Prosecution of midwives

Prosecution of midwives

In Indiana and nine other states, midwives must be licensed physicians or nurses. Some midwives in Indiana who don’t meet those requirements are being prosecuted. According to the New York Times:

Doctors, legislators and prosecutors in Indiana… say home births supervised by midwives present grave and unacceptable medical risks. Midwives see it differently. They say the ability of women to choose to give birth at home is under assault from a medical establishment dominated by men who, for reasons of money and status, resent a centuries-old tradition that long ago anticipated the concerns of modern feminism…

Midwifery is an autonomous profession,” [midwife] Ms. Ayres said. “It’s an art and a science that predates the medical model of care. Midwifery sees birth as normal and basically safe.

“It’s made safer by reliance on the woman’s power,” she continued. “The medical model assumes the woman is passive and her body needs to be acted upon. Every birth is presented as a potential disaster from which every woman needs to be protected and potentially rescued.”

A home birth is also a lot less expensive than a hospital birth.

I’m sympathetic to the midwives’ arguments, and for a large majority of births their approach is probably right. But I’ve also seen –in my own close family and friends– how the politically-oriented, male-bashing approach of Ms. Ayres and her ilk can go terribly awry when things aren’t normal.

The results I’ve seen personally, when an expectant mom bought into these arguments and the sensitive, enlightened partners went along?

  • An emergency C-Section, ruptured uterus and baby with a 1 Apgar following an attempted Vaginal Birth After Cesarean (VBAC)
  • A stillborn baby when an experienced midwife failed to deal effectively with an umbilical cord wrapped around an otherwise healthy baby’s neck

I’m with the prosecutors and medical establishment on this one.

April 5, 2006

9 thoughts on “Prosecution of midwives”

  1. I don’t think it should be illegal, but I do think there needs to be better education and screening of expectant mothers to see who would be appropriate candidates for home births. Personally, I’d never do it because of the risk of problems. Though in my case, it’s not even an option because of my risk level.

  2. I’ve been delivering babies for 20 years, and I’ve seen the wonderful easy normal labors and deliveries at which I have been not much more than an invested spectator. I’ve also seen the simplest case turn into a tragic disaster in an instant.
    I think midwives have a wonderful role to play, and offer women an alternative to the ever more complex medical-technical experience.
    And midwives are, yes, a wonderful old tradition of women-community caring for each other, and experience many of us are missing in our lives. Do they really want to perpetuate this tradition with 15th century skills?
    Personally, I don’t want safe healthy babies for reasons of money and status. What a presumptuous and ignorant accusation.
    What would these same midwives say if anyone who had an idea, old or new, about a surgical procedure could try it out on the kitchen table? Doctors and nurses, and anesthets, and pharmacists, and chiropractors and accupuncturist (the list goes on) – and the GOOD midwives are credentialed, certified, liscenced, examined, schooled monitored, reviewed (okay, etc etc) Do they think they are immune from accountability? Or do they not want anyone looking too close?
    I, too, amd with the prosecutors AND (god forbid) even the trial lawyers on this one!!!
    Elizabeth Shangle, MD, board certified, (credentialed by everyone from the health plan to the housekeeping staff)

  3. I think a lot of this comes from hospitals insistance on being inflexable rule-makers. While nurses (the good ones) often let “confort” rule infractions go, a lot of the rules in hospitals re:childbirth are for the hospital/staff comfort rather than the mother/baby’s comfort.

    That said, CHD’s are the most common problem in infants. My son has a particularily serious CHD and I cant tell you how many woman’s stories in my support group start out “I had him at home. I noticed the next day he looked a little blue but by the time we got him to the hospital he was in renal/kidney/liver/respitory/heart failure. This failure to diagnose often killed or greatly added to their baby’s complications.
    Surely we can find a healthy compromise between home-birth and hospital?

  4. My son was born at home with a licensed nurse practitioner midwife and the obstetrician present( because her water hadn’t broken despite being in full labor he peirced the placenta with some needles thenhung around for the birth). The cord was around his neck, but was dealt with succesfully.His apgar was 8, which the midwife saidwas the best she had seen for a baby with the cord around the neck.A pediatrician made a home visit within 12 hrs.
    If women really want to be midwifes, they should get the proper medical training and get liscensed. It’s not that hard. Also like in my sons case they should have a proper support system for when things go wrong.

  5. I’m all for midwives. When in med school, they taught me to be kind & gentle when delivering babies – something that was sadly lacking in some of the residents. But, they delivered IN the hospital, with their own patients but with the docs & their toys in the background, prn. My roommate was hoping to become a midwife – after she finished nursing school & then completed the required further education.

    I am glad I didn’t have a homebirth with my kids. After many hours of failure to progress, I had a section for my first. My OB showed me his true knot in his cord. If he’d have been born at home, he’d not be the smart critter he is now. His sister had placenta previa, so I had sections all the way. I’m sorry I didn’t get the chance to push. But, I’m glad for their good outcomes.

    V

  6. I had a primary c/s for breech. NEVER AGAIN! I chose homebirth from there after because I would not walk that road again! NEVER CUT AGAIN! The c/s rate on this continent is horrific…
    I had midwives for my last two births. My daughter was born blue (there was no indication of a problem before my water broke – she was out within seven minutes from then), with no respiratory effort, less than 100 bpm, poor response. My midwives were calm and effecient. By the time the six emts arrived four minutes later.. she was fine. NONE of them had infant resuss training, they did not have an infant oxygen mask, nothing. The second midwife handed the equipment to one of the twits and marched out to the ambulance with my daughter.
    She returned home with a wonderful note from the neo natal neurologist saying she was thrilled that I’d given my daughter the best birth possible. A homebirth.
    To some of us, a hospital is a dangerous place… Without midwives I would have gone unassisted. We do not have a family physician, we do not have a pediatrician… I no longer trust the medical system at all.
    Living in Canada with regulated midwifery… thank goodness!

  7. I forgot to explain that my daughter had a cord around her neck. The cord was nice and curly from placenta to neck and neck to belly… Around her neck was completely flat. She grew in utero with it around her neck. AND no, it was not detected at either of the two ultra sounds that we had done.
    She could have died at any time before or during her delivery. We were very lucky to have her. We were incredibly lucky to have the help of midwives!

  8. To those who are pushing for more licensing of midwives, would you still want to allow home birth – attended by a licensed midwife – to be a legal and readily available option for any woman who chooses it? I am all for training and monitoring of midwifes. But if midwives are required to be physicians or nurses, it seems that the goal might be to push them out of home birth all together. Those of us who choose home birth have just as much right to do so as someone else has a right to choose hospital birth. Let’s make sure the focus is truly on creating an environment where home or hospital births are available to everyone, with midwives and doctors who are licensed and trained to do their jobs. These two professions have very different ways of handling childbirth, and their licensing should reflect these differences. And anyone who says that home birth is more dangerous than hospital birth should double check the statistics.

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