Lay midwife - baby's death - page 4

If the couple had insisted on using a certified nurse midwife, this would not have happened: A midwife present during the delivery of a newborn who died in a Town of Vernon home last month is... Read More

  1. by   HeartsOpenWide
    Quote from TheCommuter
    The instructor cynically indicated that hospitals with a large census of 'Medicaid' patients perform mostly C-sections and keep a lot of formula on hand since none of the moms breastfeed.
    I wounder if this is an underhanded reason...C-sections cost more and Medicaid will pay for it....
  2. by   fergus51
    Quote from HeartsOpenWide
    I wounder if this is an underhanded reason...C-sections cost more and Medicaid will pay for it....
    I would also wonder if Medicaid patients being from lower income groups tend to have more complications resulting in c-sections. Unfortunately, income is still a pretty good predictor of health status.
  3. by   geekgolightly
    Quote from mstigerlily
    I'm a breastfeeding advocate, at least 50% of my job is breastfeeding assistance. I breastfed all my kids and am still BF my son who will be 2 in March. I don't mind BF assistance at all, but L&D nurses don't seem to be so excited about it at our hospital, don't know why. It's like once the baby is out they can't wait to get rid of the moms. To me, that's when the fun really begins.
    Maybe I should find a hospital wherein LD and PP are separate entities. I might be surrounded by more like-minded people. I wish I worked with you adn your group! I am still nursing my son who will be 2 in less than two weeks yay for "extended" bf!
  4. by   bethin
    Quote from Marie_LPN
    Thing of it is, the CNM turned them down because they were considered high-risk.

    I'm thinking if i hear the word "high-risk", i'd better stick to the hospital for the birth, which is why i feel the majority of the fault lies with the parents.

    I can't believe lay midwives are not illegal, actually.
    Exactly. Something just didn't click with these parents. Probably if that baby had been born in a hospital, it would have survived. I have nothing against home births as long as it's a normal pregnancy and a CNM is present who isn't afraid to call for help if things get out of hand. The mother asked the midwife to call 911 and she should have. Maybe her ego got in the way but obviously the midwife wasn't thinking of the baby. How sad.

    The parents are at fault and I feel that they will regret this decision the rest of their lives. Who thinks that they can consider themselves trained enough if they're not certified???
  5. by   bethin
    Quote from mstigerlily
    I'm a breastfeeding advocate, at least 50% of my job is breastfeeding assistance. I breastfed all my kids and am still BF my son who will be 2 in March. I don't mind BF assistance at all, but L&D nurses don't seem to be so excited about it at our hospital, don't know why. It's like once the baby is out they can't wait to get rid of the moms. To me, that's when the fun really begins.
    I'm not trying to attack those that are advocates of BF but I do have a comment. When my sister-in-law gave birth to twin girls a month early(babies ok, just small) the nurses made her feel like a horrible mother for not being able to BF. First off, the babies were early and just couldn't grasp the concept. Also, she wasn't producing enough milk by a long shot. I was actually in the room while the nurse was ripping into my SIL. I couldn't believe it. My SIL tried for weeks at home to BF but she just could not produce enough milk for 2 babies. When that was mentioned to the nurse, her response was "a mother makes enough milk for her babies--no matter how many." I find this callous. I remember my SIL crying for weeks because of this nurse's comments. I wonder what they'll say when I have a baby--I had a breast reduction and my odds of being able to BF are small.

    I think BF is great IF the mother and baby are able to but I don't feel that we need to attack those that are not able to.

    Please tell me this is not the norm.
  6. by   mstigerlily
    I don't think this is the norm but there are some nurses or lactation consultants are this way. If people want to bottlefeed that is ok with me. If they want to breastfeed I am glad to help them because I think it's better for both mom & baby. But I accept either without a problem. You can't MAKE someone breastfeed if they don't want to - or can't!

    Quote from bethin
    I'm not trying to attack those that are advocates of BF but I do have a comment. When my sister-in-law gave birth to twin girls a month early(babies ok, just small) the nurses made her feel like a horrible mother for not being able to BF. First off, the babies were early and just couldn't grasp the concept. Also, she wasn't producing enough milk by a long shot. I was actually in the room while the nurse was ripping into my SIL. I couldn't believe it. My SIL tried for weeks at home to BF but she just could not produce enough milk for 2 babies. When that was mentioned to the nurse, her response was "a mother makes enough milk for her babies--no matter how many." I find this callous. I remember my SIL crying for weeks because of this nurse's comments. I wonder what they'll say when I have a baby--I had a breast reduction and my odds of being able to BF are small.

    I think BF is great IF the mother and baby are able to but I don't feel that we need to attack those that are not able to.

    Please tell me this is not the norm.
  7. by   Booty Nurse
    Quote from mstigerlily
    I guess I don't understand the scope of practice of a lay midwife. It was my understanding they are not health care professionals and therefore cannot give injections of drugs like pitocin, prescribe medications or perform minor surgical procedures like episiotomies or stitches. .
    As a former licensed midwife (now an RN, no longer a midwife), I can tell you about the scope of practice. I was trained and licensed to give pitocin (only PP for hemorrhage), start & administer IVs, do an episiotomy in an emergency, and suture. I was NRP certified and able to intubate. I carried O2 and a bag & mask. I couldn't do an immediate c/s, but neither can my rural hospital on nights or weekends, because the OR team needs to be called from home. By the time they get there and get set up, a mom could have been transferred from home. In my experience, home birth midwives are usually very alert to any sign of abnormality, and tend to transfer to the hospital or discuss the situation with their back-up doc if any deviation from normal does not resolve quickly. I can't really comment about the case in the news because the information is so limited; from the way it sounds, there were some major mistakes made. Parents are not taking a greater risk by choosing home birth. It has been shown to be just as safe in many studies. Hospital birth has its own inherent risks that home birth does not. I do think home birth midwives should be licensed so that quacks (and there are those in every medical profession) can be differentiated from the professionals. And licensed midwives are professionals. Our scope of practice is different from a CNM, but that doesn't mean we are not professionals.
  8. by   dhall4
    Quote from zebras
    as a former licensed midwife (now an rn, no longer a midwife), i can tell you about the scope of practice. i was trained and licensed to give pitocin (only pp for hemorrhage), start & administer ivs, do an episiotomy in an emergency, and suture. i was nrp certified and able to intubate. i carried o2 and a bag & mask. i couldn't do an immediate c/s, but neither can my rural hospital on nights or weekends, because the or team needs to be called from home. by the time they get there and get set up, a mom could have been transferred from home. in my experience, home birth midwives are usually very alert to any sign of abnormality, and tend to transfer to the hospital or discuss the situation with their back-up doc if any deviation from normal does not resolve quickly. i can't really comment about the case in the news because the information is so limited; from the way it sounds, there were some major mistakes made. parents are not taking a greater risk by choosing home birth. it has been shown to be just as safe in many studies. hospital birth has its own inherent risks that home birth does not. i do think home birth midwives should be licensed so that quacks (and there are those in every medical profession) can be differentiated from the professionals. and licensed midwives are professionals. our scope of practice is different from a cnm, but that doesn't mean we are not professionals.
    thank you for this post........although this midwife in question is not a quack, most lay midwives who chose to not be licensed are not quacks, they just chose to not be licensed. (not saying that you are calling her one, just clarifying)

    i said in my first post ~ the reporters write to sell papers!! not a single person on this site was at that birth so how can we comment on what was said/done?? did anyone read the article where the family does not blame her for the death & in fact believes that she saved the mom's life too? here is a bit from the article ~

    "i was asking to go to the hospital, but she didn't convince me not to go," stoiber said. (have we all had moms begging for meds/to go home/make it stop & they really just need something different to cope with the labor)

    had she demanded to go to the hospital, the midwife would not have been able to stop her, stoiber said.
    as soon as the baby was delivered and it was apparent she wasn't breathing, the midwife tried to resuscitate the baby and yelled for someone to call 911, stoiber said.
    stoiber also credits the midwife with saving her own life by injecting stoiber in the thigh with pitocin, a medication normally used to start or improve uterine contractions. the drug stopped her hemorrhaging, stoiber said.
    "i believe i might not have lived had she not done it," stoiber said.



    i said something in reference to how it would not have been any different in the hospital ~ yes there is staff to do a c-section, but would that have guaranteed a positive outcome?? i have been to births where an "emergency c-section" takes almost an hour before the mom is taken in, not all hospitals have staff on hand, so then they need to call people in. when i referred to a loss in the family it was not my child, but my brother's ~ when they became pregnant again the dr told them that under no circumstance could he promise a positive outcome even though she was seeing 3 dr's & having monthly/weekly ultrasounds. she ended up having a healthy son ~ but then she lost her next baby......

    dana
  9. by   Q.
    However being that the case seems to strongly suggest shoulder dystocia, the outcome would have had a chance at being positive at a hospital since the liklihood of a practitioner skilled in shoulder dystocias present would have been much higher.
  10. by   FocusRN
    Okay I am NOT a midwife but have looked in to the profession heavily. Firt I would like to say to the OP that you can't be absolutely sure. Second I would like to say that the OP post said that a CPM turnde the oman down, not a CNM. The difference? A CPM is NOT a nurse he/she is just a lay midwife certified by NARM (www.narm.org). A CPM can be a person who went to midwifery school, an apprentice, or even a person who studied midwifery on their own with no formal guidence in theory. Which is better all depend on how you look at it. I don't personally think that a CNM is best, simply because being a nurse first he/she is trained to think medically an then as a midwofe from the holistic point of view. On the other hand a CPM or lay midwife , usually think from the holistic point of view first, and CPM's are trained to keep safety at the forefront. And safety doesn't always mean medical intervention, some times the medical intevention, is what risks safety.

    Back to the issue at hand, the woman should not have been taken by a midwife, and better yet she shouln't have even gone to one. She knew her history, and as a matter of fact there are a few docs locally that I know wouldn't take her as the claim to only specialize in low risk pregnancies.

    As for the midwife using scissors, I just can't see it unless, she either had NO other tools at hand or, she had two hours of training.

    Just my two cents. Oh and I usally only read the OP so that is what my post is in reference to.
  11. by   mstigerlily
    Quote from dhall4
    I said something in reference to how it would not have been any different in the hospital ~ yes there is staff to do a c-section, but would that have guaranteed a positive outcome?? I have been to births where an "emergency c-section" takes almost an hour before the mom is taken in, not all hospitals have staff on hand, so then they need to call people in. When I referred to a loss in the family it was not my child, but my brother's ~ when they became pregnant again the Dr told them that under no circumstance could he promise a positive outcome even though she was seeing 3 Dr's & having monthly/weekly ultrasounds. She ended up having a healthy son ~ but then she lost her next baby......
    Dana
    As far as listening to the mother defend the midwife, well first of all she is grief stricken from losing her baby, secondly, she is the person who made the decision to have her baby at home in the first place (thus probably feeling some guilt/conflict over the bad outcome so I don't know if her comments hold much weight). Her feelings might change as time goes on and she reflects on the choices made by everyone involved.

    Yes, there is too much medication intervention at births, I've often complained about that at our hospital. 99% epidural rate, 35+% csection rate. Inductions or csections for convenience are common, sometimes weeks early. Everyone is flat on their back, vacuums are often used for the second stage and episiotomies are VERY common. It's not the ideal. But I work in a busy urban hospital but an affluent high risk population so that explains some of it. I love the idea of a birthing center next to a hospital staffed with midwives, I would love to work at one.

    No, no one can "promise" a positive outcomes. Doctors are not Gods. They do what they can. Yes, some babies will die anyway. But I do know that OUR hospital's policy is "15 minutes from decision to incision" we have a dedicated OR suite right next to L&D and anesthesiologists and surgeons on site 24/7/365. NO ONE waits an hour for an emergency section. We have a LII nursery next to the OR and LIII nursery 10 minutes away. ALS nurses are standing by in the room of ALL high risk births and ALL c-section births.

    If a baby is alive when born, it can be kept alive. I watched our ALS nurses restart a baby's heart and vent him after he was found cold and blue in his crib on the postpartum floor. It took about 8 minutes, but soon his VS were normal and he was pink. Yes, he was on a vent and sadly, had been gone too long so was brain dead so the decision was made to let him go. But to say NOTHING would have been different in a hospital is ridiculous. If she was high risk to begin with, with a prolonged troubled course of labor and a long second stage, the risk grew and grew exponentially as time went on.

    It's a lot of trouble for some people to conceive babies, to carry them for nine months and giving birth is no picnic either. It's not just "oh well, these things happen, we'll try again. Each baby is an individual and not disposable. I don't know why people don't take this seriously and take any medical problems they have with the pregnancy seriously and take advantage of medical technology to keep their baby safe. If you want that baby and are high risk, take the necessary precautions to keep you and baby alive and well.
    Last edit by mstigerlily on Dec 15, '05
  12. by   momx3boys1girl
    [quote=mstigerlily]What would be different in a hospital? Well for one they would have a surgeon available and a dedicated OR suite so they could section that baby within minutes if necessary. Then, they would have the ALS team standing by to resucitate that baby, restart it's heart, intubate, vent if necessary, transport to a LII or LIII nursery. What do you MEAN what would be different? Everything would have been different.
    QUOTE]

    I want to know exactly how you would preform surgery once the babies head is already out?? Its not like you can push it back in unless the baby is already dead, because doing so would surely kill the child. Most midwives carry emergency equipment with them including DeLees for suctioning, O2, etc. I know this midwife is certified in NRP because I took the course with her only a month before this happened. It sucks but sometimes babies die at home or in the hospital. It is a part of life and it doesn't help to blame anyone. Jen
  13. by   Q.
    Quote from momx3boys1girl
    I want to know exactly how you would preform surgery once the babies head is already out?? Its not like you can push it back in unless the baby is already dead, because doing so would surely kill the child.
    Not true. I've seen babies crowning and pushed back in for emergency c-section at least 4 times in my career. All those babies survived and thrived.

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