tag:blogger.com,1999:blog-346749784229772317.post5378892103751096404..comments2022-03-09T03:58:19.101-05:00Comments on Safer Midwifery for Michigan: Breech Birth at HomeMWShttp://www.blogger.com/profile/04125751490256911705noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-346749784229772317.post-13189001358612961492012-10-13T09:03:21.011-04:002012-10-13T09:03:21.011-04:00No, what you describe these midwives as doing is n...No, what you describe these midwives as doing is not informed consent at all. It is manipulated consent under the guise of informed consent, and it will simply be used to turn around and insist that it was the parents' choice when a tragedy occurs.Beckyhttps://www.blogger.com/profile/00906873166719359978noreply@blogger.comtag:blogger.com,1999:blog-346749784229772317.post-67405660555014784742012-10-11T10:13:34.057-04:002012-10-11T10:13:34.057-04:00My MEAC education requirements included writing up...My MEAC education requirements included writing up informed consent documents. This was challenging because there was huge pressure (not so much from the school, but from my preceptors and midwifery community) to abide by the 'informed consent' doctrine - which meant, essentially, to risk out nothing, but just to providing some sort of information so the parents felt they were educated and informed on the subject. <br /><br />I don't remember what I wrote specifically about breech birth - something wishy-washy, I'm sure. But I've been thinking lately about how I would provide informed consent - how I'd really like to do it - not how I was expected. It would go something like this:<br /><br />___________________________<br /><br />"- Your baby is breech, and as a midwife, I am not qualified or trained to attend vaginal breech births.<br /><br />- There are increased risks of vaginal breech birth due to the position of the baby and the risks are further increased when the birth occurs distant to skilled medical services, and/or under the care of an untrained provider.<br /><br />Options: <br /><br />- referral to one of two local physicians that attend vaginal breech birth - this requires screening and evaluating the appropriateness of vaginal breech birth. <br /><br />- referral to a physician for planned c-section<br /><br />In interest of informed consent:<br /><br />- Out-of-hospital vaginal breech birth is not prohibited by law in our state.<br /><br />- There are midwives who attend breech births in out-of-hospital settings.<br /><br />- There is no requirement for midwives to be trained in breech deliveries in order to attend breech birth at home. <br /> <br />If a planned OOH vaginal breech birth is desired, despite the increased risks, you are free to terminate care with me and transfer your care to another provider. I do not make recommendations or referrals for OOH breech providers."<br /><br />____________________<br /><br />Maybe this language isn't strong enough - but my experience is that clients usually trust their midwives. And I would *much* prefer to referring one of my clients to a physician with training and skills in attending breech birth (as well as c-sections), than seeing them attempt a breech delivery at home. But it is not illegal where I live - and midwives are doing it. I don't want to lie about that either. I feel like I lose credibility if I'd conceal that there are midwives attending breech birth at home. Sure they do.... but they aren't trained to do so... do you want to take that chance? Between a CPM who has attended 3 breech births and an OB/GYN who's attended 100, which one do you want? Isn't this informed consent?<br /><br />What I've noticed about the midwives who attend breech at home is they usually offer NO alternative - no referral to a doctor who does breech. They lay it out as "gentle home birth with us" vs. "traumatic, risky c-section with the evil MDs."<br /><br />Surely this is not informed consent. <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-346749784229772317.post-74726843952954260022012-10-10T22:30:46.621-04:002012-10-10T22:30:46.621-04:00In the US it is very difficult to find any doctor ...In the US it is very difficult to find any doctor that will perform a breech delivery in hospital, because of the evidence that a vaginal delivery has higher mortality and morbidity rates. There is some evidence from Europe that for a very select population of breech positioned babies, that vaginal delivery has nearly the same mortality as cesarean. It still has higher morbidity but there may not be long term consequences of that morbidity. Very strict guidelines need to be used, however, as per the SOGC and European authorities, and vaginal delivery will be the exception rather than the rule for breech babies. As cesarean rates for breech went up in Europe in response to the Term Breech Trial, mortality rates among breech babies went down, because the health care systems were being much more selective about which pregnancies got a TOL.<br /><br />I think there'd have to be some significant medicolegal reform before we see breech vaginal delivery make a big come back in hospital in the US. Still, that doesn't make breech delivery out-of-hospital magically safe. The evidence is that breech delivery is risky and dangerous, and that careful monitoring and management is needed.Beckyhttps://www.blogger.com/profile/00906873166719359978noreply@blogger.comtag:blogger.com,1999:blog-346749784229772317.post-40374713113698165992012-10-10T15:58:06.001-04:002012-10-10T15:58:06.001-04:00Practicing medicine without a license is illegal r...Practicing medicine without a license is illegal right? Is there any way this conference can be closed down? karenhttps://www.blogger.com/profile/14942575379261463930noreply@blogger.com