Checks and Balances

I originally sought the care of midwives because I wanted more personal care.  I didn't like the fact that our OB's office had 10 doctors, each of whom we would meet during the course of our prenatal care, but none of which I felt really knew us.  We had no idea who would show up at the birth, and I was worried about how they would care for us if they didn't know us.  Our first baby was born naturally, vaginally, and without issue in the hospital, with a doctor we didn't know too well.  He treated us with kindness and respect, and ultimately did many things to keep me, and my baby safe. 

Converesly, our three midwives spent an hour with us at every prenatal appointment.  We knew them intimately, considered them friends.  Hell, we even enjoyed tea and family play with a train table my son still talks about.  The resulting care?  Our baby died because of preventable injuries sustained at birth. 

Are doctors perfect and midwives evil?  Absolutely not.  Could this story easily have been the reverse experience?  Sure.  What then was the difference in care?

I've come to understand that while relationships matter, safety and the checks and balances of a licensend, ethical profession matter more.  While I once complained about long waits, short doctor visits, and too many care givers in a practice, I now see the need for a collaborative approach.  All good care givers need appropriate checks and balances, even midwives.  They need to hear differing viewpoints, to bounce ideas off of one another, and to be held accountable when mistakes are made, in order to funtion in a healthy, balanced way.  I now see the value in the kind of care I once resented...just too little too late. 

Appreciating and assessing risk factors in a client seeking an out of hospital birth is critically important to protecting the safety of that mother and baby.  Midwives often say that birth is normal, safe for low risk women without signs of complication.  The problem lies in the efficiency of how assessents are performed, and even more importantly how they are valued.  Disregarding the importance of assessments, avoiding them altogether, or even failing to risk out appropriately based on the results of such assessments is putting mothers and babies in great danger.  Risks are being taken then, that do not need to be taken.  How is this possible?  There are no checks and balances, no guidelines, no scope of practice for midwives practicing out of hospital birth in MI.  They can take any risks they want, avoid any assessments they choose, and call anything a "variation of normal".  No questions asked. 

If a midwife presents biased information about gestational diabetes testing to a mother, then tells her how great her nutrition habits are, and further expresses a belief that many times the test shows a false positive, why on earth would the client then value that test?  Has she been adequately informed, in a way she can truly make an educated choice for herself and her baby?  Does she know the risks of not doing the test?  Again, there is no standard for what "informed consent" actually means in midwifery. 

Why is this so vitally important for out of hospital birth?  In the event of an emergency due to any complication, a mother or baby in the out of hospital birth environment are at detrimental disadvantages to get the care they need immediately.  Precious minutes cost lives.  If midwives were truly attending only low risk women, results would no doubt improve.  Unfortunately, that's not what's happening.  Instead we have midwives who don't inform clients, who don't value assessments, who don't risk out.  We have midwives who are boasting online about delivering three breech babies in a year, delivering twins, and this is not to mention all of the severe near misses...those situations midwives knowingly take on to "honor a mother's right to out of hospital birth" instead of telling her the safest place in a high risk situation is at the hospital. 

Are midwives capable of implementing appropriate checks and balances?  Sure.  Are they capable of defining appropriate assessments, and adhering to low risk birth in the name of safety?  Sure.  Are midwives able to practice conservatively and collaboratively?  Yes.  The problem is that it isn't happening consistently.  Women and babies deserve a consistent standard of care, and midwives who function within a defined scope of practice.  Families want midiwifery they can rely on and trust.  At present, hiring a midwife in MI is (as I've said many times before) like Russian Roulette. 

This is precisely why we NEED Safer Midwifery in MI!! 

(In Development:  A document is currently being developed in conjunction with exemplary midwives, that lists the appropriate assessments that every midwife should seriously consider with her patient's clinical history.  We'll highlight it here on the blog as soon as it is finished, so women know what to look for in prenatal care.)