Midwives without nursing degrees risk prosecution

Specialties Ob/Gyn

Published

Specializes in Maternal - Child Health.

pushinrn,

I appreciate your post. Your comment about the goal of a healthy mom and baby reminds me of a situation we had at a facility where I used to work.

It was birthing center connected to a small, community hospital. The birth center was attached to the hospital by a long corridor, but was physically separate from the rest of the hospital, with the intention of creating the atmosphere of a free-standing facility. We were the first and only birth center in the area, and accepted only low-risk patients. That was well-known in our community, as was the fact that the facility was gorgeous, with private jacuzzi family-style rooms. On occasion, we would get an emergency admission of a high-risk patient. We would stabilize and transfer (if at all possible) to the local university hospital that was well-known for excellence in high-risk OB. Our docs had privileges there and would follow the patient. But their facility was not nearly as nice.

We had a run of patients come in with various high-risk conditions, including early PTL, bleeding previas, incompetent cervix, etc. who refused to be transferred because it was so much nicer for them to be hospitalized in our facility. One of them electively delivered a 28-weeker at our facility, which had no neonatologist on staff and no pediatrician in-house. The baby suffered an anoxic brain injury likely due to the fact that the OB had great difficulty intubating the child at delivery.

So, even in the realm of hospital care, we run into patients who are so focused on "their birth experience" that they lose sight of the ultimate goal of a healthy baby.

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I'd love to see a study done regarding the correlation between the 4-page birth plan and eventual C/S. Unfortunately some folks have such a hard time giving up control that they can't let their bodies labor. But the worst is seeing the home birth transports come in absolutely scared stiff- I've heard the things they've heard- and while they aren't true (mandatory epidurals, manditory pit) these poor women don't know that and they are terrified. It doesn't have to be this way- it's not a competition for patients; but I have no idea where one would start to make it better.

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Not sure how you make the leap from homebirth to abortion- The logic is not the same in regards to these very separate issues. "Therapeutic" Abortion is a surgical procedure, Birth (whether preterm, spontaneous abortion, or other physiologic cause) is a natural process. The laws regarding them must be thought out differently as one is totally planned ("Therapeutic") and the other (Birth) may or may not be. If one was to outlaw homebirths, then the women who were trying to get to a hospital birth and had the baby in the cab would be imprisioned- makes no sense. As for your comment in regards to trying to equate MO laws on UNLICENSED/UNCERTIFIED people being criminally culpable for attending home births to attempts by some groups to criminalize licensed physicians who perform a legal surgical procedure- I again can't see the reasoning- apples to oranges.

Now, back to topic- I think the home birth movement is great, I would prefer some standard in caregiving however. I can see how requiring a CNM/CPM could help outcomes, and honestly, I think the 13 states that require strictly CNM would benefit from allowing CPM's to practice.

I think my problem with the unlicensed/uncertified people as sole attendants in the home births comes from the fact that they may not be able to recognize problems before they develop into disasters- in which case, why pay these people at all? My grandma would do just as good a job, and do it for free. If you are willing to take the time to apprentice and then charge for your services, why not develop the physiologic underpinnings of your actions? Then become certified to allow for some verification of your knowledge as set forth in a certification standard. This way the women you serve will have an assurance that the care they receive is of good quality.

To the OP- thanks for the thought provoking article.

It isn't a matter of not wanting to be certified or even of not BEING certified for many, it's a question of the state making it illegal. Many illegally practicing midwives are certified by the national cartification bodies that make them legal in other states.

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Specializes in Community, OB, Nursery.

If I worked in a NICU I might have a different view. As it is I see the opposite - perfectly normal mothers and babies that are mucked up by unnecessary intervention.

A few months ago, we had a mom come in at 37+3, and she's 4cm. It's her 3rd baby. (I think I vented about this here, actually.) She's had 2 babies before. She's proven that she can do it. Baby's strip looks fine. She's contracting q10min or something. Instead of letting her go on her own - which she's probably going to do, and soon - they AROMed her and started Pit! :angryfire So instead of a normal delivery and great baby, you get a 37 weeker that's shell-shocked and retracting like a turkey. Either way she'd have been a 37-weeker. But had Mom been left to deliver when she was ready and not on someone else's schedule, or because some resident wanted to practice AROMing, baby would have probably been given enough time to make the transition smoothly.

Or a 7lb 3oz baby causing a 4th degree tear in a perfectly normal mom, just because someone doesn't want to wait around while she pushes and so gets the forceps. I could go on.

There has to be a happy medium somewhere.

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So, even in the realm of hospital care, we run into patients who are so focused on "their birth experience" that they lose sight of the ultimate goal of a healthy baby.

You know, I absolutely agree with this. But the thing is, many women are so focused on "their birth experience" that they make choices that don't really ultimately lead them to the goal of a healthy baby. For some women, that means they choose a home birth when they might be better served being in the hospital - preterm labor, for example. Other women choose hospital birth and interventions when they might be better served by not being offered or not asking for those interventions. For example, I saw someone in clinic last week at 36 weeks. She asked me to check her, and I (grudgingly) gave in. She then asked if she was dilated enough to break her water so she could have her baby. Her ideal of the best birth experience was one where she didn't have to wait to go into labor on her own, or go to term for that matter, because she was tired of being pregnant. Choosing interventions to avoid the discomforts of late pregnancy, labor, and delivery is just as much trying to get your desired "birth experience" as choosing home birth.

It's not just women birthing at home. It's bigger than that. I agree, there has to be some happy medium in the middle. Somewhere between the inappropriate home birth and the "induction/cytotec/pit/epidural/c-section" cascade of intervention.

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Specializes in nursery, L and D.

You know, beckinben, that I think we, as a medical community, have made women feel this way about their births. As far as the "get it over with" mind set goes, that is. We have medicalized, interventioned, and non-naturaled birth to the point were it is akin to major surgery (and ends in major surgery 30% of the time).

I can't really blame those moms, that think it is fine to deliver at 36 weeks, b/c I have seen what they see on TV. 28 week quads that are fine, and look at all the attention the mom gets!, focus on stretch marks, being thin as fast as possible, and my least fav., that commercial for some shampoo that has a woman b-feeding, and says pregnancy leaves your breast and hair flat!

Every time I start to get ticked off at some of those moms I stop and think about it. We as nurses know that a 36 weeker is not a good thing, much rather have a 40 weeker, but the general public is bombarded with all this info that says pregnancy is a state to be shortened whenever possible, and that tiny pretermers are cute, and usually do well. Then we come in, tell her that we are going to "speed things along" by AROM, pit, c-sec, etc, etc. Its a wonder any woman today has any faith in her body to have a child without medical intervention!

I live near Arwen, and not only is CPM's illegal, there are NO CNM in the area that do home birth. I do know some underground CPMs, that are very knowledgeable, but if they get caught, its off to jail. There really are not any good choices around here.

We really need that happy medium around here that beckinben mentioned, but it doesn't look like it is coming any time soon.

This is really weird, but I wrote that depressing last sentence, then up comes this article on my news site!! Maybe there is hope, after all!

http://hamptonroads.com/2008/01/nc-panel-consider-easing-rules-home-births

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