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 alone. Not 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 Standards. They 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
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.
The Importance of Defining Risk