Monday, August 13, 2012

A Democratic Citizen

A friend recently shared a radio show called On Being. This is part of a quote from Jacob Needleman.  It is relevant to the conversation in our state about midwifery, and people who constantly sling hurtful comments in various conversations, causing a tailspin of noise, but no real progress: 

"A democratic citizen is not a citizen who can do anything he wants; it's a citizen who has an obligation at the same time. And just to give you an example, if I may, the freedom of speech...what is the duty associated with it? Well, if you ponder that a little bit, you'll come to the conclusion very clearly that the right of free speech implies the duty of allowing others to speak. If I have the right to speak, I have the duty to let you speak.

Now, that's not so simple. It doesn't mean just to stop my talking and wait till you're finished and then come in and get you. It means I have an obligation inwardly — and that's what we're speaking about, is the inner dimension. Inwardly, I have to work at listening to you. That means I don't have to agree with you, but I have to let your thought into my mind in order to have a real democratic exchange between us. And that is a very interesting work of the human being, don't you think?"

The question is not how do we protect midwives.  It's not even how do we preserve choice, although that is important too.  The real question is HOW do we make out-of-hospital birth as safe as it can possibly be?  What expectations need to change?  What guidelines are fair and balanced?  Who holds what responsibilities?  What measures of safety and outcomes can be employed?  None of this can be answered without closely & honestly examining the glaring problems that are pervasive in midwifery today, and the impact they are having on families.  If we can clearly identify those problems, we can in turn, talk about solutions that will move us forward.  

PS.  It is not democratic conversation to respond to questions about improving midwifery by sharing how great your home birth was, and how your midwife is infallible.  Nor is it democratic to threaten people who see room for improvement within the profession itself.  The point is a) recognizing there are problems being expressed, and b) getting to work at solving them.  Pretending that there are none gets us no where.   

The Problems with Michigan Midwifery
(Note, this primarily refers to out of hospital midwives in MI.  Those practicing in hospital affiliated birth centers have graduate degrees, an advanced practice nursing license, most have insurance, and a board of oversight.)

1)   No accountability
2)   No minimum standards for education, not consistently educated/trained
3)   No mandates or system for reporting outcomes, that would in turn help to evaluate 
4)   No license required
5)   No insurance required
6)   No consistent requirements for informed consent
7)   No oversight by a balanced and fair board (or anyone at all for that matter) = no 
       analysis of practice, no improving upon practices, no accountability for dangerous  
8)   No defined risking out criteria or screening standards
9)   No defined scope of practice
10) No transfer of care protocols or models for collaboration outside the hospital
11)  A "sisterhood" that would defend a negligent midwife before helping her improve upon 
       her practices

Let me sum it up by again stating that ANYONE in MI can wake up tomorrow and call herself a "midwife".  She can open a "birth center" in her garage, without one bit of oversight. Babies can be injured or die in her care, and there isn't a damn thing anyone can do about it.  The midwife doesn't have to report it to anyone either, so the next unsuspecting family won't have a clue about her prior history.  No regulation = a walk in the park for negligent midwives.  Unacceptable.  Time to start talking about real solutions that will protect families, and save lives.  The people of Michigan deserve excellent midwives and responsible care. 

1 comment:

  1. You are attempting to conduct some of the most introspective, intelligent, and thoughtful dialog around home birth safety - and I am perplexed that more people - especially midwives - are not actively engaged in this conversation with you.

    Since the question was first posed to me:

    "HOW do we make midwifery safer?"

    - I have turned the question over and over in my mind trying to come to a perfect but elusive answer. As a student of midwifery - I want to know this, too.

    Thank you for starting and continuing this discussion - and for allowing many voices, including mine, to participate in it.