“We’ve never heard such a ruckus”

That was the quote from the Senate Chairman when talking about the recent Mississippi legislation (that died in committee), that would have made all non-nurse midwives illegal in our state. With over 5,000 phone calls, the response was unprecedented. While that may not seem like a lot of phone calls, apparently, it was! Considering that our whole state population is somewhere around 2.5 million, that is 0.2% of the population calling (assuming that each phone call was by a different person, which we know was not the case, since many people called every Senator, or at least, every Senator on the committee).

What started the bill? I’m not sure, but apparently, there was a midwife (perhaps living in Louisiana, perhaps just down in that area of MS) who attended a birth in which the baby died. It’s possible that it was just one of those things, but it’s also possible that she was not as well-trained as she could have and should have been. Since I know no details, and have only a rough idea of what happened, I most certainly cannot pass judgment. Regardless of what happened or “what might have been,” this case led the Board of Nursing to get with a legislator to introduce a bill to make non-nurse midwives illegal. As far as I know, nobody knew about it until it had already passed the House and was in the Senate. Then we spread the word, and “raised a ruckus,” and got it defeated. Yay!

Now, to work.

Last Tuesday, I was part of a group that met in Jackson to begin work on crafting our own legislation to introduce next year that will make CPMs recognized and licensed, and will create a review board to oversee them. I’m not totally sure how that will work, because I’ve just never dealt with that aspect of things before. However, there were some TN CPMs at the meeting that talked about how it worked in their state. You can join the Yahoo group MSFriendsofMidwives to see the latest version of the bill and to stay informed on the process.

Currently in Mississippi, there is only one CPM, although there are several out-of-state CPMs who serve various parts of MS, and many other midwives who could become credentialed and licensed. With licensure and certification not having been required to practice in MS, it could easily be seen by midwives as being an unnecessary use of time and money to get that piece of paper, when there was no risk to not having it and very little if any benefit to getting it. I suppose that saying that you’re a CPM might get you a few extra clients, but it wouldn’t alter your legal status, and you probably couldn’t file for insurance repayment either (I suppose it might be possible, but I highly doubt that without the legal recognition that insurance companies would recognize you either). Under the legislation that will be proposed next year, CPMs would be legally recognized, and current non-certified midwives who can demonstrate that they meet the NARM criteria would be grandmothered in.

So, benefits of the legislation would be that midwives who are currently operating legally and safely in the state will continue to be legal birth attendants, and will also be recognized by the state. I asked about legislation that would make Medicaid be able to pay for such midwives, and was told that the legislation doesn’t specify that, but once CPMs are recognized, that such a step may come in the future — I don’t know if it would need to be a law, passed through the state legislature, or if it’s just one of those things that once they’re legal, they can get set up to file claims, or petition Medicaid to recognize CPMs. Another benefit would be that with credentialing perhaps comes a higher degree of respectability and also recognition. There is a certain something that comes with proof that others recognize the work you’ve done, whether that’s proving you can survive med school and get M.D. after your name, or that you’re a certified piano technician, and become a member of the PTG.

One downside of this particular legislation is that it would make non-certified and non-licensed midwives illegal. Those working on the legislation believe that any measure that allows non-CPMs to practice would be defeated. I can see that, based on the bill that was just defeated, that would have made all midwives (except CNMs) illegal. Yet, midwifery has been unregulated for so long in our state, that I can also see that enough legislators might support the bill, even if it did not criminalize non-licensed midwives. But, it seems prudent to take the safe track. I do wish that legislation such as what is in Oregon could pass, with licensure being optional but having benefits; however, those with much more experience and knowledge about midwifery and legislation are making the suggestions, so I’m going along.

“Why would anyone not want certification??” I can think of a few reasons. Some just don’t like government interfering in your business — it’s simply a libertarian issue. “Government is there to keep the peace, and that’s about it — everything else should be left free and open,” some might say. With certification comes regulation — in some states, non-nurse midwives have become legal, only to be basically legislated out of existence by the laws that made it practically impossible to operate. It’s sort of like the hospitals that have labor tubs, but women can’t use them if their water is broken based on a theoretical but totally unproven risk of infection; and they can’t use them if their water hasn’t broken, lest their water break in the tub, and nobody know it. As long as rules and regulations are sound, then there is minimal problem with them; but when they get to be stupid and over-reaching, they can cause more problems than they solve. In Arizona, the law says that home-birth midwives cannot attend VBACs. If you agree that VBACs should not take place at home, then you’d probably agree that this is good legislation. However, if you think that the risk of adverse events is so small that HBAC is a reasonable choice for women to make, then you’ll probably disagree with the legislation.

John Stossel is in a series of articles discussing the downside of certification (not mentioning midwives at all, and only briefly mentioning doctors). Here are two articles, “The Right to Work,” and “Licensing Madness,” as examples. He makes a pretty good case that certification serves to protect established industries at the expense of those who are equally competent to provide certain services (braiding hair, yoga instructor, writing wills), but don’t have the money (or don’t want to spend thousands of dollars) to certify just for the right to do what they already can do, especially if they’re doing it on the side, or are starting to build up a business. He points out that market forces will serve to weed out incompetent florists at least as well as (if not better than) the lengthy and expensive certification process. When it comes to businesses such as these, I’d have a hard time coming up with a counter argument — the “risk” of a bad florist is that you waste $30 on an ugly flower arrangement, in which case, you’d go tell all your friends and family and neighbors and co-workers to avoid that flower shop, and the florist would soon go out of business. But an incompetent midwife may lead to dead or injured mothers and/or babies, so it’s easier to say that doctors and midwives and such should be regulated and certified.

Still, there are probably some very good healers that could not be certified because they are alternative practitioners. For example, Chris Gardner, who wrote the book The Pursuit of Happyness, which was also a movie by the same name with Will Smith playing him, has an interesting history. If you remember the movie, he became a stockbroker while being homeless much of the time, with his son in tow. That’s only part of the story. When he was in the Navy and for several years afterward, he worked for and with a doctor. While my memory of what all he did is a little fuzzy, he had “great hands,” meaning, he was proficient in the medical work he did. He never went to one class of med school, but he had what it took to do what he did, including operate on people, teach med students how to do the right things — he even had work published in medical journals! But, because he wasn’t a doctor and hadn’t gone to med school, what would have been a promising medical career was necessarily stopped. He didn’t have enough money to become a doctor, and the doctor who employed him couldn’t afford to pay him more. “So, big deal — that’s just what you’ve got to do to become a doctor! We can’t have just anybody calling himself a doctor!” Well, true, but this also kept him from applying his skills and healing a lot of people. Sure, it kept some quacks out of the business of medicine, but it probably keeps some who would be very good doctors from doctoring.

There are definite upsides and downsides to this. Regulation helps to keep bad practitioners from starting a business, although it does not entirely eliminate bad practitioners. However, nothing can. While capitalism is a strong influence in keeping bad practitioners out of business (because people will not willingly spend their money on bad goods or services), they can for a time prosper. And if they’re schmaltzy enough, may be able to keep people blind to their incompetence or poor products or services to stay in business for a while — Bernie Madoff was a master at this (of course, he also blinded them with greed, which is another tangent and topic entirely). We’ve all known people who were certified, licensed, bonded, insured, and/or regulated who were really bad practitioners of their craft or trade. It happens. There are bad apples in every barrel. Regulation can make it so that people don’t have to do their own work to make sure people are really competent, which can be a good thing, or a bad thing if they are lulled to sleep and think that everyone who produces a piece of paper is competent.

As you can see, I’m conflicted about this — mostly because if you’ve got a bad midwife, we’re not talking about losing a little bit of money by not being more conscientious, but perhaps losing your baby’s life. Given enough time, the truly bad will probably be eliminated simply by market forces, but what may happen during that time? How many babies may die? Not something to be talked about lightly. However, we cannot protect people from themselves. Some people are going to choose things that others may think are “woo” (acupuncture, acupressure, magnets, copper, feng shui, craniosacral therapy, chiropractic care, herbs, vitamins, supplements, etc.) — we can’t stop them from doing that. And if a woman thoughtfully considers the matter, and chooses a non-certified midwife, or even just has a few friends over to attend her birth, can we really stop her? Should we? At what point does “society” get to dictate who attends her birth? Recently, there has been a national conference on VBAC (which since you’re birth junkies, you’ve probably heard about, unless you’ve been living under a rock). A similar argument has emerged from the pro-VBAC community, namely, that women have the right to choose how to give birth, and should not be forced into a C-section, even if there is a risk of uterine rupture and perinatal mortality. Does someone else get to choose how women give birth, or is that something that each woman should be able to choose for herself?

I think highly enough of women and our intellect to say that if a woman understands that she is hiring as a midwife someone who has only attended ten births, hasn’t really read too much about birth complications, and has never handled a postpartum hemorrhage or a “slow to start” baby, or any other complication, that she should still be allowed to hire that midwife, knowing the risks. I would want someone more qualified than that, but some women are comfortable with that level of skill and knowledge. Unless the midwife misrepresents herself or her skills, then I just don’t see that “we” should try to save the woman from herself. Others may disagree — it comes down to where on the “libertarian” continuum you find yourself.

Great VBAC story

This one is a bit different, in that it’s told by the L&D nurse, instead of the mom, but it is wonderful, just the same. Enjoy!

[Yes, RR, I’m thinking of you, in posting these hospital stories! :-)]

Considering a VBAC

I like what NavelGazing Midwife has to say about the process of considering whether to have a vaginal birth after a previous cesarean, or whether to choose a c-section for a subsequent birth. She says in part,

I encourage you to start a list, even from the very beginning of research. A column for Risk of CBAC and then another for Benefit of CBAC. Then do the same for VBAC. As you learn, put your thoughts into those columns. I promise, as you read more and hear about more, your risks and benefits might flip flop several times. But, having the columns allows you to keep a somewhat logical head about the impending decision.

Then from VBACfacts, a post titled,

An OB you like or who makes you comfortable isn’t enough

It includes a letter from a woman who just had a repeat Cesarean after wanting a VBAC. She begins,

It is with great reluctance that I submit payment to you for services rendered.

I hired you for an intervention free VBAC.  Instead I had EVERY intervention I told you I did not want.  Under your care, I failed in the most basic way a woman can fail – I failed to birth my children.   You ignored each and every point on my birth plan.  I cannot help but wonder if you even read it, or if you ever had any intention of following it.

“A decision made out of fear is no decision at all”

I recently received the following comment, in response to a past post about multiple Cesareans. It provided much food for thought, so I wanted to share it so all my readers could see it.

I really appreciate this site and its boldness for spreading truth.

I have had 6 unnecessary c-sections. They have all been low-transverse and healed well. My first was due to malposition which could have easily been changed if I would have been “allowed” to move. I was dilated and effaced completely with no induction. My 2nd c-section was due to the nurse “accidentally” rupturing my membranes when I was only dilated to 7 and the baby not coming right away. How stupid of me to allow them to cut me again and not just wait. I had this baby over four years after my first. There was no reason at all to operate. My doctor was distressed!

My 3rd c-section was about 2 years later and was elective due to scare tactics. With my fourth pregnancy I was much more educated in the field of child birth and VBAC and was completely prepared to have this baby naturally. Everything went great until I went to the hospital. I was treated like a criminal preparing to commit murder. I dilated to 10 on my own, but was still harassed and harassed until finally forced to have a c-section. During this operation my fascia was not put back together and I had a bulge the size of a small water balloon below my navel. I still suffer from this operation that was performed over 8 years ago. My 5th c-section was performed after finding a doctor who I felt supported me. I dilated again to 10. The baby was even descending into the birth canal. I had a nurse that was extremely nervous and told me I was taking too great of a risk. She frightened the dr and he demanded that I have another c-section. During this c-section the doctor nicked the main artery that connects my left fallopian tube to my uterus. I almost died from blood loss in this operation. I needed at least 2 or more transfusions and I had to spend the entire night in the ICU without my baby boy. It was horrible!!! That was considered the “safe” option….a c-section! My 6th c-section was in April 07. It was planned and I had a wonderful birthing experience. The doctor treated me human and cared very much for me. He told me that my uterus looked great and I was ready for baby #7. He knew we wanted a big family. That was in Germany.

So, here I am now…I am in TN. I am almost 30 weeks pregnant and still have not even seen a OBGYN. This is the first time I feel very frightened about the medical system. I have been in contact with a Dr. via phone and email. She is a Dr/Midwife and we are seriously considering a Home birth. This is where I am now thanks to the abuse I have received in the hospitals. I am a woman wanting to have a baby. I want to be treated like a human not like an atomic bomb waiting to go off. I have read and read and read both sides…I know the risks. I am concerned about the safe delivery of my baby. But I have been frightened away from medical staff…There is so much more to my story. But, it would be too long to write here. I have been abused emotionally and physically. I feel I have been violated and have lost my body to a system…an evil system that believes that having a baby is a medical condition. Having a baby is not a medical condition. It is a normal, natural, God-given process that man has perverted and taken control over. Allow woman to just have their baby in a peaceful and safe environment. Leave us alone! If there is an emergency, we are thankful to have the medical staff…but until then, please let us be and let us give birth! The doctor does not need an enema every time he has to use the rest room and women do not need any interventions or inductions to have their babies!!!!!

Sincerely,

A woman who just wants to give birth not have an operation,
Angela
PS. A decision made out of fear is no decision at all!!!!!

Empowering Birth Stories

Rixa at Stand and Deliver is sponsoring a giveaway for the new book by Ricki Lake and Abby Epstein, Your Best Birth; and one of the ways to enter is to tell or link to a story of empowering birth (also “what I wish I had known before” and “tips for creating a better birth experience). So, if you are in the mood for reading empowering birth stories, head on over and read your heart out!

VBAC Bibliography

April is Cesarean Awareness Month, and a lot of bloggers have been posting a lot of C-section related stuff (more so than usual), and here is a wealth of information on VBAC — nearly 100 links or other sources. Wow. Enjoy (or not as the case may be, since some of the links look sad just by the title).