Lay Midwives?

judyblueeyes · Jan 20, 2006

despite the death being NOT of her fault or doing.

Do you have any information about what exactly went wrong? Just curious.

SmilingBluEyes · Jan 20, 2006

You make a valid point, Judy.

The way the article reads, it appears she did not do anything to kill the baby. The baby died in the birth canal---- as we know, these things can happen, despite the best care and every precaution we can take.

But like I said, you point out something valid; I "ASSUMED" a bit here. I should have said, "even if she did nothing wrong that led to the death of that baby, there is a huge price to pay for breaking the state laws and practicing w/o proper license or scope to do so".

Hopefully, that clarifies my position more.

fergus51 · Jan 20, 2006

I'm fine with midwives who take a recognized program and are licensed. I am not ok with lay midwives who have little to no formal training. I think they are dangerous and I wouldn't risk using one.

SmilingBluEyes · Jan 20, 2006

Exactly my thinking, fergus.

matchstickxx · Jan 21, 2006

Do you have any information about what exactly went wrong? Just curious.

From a previous story in the newspaper...

On June 3, Williams helped deliver a boy, Oliver Meredith, in the parsonage of First Southern Baptist Church in Edinburg, where his father was a pastor. Authorities say the newborn died as a result of pooled blood in the head and neonatal asphyxia.

http://www.indystar.com/apps/pbcs.dll/article?AID=/20060114/NEWS01/601140515&SearchID=73233177931117

J'sGirl82 · Apr 10, 2006

You know, what does it matter ? I mean, if somebody wants to deliver outside the hospital, with somebody who is in a profession that truley has no medical expertise whatsoever, then they should proceed at their own risk, and that of their child. And if people want to deliver babies for women who don't feel the hospital is for them, that's their decision. There should be some sort of "Release of Liability" form. I don't think they are "praticing medicin without a liscense" either. How is it that people that choose cpm's don't know what could/could NOT happen ? I mean seriously. How could they not know ???? Don't get me wrong, there is nothing wrong with Homebirth, or lay midwives. But to me it's pretty cut and dry, you get what you pay for. Isn't there some state that has plans to move CPM's into a Clinical Setting ?

midwife2b · Apr 13, 2006

I've been reading a bit about "unassisted birth" and "unassisted VBAC". Now that is kind of scary to me!

Does anyone know of a family who has been that route?

mcdonaldgirl · Apr 13, 2006

The death of the baby was truly sad.....

This may be a bit off-subject, but...... weren't midwives used alot at the turn of the 20th Century? No-one had access to hospitals that easily.....and if you were "sick" enough for the hospital, you were close to death.

"Mac"

HeartsOpenWide, RN · Apr 13, 2006

I know of an excellent lay midwife who use to work in the NICU as an RN when she was younger. I plan on using her for the birth of my children and would chose her over an OB and hospital birth except for rare circumstances. Although I relies that there are many lay-midwives out there that give all midwives a bad name and that comparison to "hippies" not all are bad, in fact many are very good.

J'sGirl82 · Apr 19, 2006

http://www.texasmidwives.com/SafetyStats.htm

Mind you this is for Texas, not any other state, just to play Devil's Advocate here.

he following table lists the infant mortality rate of midwives, CMNs, MDs and DOs for 1990 - 2000.

Infant Mortality Rate by Attendant Type 3

Rate per 1,000 live births

Year

Midwife

CNM

MD

DO

1990

3.0

7.6

7.7

1991

3.0

2.1

7.3

7.6

1992

2.3

2.8

7.5

7.7

1993

1.8

3.3

7.3

6.1

1994

1.7

4.5

6.8

6.4

1995

2.1

2.5

6.5

4.7

1996

1.1

3.1

6.3

4.0

1997

2.8

2.6

6.1

5.0

1998

1.7

2.4

5.7

6.5

1999

1.2

3.6

6.0

5.9

2000

0.3

1.9

5.5

4.7

As one can clearly tell, except for 1991, midwives in Texas have had the lowest infant mortality rate of any attendant type from 1990 - 2000. The source table for this information also indicates that midwives in Texas had lower cesarean rates than all other provider types, with rates typically under 2/1,000. Cesarean rates for both MDs and DOs were consistently higher than 200/1,000 from 1991-2000.3

Regulation of midwives and detailed rules for practice in the Midwifery Act does not account for the comparably lower infant mortality rate. In fact, all levels of infant mortality decreased some since 1990 and maternal mortality rates remained at 0.1/1000.2

Documentation and identification records of midwives from The Texas Department of Health Midwifery Programs do, however, indicate that the numbers of legally practicing midwives have steadily decreased since the passage of the 1989 Lay Midwifery Act. In 1989, there were 604 identified midwives practicing in Texas,5 14,474 births attended by midwives and others, with almost 9000 of these births taking place outside of the hospital.4 (Bureau of Vital Statistics {BVS} Table 2 report for "Resident Births by Attendant and Place of Delivery Texas, 1966-2000" does not differentiate between midwives and all other non-physician attended birth or between home births and all other forms of out-of-hospital birth sites. BVS statistics from 1990-2000 are broken down by attendant: Medical Doctor, DO, CNM, Midwife, Other and Unknown.) In 1993 when new education and restriction laws took effect, the number of midwives fell to 262,5 with 12,682 births attended by midwives or others and 5,871 of these births occurred outside of the hospital.4 In 1997 when the most recent changes took effect, there were 217 licensed midwives,5 3,549 midwife assisted births,4 and 3,825 births were listed as out-of-hospital.3 The last available tabulated year for birth and death statistics from the BVS is 2000 and indicates that the 182 licensed midwives5 assisted in 3,910 births3 and 3,360 births took place outside a hospital setting.4

Home birth and midwife-assisted births in Texas are typical of safety results documented across the world. Medical research for over a decade has concluded that home birth safety statistics are at least as good, if not better than hospital birth statistics. These statistics are true even when some studies looked at midwife-attended, out-of-hospital births which could be classified more high risk than current midwifery standards allow and those births which include unplanned out-of-hospital births.6, 7, 8

Current educational requirements for new midwives in Texas includes both academic study from a variety of medical, midwifery and other authoritative sources and clinical, hands-on, apprentice-modeled training. Certification in both CPR and Neonatal Resuscitation (NNR) are also required in order to practice legally. Standards for education and midwifery practice are consistent with those contained in the MANA Core Competencies.9 Continued documentation as a midwife requires annual continuing education hours, current CPR and NNR certification, and annual application with fees submitted to the Texas Department of Health Midwifery Program. The Midwifery Program is overseen by The Texas Midwifery Board.

demetria · Jun 9, 2006

I think there needs to be some way to regulate midwives. Not all people who present themselves as midwives are competent. Of course, not every poor homebirth outcome is a result of using a midwife. Hospital deliveries can have devestating outcomes too.
Aside from word of mouth, how's a mom to know if a midwife is competent or if they just been lucky that nothing bad has happened yet. A friend of mine had a home birth with an unlicensed midwife. The midwife had an "apprentice" with her who would be a midwife after she accompanied/ assisted her trainer on 100 deliveries. This was many years ago before I was even in nursing school. At the time I thought 100 deliveries sounded like a lot, but now I realize it really isn't that many.

Each state is different, but anyone can do the work and take the CPM test, www.mana.org and www.narm.org

demetria · Jun 9, 2006

I'm fine with midwives who take a recognized program and are licensed. I am not ok with lay midwives who have little to no formal training. I think they are dangerous and I wouldn't risk using one.

The evidence though states otherwise. Very few people are going to practice midwifery without being qualified. You know the old joke.. what do you call a doctor who got Ds in med school.... DR.

You will always have a crappy fringe of practicioners, they are the minority, especially in midwifery.

I think apprenticeship is an amazing way to learn and study. Many of the worlds best midwives were trained this way. Midwifery is still the primay mode of birth care throughout Europe. We have an awful birth record as a nation and I believe that all types of midwives should be embraced. Yes training is essential, so we could have the CPM as a national standard, allowing the general to see what their midwife had to do and test through to become a midwife.