tag:blogger.com,1999:blog-1762736094770946238.post6242894340228087319..comments2024-03-20T04:26:10.510-07:00Comments on Married to Medicine: The Home Birth, "Natural" Child Birth, and U.S. Hospital Birth Debate Part I: Hospital Safety, C-Section Rates, and PaternalismElleMurahttp://www.blogger.com/profile/01585481665526225076noreply@blogger.comBlogger53125tag:blogger.com,1999:blog-1762736094770946238.post-56037320068839055172014-10-27T21:55:46.813-07:002014-10-27T21:55:46.813-07:00Not a criticism but more an observation - I was su...Not a criticism but more an observation - I was surprised not to see 'maternal request or choice' cited above as one of the factors driving caesarean rates in the U.S. and also in many other countries around the world.<br /><br />I wonder if you might be interested in reading the book I co-wrote with Magnus Murphy MD called, "Choosing Cesarean, A Natural Birth Plan"; it was published in 2012 by Prometheus Books NY.<br /><br />I have been battling the 'infant mortality' issue versus 'perinatal mortality' (the rate we should really be looking at if we're going to compare intrapartum care outcomes) for many years now, so I really appreciated reading your distinction for readers here. Thank you.Pauline Hullhttp://cesareandebate.blogspot.ca/noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-1527884652909649172014-03-29T03:31:11.319-07:002014-03-29T03:31:11.319-07:00Oh Dani I can't tell you how much I admire and...Oh Dani I can't tell you how much I admire and appreciate what you do. You provide a reasonable, educated and comprehensive argument every single time. BirthUSA makes the same tired, unseasoned and unreasonable arguments. I think it's very difficult to believe you're on the evidence based side and then have someone so thoroughly and thoughtfully poke holes through your every belief. While you might not change anonymous' mind, you certainly have managed to convince many others. The simple truth is that the facts and evidence are against homebirth with CPMs. While some may be wonderful and well qualified, the total lack of ability to effectively distinguish between them and charlatan birth junkies demonstrates the need to abolish this fake credential. Thanks for doing what you do. Please don't stop...we need you and Lisa and others to keep fighting for safer homebirth. 30+ preventable deaths a year is too many. Hugs. KW. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-71307264957667978712014-03-25T18:10:37.002-07:002014-03-25T18:10:37.002-07:00Because the CPMs are only involved in home births....Because the CPMs are only involved in home births. Unlike CNMs and midwifes of all other comparable nations, they have no hospital-based training whatsoever. That's why they call themselves "experts in normal birth." They are not trained in emergency medicine of any sort and other than hoping to catch the signs to transfer to a hospital in time - if there even are such signs, which there sometimes are not like in the case of a baby born with a diaphragmatic hernia - they have neither the training nor even the equipment to handle medical emergencies. That's why you'll hear them say things like "birth is the safest day of your life" and "birth is not a medical procedure." Those things would have to actually be true for their system to work. And they are true… just not always true. A "low-risk mom" is not a "no-risk mom."ElleMurahttps://www.blogger.com/profile/01585481665526225076noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-17218341001504235382014-03-25T18:05:37.478-07:002014-03-25T18:05:37.478-07:00My husband just finished a OBGYN clinical rotation...My husband just finished a OBGYN clinical rotation and delivered 40 babies in one month. I have a hard time imagining why it would take someone several years to attend 50 births. It seems like someone could easily meet the requirements in a matter of months. That's pretty troubling.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-14962370968303858202014-03-25T16:55:57.525-07:002014-03-25T16:55:57.525-07:00You might also like to know that I used to attend ...You might also like to know that I used to attend home births and was planning to have home births myself...... until I dug a little deeper and found out how seriously flawed our home birth midwifery system is here in the USAAnonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-58455138492509317472014-03-25T15:57:08.259-07:002014-03-25T15:57:08.259-07:00"you cannot even FATHOM the possibility that ..."you cannot even FATHOM the possibility that there are other ways for women to safely give birth that do not include the hospital setting."<br /><br />http://whatifsandfears.blogspot.com/2014/01/home-birth-guidelines-for-safety.html?m=0Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-56010018832942372632014-03-25T15:54:49.242-07:002014-03-25T15:54:49.242-07:00It's no wonder you want to hide behind your co...It's no wonder you want to hide behind your computer, without revealing your name. You can't answer any of my questions, you can't admit that the training for CPMs is lacking and doesn't meet standards for the rest of the developed world, you clearly hate that there is someone out there advocating for the truth about things you clearly didn't know or understand, you are pulling one strawman argument after the next and now you are trying to act like you are ending the conversation b/c of "my POV" when it's obvious that you don't know how to respond to what I've said. It's ok, I (and anyone reading this) can see the truth of what's going on here. I know you are reading my response and you just don't know how to respond sensibly, without strawman arguments, without trying to put me down b/c *I* have clearly struck a nerve with YOU.Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-89877930225238137902014-03-25T15:45:41.565-07:002014-03-25T15:45:41.565-07:00clearly I struck a nerve. I wonder why that is?
...clearly I struck a nerve. I wonder why that is?<br /><br />Anyway, you clearly have your head stuck far in the sand. You are absolutely right, there are no CPMs out there with adequate education, training, licensing and regulation of their practice to make them viable options to the birthing community. Doula Dani knows best!<br /><br />And now I bid you adieu. Its not even worth considering continuing the conversation because your POV is just so completely skewed that you cannot even FATHOM the possibility that there are other ways for women to safely give birth that do not include the hospital setting.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-89392910633262447642014-03-25T14:44:23.095-07:002014-03-25T14:44:23.095-07:00"Your role is to support woman in their birth..."Your role is to support woman in their birthing choices and I am not really seeing a lot of that here."<br /><br />That's ridiculous. If someone wants to make a dangerous choice with her pregnancy and/or birth, I do *not* have to support it just b/c I'm a doula. I *know* my scope of practice very well and understand my role as a doula and I take it very seriously.<br /><br />When I signed up to be a doula, I didn't sign over my soul. There was nothing in the literature I received from my certifying agency that stated I must take any client that wants me and must support all birth choices. I'm allowed to have my own personal beliefs and preferences.Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-84232128216968909542014-03-25T14:28:08.825-07:002014-03-25T14:28:08.825-07:00"so the CMPs training are not up to par by YO..."so the CMPs training are not up to par by YOUR standards."<br /><br />Not just MY standards but the standards for midwives in the rest of the developed world. Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-68754625380650156522014-03-25T14:25:08.874-07:002014-03-25T14:25:08.874-07:00I am not making decisions for anyone. Where did I ...I am not making decisions for anyone. Where did I say I'm trying to make decisions for someone? I'm putting information out there so women can make informed decisions. You can hire whoever you'd like. You are making a strawman argument. I never told you who to hire or who not to hire. <br /><br />You wrote in your first comment that CPMs have rigorous training. They do not. That's what this conversation is about. It's not about trying to force women into making certain decisions. The conversation is about training and education of CPMs. Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-67981790962414562352014-03-25T14:04:13.588-07:002014-03-25T14:04:13.588-07:00so the CMPs training are not up to par by YOUR sta...so the CMPs training are not up to par by YOUR standards. I don't know why you think your standards in a health care provider should be everyone else. Like I said earlier, I make educated decisions. I researched my providers. And I am comfortable with their numbers. Thankfully I live in a state where I reserve that type of autonomy over my care. I know what level of risk I am comfortable with and I get that it isn't the same as yours--yet I am not sitting here telling you what type of provider you must choose, why, and where you must give birth. I do not think that highly of myself to where I feel the need to make that type of decision for another. <br /><br />I am not quite sure why you have an issue what in what I, or any other birthing woman does for that matter, or how exactly that it affects you in the slightest. As a doula, I am somewhat appalled that you think you have the right to make such decisions for another woman--that you are so vocal against a woman making a particular choice for herself. Your role is to support woman in their birthing choices and I am not really seeing a lot of that here.<br /><br />Transfer of care can and does happen seamlessly. Maybe not in all states, but again, thankfully I live in one which values CPMs, their role and a woman's choice in choosing them. When my midwives make a labor transfer, they call up the local hospital and OB on call, tell them the situation and that's it. They go to the hospital with their patients, but then they are just there as labor support, not as a provider. They just don't dump women off on a hospital's door step and then wipe their hands clean. My particular CPMs have never had an truly emergent transfer (where it was a life or death situation for either mom or babe) and again, have never had a mom or baby die under their care. You want to know why? Because their care is regulated where I live. Their scope of practice is clearly delineated and the types of patients that they can see in pregnancy and attend in labor and delivery are plainly laid out. Any deviation from this and you risk out/transfer out.<br /><br />A CMP in a state where their practice is regulated ARE good for the child birthing population. It holds them responsible for their care that they give. It gives women options, choice and a voice. And yeah, I am a-fucking-okay with that.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-40907310458599924672014-03-25T13:15:41.063-07:002014-03-25T13:15:41.063-07:00The problem with the CPM and why I *can* make blan...The problem with the CPM and why I *can* make blanket statements is b/c training and education are lacking. With a MD or CNM or CM - you know the very minimum required skills/education/training is enough - if they earn that title of OB/GYN or CNM or CM, then they are qualified to deliver babies as soon as that title is earned, as it is a rigorous process to earn it. With a CPM you do not. While, yes, there may be some CPMs that are more than qualified but that is not b/c they simply met their requirements. It's b/c they went above and beyond what was required.<br /><br />Majority of all currently practicing CPMs went through the PEP process - which is *not enough.* The CPM credential should mean something on it's own. A woman shouldn't need to go digging to figure out if her particular CPM is well-trained enough. If a woman earned the title CPM it should mean she is well-trained enough -- but that is not the case.<br /><br />A CPM does not have hospital privileges. Why would this not be a basic requirement of the process like it is in all other first world countries? Think of how many women transfer during labor, especially first time moms... how nice it would be to have her care provider there with her, continuing care. Most importantly, think of the ease of transfer if a midwife could call into her hospital in the middle of the transfer to fill in the hospital/OB/charge nurse with the details of the situation in case of an emergency. Hospital transfers take time b/c monitoring and assessment takes place before they can do anything... and in the event of an emergency, those are precious minutes.<br /><br />Philosophy is a different ball game. I'm talking about what makes someone qualified to deliver babies or not. Yes, I, too, believe that a belief in the normal process of birth when caring for low risk women is important. But when I go searching for a care provider, what I want to know first and foremost is: are they qualified and well-trained? Are they going to keep my baby and me safe? <br /><br />These are things that matter to me the most. Most of the time, for a low risk woman who goes into labor spontaneously, it will be an uneventful situation. But a philosophy or trust in birth is obviously not going to keep a woman protected if things become an emergency or when actual life-saving skills and life saving meds/equipment are needed.Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-12211986673577955172014-03-25T12:37:27.460-07:002014-03-25T12:37:27.460-07:00I already addressed it in a response to another po...I already addressed it in a response to another poster. But the short answer is yes. I believe in CPMs. I don't necessarily think that years upon years are a requisite for the makings of a good provider. I also believe in physiologic birth and no, I do not believe that ALL birth has to happen in hospital. I believe in women being able to choose the provider, and type of birth, that they feel is best for them.<br /><br />I am an informed consumer. I pick my providers based on many things. Their education, their certification/licenses, and their statistics. And there are exceptional CPMs out there who have attended hundreds and thousands of births, that have no maternal or perinatal/neonatal deaths, that properly risk women out of their care (meaning they are properly screening their population), that have low transfer rates (and excellent relationships/collaboration with local OBs and hospitals despite not having hospital privileges) and even lower c/s rates for then those transfers do occur. Its completely arrogant and disingenuous to claim that all CMPs are essentially "midwife" wannabes and that they are all bad providers and all uneducated and inexperienced. <br /><br />I've read your blog and I see why YOU PERSONALLY are against CPMs. And thats fine. You (and others here) are free to hold those opinions. But what becomes a problem is when you make blanket statements about a whole profession. You are just as bad as those in BOBB stereotyping OBs as c/s happy surgeons. The are good OBs, there are bad OBs. There are good CNMs, and there are bad. There ARE good CMPs and there are bad. <br /><br />Okay that wasn't a short answer, but there is is anyway. Tear it apart as you wish.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-87726728746788134952014-03-25T09:08:08.831-07:002014-03-25T09:08:08.831-07:00What about the other questions I asked?What about the other questions I asked?Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-79227460958555574442014-03-25T07:46:10.311-07:002014-03-25T07:46:10.311-07:00keep on keeping on FooFkeep on keeping on FooFAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-21697696715568632242014-03-25T07:43:50.586-07:002014-03-25T07:43:50.586-07:00you never asked a question of me FooFKittlen. And...you never asked a question of me FooFKittlen. And I responded appropriately to issues you addressed. If reading comprehension is lost on you, that is not my problem.<br /><br />I have seen the MANA study Doula Dani. And as a consumer, I prefer their number over some of the local hospitals in my area.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-57630848196215636722014-03-25T05:56:38.087-07:002014-03-25T05:56:38.087-07:00That's cause that flew right over your head, h...That's cause that flew right over your head, hon. We have interacted before. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-43865079006463326342014-03-25T05:54:50.258-07:002014-03-25T05:54:50.258-07:00You didn't answer or address anything I said. ...You didn't answer or address anything I said. Typical. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-60258039717076273972014-03-24T19:33:54.172-07:002014-03-24T19:33:54.172-07:00Anonymous - I know exactly what it takes to become...Anonymous - I know exactly what it takes to become a CPM b/c it is something I thoroughly considered doing. I decided to go the CNM route. <br /><br />Again, the training to become a CPM is incredibly lacking. Do you understand the requirements would not be enough in any other first world country? <br /><br />Do you understand no education beyond a high school diploma is necessary? <br /><br />Compared to a CNM, who must be an RN and have a 4 year bachelor's degree (typically is a BSN) and a graduate degree in nurse midwifery from an ACNM midwifery program.<br /><br />Or even compared to a CM, who must have a 4 year bachelor's degree with a minimum of certain science courses and a graduate midwifery degree from an ACNM midwifery program.<br /><br />You think the CPM is enough? After 2 years of apprenticeship and only 40 births and a woman can qualify to take the test. You think this is thorough? <br /><br />Have you seen the data collected from California, Colorado and Oregon? Have you seen any of the new studies regarding home birth in our country? I asked you this before but you didn't answer. <br /><br />Have you looked at the MANA study and compared it to hospital data or even compared it to the Birth Center study? I wrote it all out on my blog. What's your response to these numbers?<br /><br />http://whatifsandfears.blogspot.com/2014/03/mana-study-part-3-total-mortality-rates.html?m=0Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-31837843638584213122014-03-24T16:46:38.480-07:002014-03-24T16:46:38.480-07:00@FooFKittlen, CPMs in my state are credentialed. ...@FooFKittlen, CPMs in my state are credentialed. Further, my hospital works closely with the CPMs at the local birth center for the very reason of ensuring timely transfers and continuity of care should a woman need more advanced care. CPMs and the medical establishment can, and do (at least in my state) have a working collaboration that serves the benefit of women. Perhaps you live in an area where these relationships do not exist, and for that I am saddened for childbearing women.<br /><br />@Doula Dani and others, CMPs certified through NARM, on average, have 2 years worth of required didactic with an additional 3-5 years of a clinical component (the 3 phases process). Then they must be signed off on their skills/deemed proficient...all of this is before even sitting for the written exam. I am not quite sure where we are coming up with the assumption that any ole bumkin off the side of the road can deem themselves as a CPM? They can't. Now if we are talking LM then sure, you may have an argument right there.<br /><br />@TMG, thanks for finally answering. At least now I understand where your POV is stemming from. I disagree with a Masters being the entry level of education for a midwife just like I believe that there is a place and role for different types of midwives (CNMs and CPMs). It doesn't have to be one or the other. And I am sure it comes as no surprise that I also believe that not all birth need to happen in hospital...which is why I also believe in the need for credentialed, out of hospital midwives.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-201998916134569612014-03-24T16:09:00.809-07:002014-03-24T16:09:00.809-07:00iFoofKittlen, considering that I don't even kn...iFoofKittlen, considering that I don't even know what PWIOPM is, me thinks my identity is safe. :-)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-88289494335935650922014-03-24T14:20:54.769-07:002014-03-24T14:20:54.769-07:00You're obviously a professional at PWIOPM, and...You're obviously a professional at PWIOPM, and I'm pretty sure of your identity. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-1781842591927190582014-03-24T14:18:19.790-07:002014-03-24T14:18:19.790-07:00Not "same level of experience", but gett...Not "same level of experience", but getting their experience under someone who has a masters degree and is qualified to serve as an apprentice. So not someone fresh out of school.The Momma Giraffehttps://www.blogger.com/profile/00467522836286073027noreply@blogger.comtag:blogger.com,1999:blog-1762736094770946238.post-65768079450520747862014-03-24T14:17:13.691-07:002014-03-24T14:17:13.691-07:00All midwives should have a 4 year undergrad degree...All midwives should have a 4 year undergrad degree plus at least 2 years of master level studies, culminating in a masters degree. And an apprenticeship under someone with the same level of experience. Number of births attended should be more than 50. Let's aim for at least a couple hundred AFTER completing schooling.<br /><br />Better?The Momma Giraffehttps://www.blogger.com/profile/00467522836286073027noreply@blogger.com