Cuff the Midwife

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Andrew Donaldson

Born and raised in West Virginia, Andrew has since lived and traveled around the world several times over. Though frequently writing about politics out of a sense of duty and love of country, most of the time he would prefer discussions on history, culture, occasionally nerding on aviation, and his amateur foodie tendencies. He can usually be found misspelling/misusing words on Twitter @four4thefire.

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28 Responses

  1. Avatar Road Scholar says:

    “Natural” isn’t necessarily better. When our 2nd was born, after many hours of labor with little progress, it was determined that the placenta was covering the cervix (placenta abrupta), necessitating an emergency C-section. If we had attempted a home birth it’s quite likely both mother and child would have perished. Instead, mom’s fine and that kid is in high school now.

    Sometimes there’s good reasons for regulations.Report

  2. Avatar Em Carpenter says:

    Awful. That was not a “midwife”; midwives ARE trained professionals who know when to transfer.
    My pregnancies were both high risk by the end due to pre-eclampsia and even without that I would have chosen to give birth in the hospital. With an epidural, I add, with no shame.
    That said, I cannot believe home births are illegal. WTH? Women gave birth in caves and fields! It’s wonderful that we now have the resources for safer births and women and babies no longer routinely die during childbirth, but there’s no reason why a normal, uncomplicated pregnancy can’t be delivered at home. The key is knowing when to transfer and having a plan to do so, which was the failure here. It wasn’t even a close call.
    I have friends who’ve had multiple home births, and who attempted but ultimately needed to transfer to a hospital and did so. I prefer the comforts of life saving equipment and a NICU down the hall, but I think it’s ridiculous to make it illegal. Unlicensed “midwifery” on the other hand absolutely should be.Report

    • Avatar Oscar Gordon in reply to Em Carpenter says:

      My aunt tried home birth for both kids. One was fine, one had to transfer. In both cases, the midwife had the plan and the plan worked.

      With regard to the OP, I have to wonder how the ‘midwife’ avoided trouble previously?Report

  3. Avatar Mike Dwyer says:

    Personally, I think the parents should be charged as well. It’s hard for me to think of any other major medical procedure, which involves not one but, two lives potentially at risk, that peoplw would opt to attempt at home and then be prepared to ‘transfer’ when things get dicey. It’s the ultimate First World ridiculousness.

    History is littered with women that died in childbirth, often in the care of midwives. Medicine has gone to great lengths to try to make the very dangerous process of childbirth safer so yeah, midwives should be illegal. My state, under our idiot governor, legalized midwives in April. I expect similar stories to this down the road, whether they are legal or not.Report

    • Avatar Em Carpenter in reply to Mike Dwyer says:

      Real midwives are actual nurses who are specially trained in labor and delivery. They are not lay people like this woman apparently was. Untrained, fake midwives absolutely should be illegal.Report

    • Avatar Tod Kelly in reply to Mike Dwyer says:

      “I expect similar stories to this down the road, whether they are legal or not.”

      FWIW, over two decades of research from the AMA, ANA, ACOG, and pretty much everyone else suggest the opposite.Report

    • Avatar dragonfrog in reply to Mike Dwyer says:

      This was one of the studies we relied on in deciding on a home birth for our first child – http://www.cmaj.ca/content/cmaj/181/6-7/377.full.pdf

      It turns out that what might intuitively seem “ridiculous” was probably the safer option in our case.Report

      • Avatar Mike Dwyer in reply to dragonfrog says:

        I’m certainly no expert on this topic, but don’t women who plan home births sort of self-select for being the most hyper-involved with their pregnancy? It just strikes me that they were always going to have the best outcomes because of the care they took.

        I see a nurse practitioner instead of a family doctor because I get more attention and (I think) better care from her. But I also like that she has access to all of that cool technology in the doctor’s office. I’m all in favor of midwives if that is the preference of the mother, but I personally think it is safer in the hospital. It’s just hard for me to envision a medical scenario where you plan to go to the hospital if things go sideways, but your preference is to start things out away from all of the gadgets that might save you or your baby’s lives.Report

        • Avatar dragonfrog in reply to Mike Dwyer says:

          That is possibly the case – I don’t know how you’d control for the number of pages the mother has read on the topic of pregnancy…

          The proximity of all the life-saving gadgetry was certainly a consideration for us. But it also comes with some risk, apparently.

          Given the risk of perinatal mortality was well under 1 in 10,000 for all three groups, the increase in risk due to whatever causes associated with hospital birth (stress, discomfort, baby turning breech because the mother can’t move freely during transport to hospital, greater exposure to pathogens, are some that come to mind) wouldn’t have to be very much at all to more than outweigh the reduction in risk due to proximity to a NICU and obstetric surgery.Report

  4. Avatar Doctor Jay says:

    Home birth is illegal in Nebraska. Which means, I would think, that there is no licensure for midwivery in Nebraska, so there’s no path to get licensed or qualified for anyone who wants to do this in Nebraska. You could go to another state, but that’s not having the child “at home”, is it?

    It feels to me like the Noe’s bear a lot of culpability here.Report

    • Avatar Oscar Gordon in reply to Doctor Jay says:

      Midwives are legal, but have to operate under the supervision of a doctor.

      Nock advertises herself as an unlicensed, ‘old-school’ midwife.Report

      • Avatar Doctor Jay in reply to Oscar Gordon says:

        This time, he said, Ms. Hock once again warned Ms. Noe of the risks of a breech birth, but that she had opted to remain at home.

        That’s quite a spot to be put in. You think Mom should go to the hospital but she refuses. You probably realize this is beyond your skills. What are you gonna do? Leave and tell them, “you’re on your own, I could get arrested?”Report

  5. Avatar LeeEsq says:

    Midwifery and the war against it is seen as one of those great feminist issues in certain sections. Mean men forcing women into housewifery and ending tradition in the name of scientific capitalist modernity. Now, the real solution is to bring women into the medical profession, which happened, but the 1960s created a market for this nonsense.Report

    • Avatar dragonfrog in reply to LeeEsq says:

      “the real solution is to bring women into the medical profession”

      Midwives are part of the medical profession, just as much as physicians and nurses.Report

      • Avatar Road Scholar in reply to dragonfrog says:

        Ideally they should be thought of as Nurse Practitioners specializing in obstetrics. And require the requisite training and licencing.Report

        • Avatar dragonfrog in reply to Road Scholar says:

          As I understand it, that’s the case in some US states, while in others, and here in Canada, midwifery is a separate educational stream from nursing.

          Comes out the same though, really – whether midwifery is a specialization of a nursing program, or an administratively separate program – there is a professional college that certifies university programs and manages licensing of individual midwives.Report

          • Avatar InMD in reply to dragonfrog says:

            Professionals (including NPs) are regulated at the state level. Currently NPs run the gamut from being not much different to RNs (i.e. close physician supervision required) to unsupervised independent practice within the scope of their license. The general trend is towards liberalization but there are still large gulfs between jurisdictions.Report

  6. Avatar InMD says:

    What an awful story. I’m always hesitant about being all ‘pass a law,’ ‘call in the cops’ but the weird, quasi-crunchy cult of motherhood that convinces people to make such idiotic decisions… well it makes me understand where that urge comes from.Report

  7. Avatar Tod Kelly says:

    “The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician.”Report

  8. Avatar J_A says:

    When I lived in Panama in the early OO’s, I was friend with the expat general manager of a large multinational with significant operations there. The company’s operations are based in the East of the country, near the indigenous Ngobe Bugle Autonomous Region.

    With resources from the company’s, his wife, a nurse, almost single handedly set up a very successful midwifery program for the Ngobe Bugle communities (a very remote, very mountainous area).

    She would go up the mountains and meet the local midwives, and asked about their techniques, and their success and failure rates. She would poll the communities’ satisfaction with them.

    Those she found had the aptitude and the attitude would be selected for training. Training happened in the area itself (which built trust) in groups of five to ten midwives. They were taught first about hygiene and cleanliness and how they could make the delivery as sterile as possible when you live in a dirt floor cabin and cook with wood. They were taught how to follow up the pregnancy itself, and detect high risk conditions. They were taught how to handle difficult presentations as best as possible, and, very importantly, when the situation would be more than they could ever handle, and how to call for help from the closest (which could be a day walking) medical center. Eventually, they visited some local medical centers so they could see themselves the process there.

    The program was very successful. My friend’s wife would tour the area every six months or so to follow up with the trained midwives, who were also encouraged to pass on what they had learned to others.

    I think the key to her success was to be respectful, and to go for incremental successes. She didn’t want to replace the midwives, she wanted them to be better, and for them to recognize themselves if more specialized help was needed.Report

  9. Avatar trumwill says:

    Maybe this is a little too bias-confirming, but I think anti-midwifery attitudes have probably played a role in the ignorance that contribute to situations like this. A lack of faith when people (including the midwife!) say “This seems like something an obstetrician should do.” When the line is that they shouldn’t do anything, it’s harder to say they *definitely* shouldn’t do that.

    Home birth is fine, and it seems unnecessary for an obstetrician to be on-site most of the time, but it would probably be good to require an obstetrician to sign off on it so that they can tap the breaks if there are indications of a problem (such as breech).Report

    • Avatar dragonfrog in reply to trumwill says:

      I think a *properly trained and licensed* midwife – unlike the “midwife” in this case – should be capable of signing off on a home birth.

      In fact, that seems like one of the very central competencies of a midwife, something I’d expect them to have more expertise at than an obstetrician.Report

  10. Avatar Trumwill says:

    Maybe. I guess I see this as more of a two-opinions-are-better-than-one thing (you obviously need a midwife to sign off on it because they need to do it). In this case the differing backgrounds may be complementary.Report

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