sometimes termination can be defined as induction or C-section. Even Roe allows the state to limit choices in the 3rd trimester. She has a right to getthem out of her body. She doesn’t have a right to kill them if they can be removed from her body alive.

Fair enough, and internally consistent, thank you. (Not that you care what I think, I’m sure, but you don’t hear enough on this board about when you’re right and reasonable, so I thought I’d let you know.)

For me, it’s more about informed consent to a surgical procedure with very real risks - and especially greater risks than average for this woman. She was able, apparently, to articulate the possible or even probable outcome to her decision to refuse consent, and that’s enough for me to determine she’s of sound mind and decision making capability. The only other people affected aren’t morally or legally people yet, so I don’t give them the same weight I do her. And very most especially, I’m appalled and outraged - not as a doctor, not as an almost-RN, but as a woman and human being - that this was all done clandestinely, without giving her the opportunity to seek a second opinion or appear before a judge herself to argue her own case. I’d like to think it wouldn’t happen that way now, nearly 30 years later, but I’m really not that confident about it.

It makes me think of a lecture I heard from a medical ethicist (hospitalist and doctor) who assured us that Jehovah’s Witnesses WANT to be forced to take blood or give it to their children. That they won’t be held religiously or morally responsible for it if they refuse it and a judge orders it and they get it anyway, so when they refuse, they’re not really refusing, but asking their doctor to go get a court order so they’re not culpable. I really don’t know which I find more offensive: that some JW’s may indeed think that way and are playing a nudge-nudge-wink-wink game when they’re refusing, or that doctors and ethicists *think *that’s what’s going on in some sort of paternalistic, “of course they can’t REALLY think for themselves so they want us to do it for them” attitude.

It’s absolutely true that a layperson doesn’t have the knowledge of medicine that a doctor does. Ignoring doctor’s medical opinions entirely is not the way to go, sure. But it’s also true that a doctor doesn’t have the knowledge of each person’s life, values and relationships that the person has. Surely completely ignoring the patient - not even letting her speak for herself to a judge - isn’t the way to go, either.

And…as the thread has moved on as I’ve been typing…SERIOUSLY? You’d rather have a dermatologist 30 years out of medical school deliver your baby than a CNM, if those were your only options? Okay, now you’re back into crazyland… You have absolutely zero idea how modern medicine works. Nurses, even those who aren’t CNMs, are not doctor’s helpers. We haven’t been for more than 100 years now. We’re competent medical professionals in our own right, and in the case of a CNM, that includes delivering all care during pregnancy, labor and delivery in all but a small percentage of pregnancies. Are there some things outside the expertise of a CNM? Yes, and doing the c-section procedure is one of them. But it would also be outside the expertise of the vast majority of doctors, too!

[Telemark]

@Diogenes_the_Cynic

If midwives knew as much as doctors, they’d be doctors.

This is why it’s difficult to have a reasonable conversation with you. You constantly make blanket unsupportable statements. No good doctor would dismiss a nurse’s opinion because she’s not a doctor. They know different things; it’s not a hierarchy of knowledge. You’ll ignore this and repeat your screed, but repeating it won’t make it right. You’ve backed yourself in an unsupportable position and will respond (as usual) by making more and more grandiose proclamations, further Dio’ing this thread.

So, in summation, you’re wrong but you don’t care.

[Zeriel]

@Diogenes_the_Cynic

Yes they do. They have all the training and the testing and the qualifications. If midwives knew as much as doctors, they’d be doctors.

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.

For damn sure I’m trusting a CNM over the word of some random doctor, and holding her about equal to a Ob/Gyn.

And I say that as someone who dislikes home births and thinks non-licensed midwives are as bad as homeopaths and chiropractors.

I should note, when my daughter was born, the sole care the OB/GYN did was to turn the baby’s head slightly because the way she was facing was slowing down labor somewhat. The entire rest of the care was delivered by either an anesthesiologist (the epidural) or by obstetric nurses.

[sugaree]

@Diogenes_the_Cynic

It’s not that I have so much faith in doctors as that I have even LESS faith in non-doctors. I’m going to gamble on the person with the most training.

Which, in the case of a CNM vs. a non OB-GYN, would be the CNM. Seriously, do you think I go to a neurologist for my gynecological care? No, I go to a physician’s assistant (and I used to go to a nurse-practitioner).

Three days ago, you didn’t know such a position as a CNM existed; today you’re positive they are inferior to doctors in all cases, rather than simply occupying a different and complementary niche in the medical responsibilities organization. How did you gain so much knowledge in three days?

[Zeriel]

@sugaree

Which, in the case of a CNM vs. a non OB-GYN, would be the CNM. Seriously, do you think I go to a neurologist for my gynecological care? No, I go to a physician’s assistant (and I used to go to a nurse-practitioner).

Three days ago, you didn’t know such a position as a CNM existed; today you’re positive they are inferior to doctors in all cases, rather than simply occupying a different and complementary niche in the medical responsibilities organization. How did you gain so much knowledge in three days?

To be (somewhat) fair to Dio, it seems like he sees the word “midwife” and his brain simply refuses to accept that it could possibly be used as the actual modern name of a specialist branch of registered nursing.

[sugaree]

Well, there’s the problem. His brain stops. His fingers keep typing.

[Diogenes_the_Cynic]

@Telemark

This is why it’s difficult to have a reasonable conversation with you. You constantly make blanket unsupportable statements. No good doctor would dismiss a nurse’s opinion because she’s not a doctor.

I didn’t say they would, but if a doctor disagrees with a nurse, I’m gambling on the doctor.

[Diogenes_the_Cynic]

@sugaree

Which, in the case of a CNM vs. a non OB-GYN, would be the CNM. Seriously, do you think I go to a neurologist for my gynecological care? No, I go to a physician’s assistant (and I used to go to a nurse-practitioner).

Three days ago, you didn’t know such a position as a CNM existed; today you’re positive they are inferior to doctors in all cases, rather than simply occupying a different and complementary niche in the medical responsibilities organization. How did you gain so much knowledge in three days?

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?

[sugaree]

@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?

I see you’re not really grasping this collaboration thing. Nor does the concept of specialization seem to be taking root in your mind.

[Telemark]

@sugaree

I see you’re not really grasping this collaboration thing. Nor does the concept of specialization seem to be taking root in your mind.

He gets this way sometimes. We haven’t found the reset switch.

[Drain_Bead]

My mother, who has been an MD for over 20 years now, has delivered exactly ONE baby in her entire career, and that was when she was in medical school and the woman’s doctor didn’t make it in the room in time. The first thing my mom did after she caught the baby was to yell “NURSE!” because there wasn’t one in the room. She didn’t yell for a doctor, she yelled for an OB nurse.

[Smeghead]

Well, we’ve now reached the point where whatever substance there once was to this thread has now been permanently obscured by the rich, frothy ranting. Last one out shuts off the lights, OK?

[Phlosphr]

@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?

Here you go Dio - pertaining to Nurse Midwives at Boulder Birthing Center, read carefully: (Underlining mine)

We are also nurses. We believe that birth is a natural process and a majority of the time a non-medical event. Although it is likely that you won’t need the services of a doctor during your pregnancy, we work closely with the medical community. We consult and refer if you require the services and expertise of physicians. We are certified by two boards, those of registered nurses (RNs) and Certified Nurse Midwives (CNMs). Boulder Women’s Care , an OB/GYN practice of five, female physicians is available if complications arise.

And:

Certified Nurse Midwives (CNMs) provide health care involving emotional and physical support to women before, during, and after childbirth. Nurse midwives focus on education about pregnancy, the birth process and post-partum period with the goal of empowering women. They are educated in two disciplines: nursing and midwifery. Midwife literally means “with woman” and nurse midwives believe in being present throughout the labor process. Nurse midwives follow a long established tradition of dedicated, warm and competent care. CNMs have graduated from an accredited education program and passed a national certification exam. They work collaboratively with physicians, who are available for consultation and referral if necessary.

Cite

Admit it, you do not understand midwifery, and therefore think a doctor is *needed *in all birth situations, when in fact they are not. What further substantiates my claim, is that you think being a doctor or "gambling’ on the doctors decision is the only thing that creates safety in a birth - when, in fact, that is not true.

[Zeriel]

@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?

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.

Since “Certified Nurse Midwife” is (AFAIK) ALWAYS a subset of “RNs and APNs”…

[Diogenes_the_Cynic]

@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.

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.

[Phlosphr]

@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.

read my post to you.

[BottledBlondJeanie]

Dio, are you serious? As much as I’m not an advocate of homebirths, CNMs are much more experienced with respect to pregnancies that your average oncologist. One thing I learned in my legal practice is that a good, experienced specialized nurse (RN) is often better than an MD or DO that does not specialize in that area. Does that mean that a nurse should do my cardiothoracic surgery? No, but experienced, specialized RNs are darned good at diagnoses, medication and patient management despite limitations as to what nurses are actually allowed to do.

If I were having a baby in an emergent non-hospital situation and there was an oncologist and a good CNM available, I’d defer to the CNM.

We’re well past debating homebirth here.

[MandaJo]

@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.

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?

[Shayna]

@Phlosphr

For the love of OG I’m not a Scientologist. If you want to call me anything call me a Neo-Pagan-Humanist…

Jeez people.

I can attest to this.

@monstro

I was a difficult birth, having been breech and delivered c-section (oh yeah, and I had someone else tagging along with me!) Would we have made it if my parents have taken the path of hardest resistance and had us at home? I don’t know, but even if we had, I don’t think I would have appreciated them taking that risk on our behalf like that. There’s risk you can easily avoid and risk you simply have to endure. I think responsible parenting starts off with a minimalist philosophy when it comes to risk, gradually increasing once the child becomes less dependent. Starting off with high risk just doesn’t make sense to me. But I tend to be overly rational.

@elbows

Well I gave birth as a hale and healthy 17 yr old. In a hospital.

Had I been anywhere else, we’d have both died.

That child, just had her first child, she went to the hospital to see the midwife (who just happened to be there) as she had a headache she couldn’t throw. They took her blood pressure, which was in stroke range, and in less than a minute she was in an OR with 23 people delivering her child, 2 months early, by C section. Two more lives, most assuredly, saved.

@Smeghead

I keep seeing people saying that most of the time, for most mothers, home birth is usually safe. I don’t disagree with that. What I’ve been trying to point out is that you cannot know if you’re in that group ahead of time. No number of anecdotes about your friend who did it fine at home don’t change that fact. Again - when my stepson was born, my wife would have been considered a perfect candidate for home birth. She was young, healthy, and had no complications in her pregnancy at all. The baby was healthy by every measure they could make. Yet if she had chosen to give birth at home - even if she had all the medical “backup” prepared and ready to go - her son would have died. No ifs or maybes or probablys about it. He would have died. He nearly did anyway.

I only had time to make it through post #240, so please forgive me for not reading the thread in its entirety. But so far there are plenty of stories here from people whose babies/wives/daughters/friends/whomever would have or could have or might have died had they not been in a hospital with top notch medical intervention available.

As I shared in the other thread, I have a family story of an actual baby who did die and a mother who was comatose for a week and will forever suffer with some paralysis and personality disorders as a result of an amniotic fluid embolism during delivery.

IN a hospital.

WITH a NICU right there.

WITH the OB/GYN right there in the delivery room.

With ONLY 5 minutes passing where the baby was deprived of oxygen before being delivered by emergency C-Section.

With MASSIVE internal bleeding and a HYSTERECTOMY having to be performed to save the mother’s life.

On a THIRD pregnancy with NO health problems for either the baby or the mother.

Brain damaged mother, dead baby.

It happens. And we always think it happens to OTHER people, not US.

I wish I had the luxury of being the “supportive” friend who will do nothing but wish you well and be excited for you about your decision. But with a literal life or death decision like this, I don’t think I’d be much of a friend if I didn’t beg you to reconsider at least using the Birthing Center that’s attached to the hospital. Please don’t be mad at me for caring enough to be worried sick.

[Phlosphr]

@Shayna

I wish I had the luxury of being the “supportive” friend who will do nothing but wish you well and be excited for you about your decision. But with a literal life or death decision like this, I don’t think I’d be much of a friend if I didn’t beg you to reconsider at least using the Birthing Center that’s attached to the hospital. Please don’t be mad at me for caring enough to be worried sick.

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 …