Tuesday, November 6, 2012

What We're Seeking: Safety Protocols for Out of Hospital Birth

Out-of-hospital birth should be an option for low risk pregnancies, and it should be practiced within a defined scope of practice, by educated, licensed care providers.  Some of the major problems with this, lie in the fact that MI has no guidelines for defining low-risk versus high-risk, for defining scope of practice for midwives practicing outside the hospital, or for establishing standards for minimum education/training for the midwives practicing in this setting.  In order for out-of-hospital birth to be a reliable option for women, these critical components of safe care must change.

Women deserve to know about risks up front.  They also deserve to be appropriately monitored and screened in the name of "preventable" trauma. 

Does out-of-hospital birth carry more risks than a birth in the hospital setting?
Yes, by proximity aloneNot to mention the direct impact of the skill set of a given care provider.  In MI "midwife" can mean a million different things. 

Do care givers practicing outside the hospital (or anywhere for that matter) have a responsibility to acknowledge and appreciate their limitations?
Yes.  This is even more important for those serving women and babies outside the hospital since risks are higher.

Women need to understand that a cesarean is not the worst case scenario, that a dead or injured baby is far, far worse.  Risk matters.  It's evaluated for a reason, and should be a respected.  Any ethical care giver that gives one iota about the safety of the mother and baby she is "serving", would value risks, and the assessments that come along with that to ensure that every precaution is being taken to protect mom and baby from harm, preventable harm. 

In many other countries, all midwives are minimally trained, educated and function by International Midwifery StandardsThey also have established absolute and non-absolute criteria that every midwife uses to determine risk, and thereby evaluate the safety of a given set of circumstances.  Take a moment to view the link above that lists many complications and clinical scenarios in which a midwife must either consult with a physician, or in severe circumstances, risk her client out for obstetrical care.  The link compares Dutch home birth standards to Oregon's mandated standards.

Let me be very clear that Michigan has NO such mandates for transfer of care.  We have NO absolute or non-absolute criteria that out-of-hospital midwives use to consistently evaluate and risk out in dangerous situations.  We have NO protocols for transfer of care or consultation.  This is what makes out of hospital birth infinitely more dangerous in our state.  The worst part?  It doesn't have to be this way.  We don't have to reinvent the wheel, we just need to be responsible about the care we are offering women.  We need to function as professionals with standards, and consistent guidelines for practice.  We need to prevent the preventable, and folks, that is not happening here. 

If my family had lived in the Netherlands or Canada, our breech presenting baby would have been risked out or given a "trial of labor" in the hospital, with our midwife and physician present.  If I had lived in Florida, Arizona, Oregon (or others), we would have risked out, likely ending with a cesarean and a living baby boy.  In MI, with no protocols for transfer of care?  Well, our midwives could tell us, and do whatever they wanted.  The result?  Our baby died in a botched, out-of-hospital breech delivery with midwives who didn't know what they were doing.  No evaluation or explanation of risk.  No informed consent.  No suggestions that we consult with a physician.  No physician or emergency staff on site.  No consequences for their actions since there are no mandates to which they are expected to adhere.

Instead?  We were sold on lies and misrepresentations of how great it would be for us, and for our baby, by the people we trusted most.  After all, "birth works" right?  "We were made to do this."  "Moms know how to give birth, and babies know how to be born."  You've heard it all before, sorry to be redundant.  My point is that midwives here can preach whatever they want, and abide by no rules.  It's a toxic concoction, and a disgraceful abuse of what midwifery was intended to be.  Out-of-hospital birth in Michigan is not being practiced safely.  Babies are dying and being injured that don't need to be, and wouldn't be if we lived across state lines, or if we simply had appropriate guidelines.   I still ask myself every single day, "How can this happen in today's world?"  "Why are people allowed to practice so recklessly?"  And these practices continue...

If out-of-hospital birth is to be as safe as it can be, then we need to define parameters for this kind of care.  Who attends these births, and what should their training be minimally?  What defines "low-risk" versus "high risk" and how should it be evaluated?  What clinical situations would make out-of-hospital birth a dangerous prospect?  How can out-of-hospital birth be safer?  What should absolute and non-absoulute criteria be for Michigan?  Why is the expectation anything less that out-of-hospital birth being as safe as possible for Michigan families?  Michigan mothers must expect more, and Michigan midwives must do better. 


For more:
The Importance of Defining Risk

8 comments:

  1. What I find curious about Michigan law is that your midwives were licensed certified nurse midwives. What restrictions pertained to their licenses? Were they operating within the legal scope of practice for nurse-midwives when they attended a planned OOH breech birth?

    If so, what needs to be remedied so Michigan families can be protected from negligence and malpractice of licensed providers.

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    1. Dear Ex CPM Student. Your question is particularly important. I'd like to devote our next blog post to addressing this in full. You are correct, two of the four midwives at our birth were nurse midwives. The other two were CPMs. Look for more in our next post:) Thank you for asking important questions.

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  2. Thank you for posting. Until hearing your story, I had no idea that there were no standards for care. And this is after spending MONTHS researching out-of-hospital birth and highly considering birthing at the GBC. It was shocking and appalling the first time I learned this, and becomes even more shocking each time I read it again. The State of Michigan is failing an entire segment of the population by failing to take action and mandate standards of care.

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    1. Dear Lansing Mom,
      Your last sentence is profoundly important. I hope that you, and every concerned citizen in Michigan will make a call or write a letter to their State Representative and Senator advocating for appropriate change. Licensing CPMs and creating a board of midwifery is NOT appropriate change. Minimum standards for education (International standards or higher), only allowing licensed midwives to practice, reporting data on outcomes, state issued informed consent (including disclosure of insurance), and clear transfer of care protocols WILL make a difference. The State and the profession of midwifery are failing to keep women safe by not addressing these issues appropriately. We need your voice.

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  3. I only wish the legislators who are pushing "licensing" upon us Michiganders would understand that offering a license to a midwife who is already practicing, who has a CPM, who is NOT going to change the way she practices to become more safe, but will just only think herself to be "protected" against lawsuits and jail, and might have the ability to bill insurance, is simply useless as a protection to the consumer. I thought licensing was supposed to be to protect the consumer, to provide guidelines, regulation, minimum standards, for any profession? As it stands, all I hear from the lay midwives and their supporters is that they need licensing to "protect choice" and to "bill insurance" and to protect themselves from jail and lawsuits. I hear nothing about how licensing will improve accountability, improve skills, standards, disclosure on stats in individual practices... why aren't these things included? If there is a complaint against your hairdresser, you can find out! You can make an informed choice to hire or not... but when it comes to the lay midwives who demand licensing, they want it as a one-way street... licenses to feel more legitimate but not licenses to be more accountable... it's truly ridiculous! With a death rate for Michigan lay midwives and CNM's acting like lay midwives, of at least 3 times hospital death rates for babies, you'd think women in Michigan would be in an uproar, but it seems the lay midwives are good PR reps as well, and brainwash their loss moms to think it was "God's will". Pathetic.

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  4. I chose to use a midwife for my 5th baby after having the previous four in the hospital. She broke my water which resulted in sepsis, after 30 hours the baby and I weren't doing well, resulted in Csection. I was in the hospital and in ICU for 30 days after the C Section with numerous infections and my organs not functioning well. Husband was at home with baby and other 4 kids, baby being the 1st he'd ever been around. The midwife I contracted with was supposed to help us through the hospital and follow up with after care. She never stuck to the contract, didn't even bother staying through the C Section. I was extremely tempted to sue, though didn't know who to reach out to for anything. My husband was so traumatized that he couldn't speak about it and just wanted to move on. I think there is a need for resources for women to have a recourse for things gone wrong. I would never recommend a home birth to anyone after my experience.

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  5. I chose to use a midwife for my 5th baby after having the previous four in the hospital. She broke my water which resulted in sepsis, after 30 hours the baby and I weren't doing well, resulted in Csection. I was in the hospital and in ICU for 30 days after the C Section with numerous infections and my organs not functioning well. Husband was at home with baby and other 4 kids, baby being the 1st he'd ever been around. The midwife I contracted with was supposed to help us through the hospital and follow up with after care. She never stuck to the contract, didn't even bother staying through the C Section. I was extremely tempted to sue, though didn't know who to reach out to for anything. My husband was so traumatized that he couldn't speak about it and just wanted to move on. I think there is a need for resources for women to have a recourse for things gone wrong. I would never recommend a home birth to anyone after my experience.

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    1. Dear Christina,
      Thank you for sharing your story. I'm so sorry for what you went through. I couldn't agree more that women need more access to resources in these events. We included a tab on our new website called "Injury and Loss" that includes how to report negligence. Perhaps I could work on making that more visible and diverse.

      I know too many families that have endured traumatic deliveries and near misses in OOH birth. We run an advocacy group with many who have been in your shoes. If you'd like to join the group of supportive families there, please let me know. I'd be happy to add you on our private FB group. I hope you've found supportive measures along the way, and I hope you and baby are doing well after such a painful ordeal.

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