# Do you have any experience with homebirths?  Midwives?  Planned unassisted births?



## abckidsmom (Jun 20, 2011)

An acquaintance recently had quite an experience with a planned homebirth, a prolapsed cord, some really excited firemedics, and a c-section without any anesthesia at all.

It all led me to wonder what the community experience with interacting with people who planned homebirths is. 

What would you do if you were called to assist a midwife caring for a woman with complications during labor/birth?  Would you take over for the midwife?  Would you let her ride along?

What if the baby was crowning, and you couldn't hear fetal heart tones with the doppler?  

What would you do if the midwife had her hand inside the vagina, holding pressure off of what she said was a prolapsed cord?  What about if she was not physically tall enough/agile enough/able to keep up with the stretcher as you crossed the yard to the ambulance?

What other complications have you seen when called to assist with births, planned or otherwise?

What's your plan for communicating what you have to the hospital?


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## Aidey (Jun 20, 2011)

I think what I would do would depend on the midwife. 

We were called for a newborn not breathing and when we arrived the midwife was bagging the baby. I don't remember the exact APGAR, but the baby's color wasn't great, pulse was over 100 and he wasn't very active. Midwife told us he was agonal when born. 

She was freaking the f out. It was a HUGE pain in the arse dealing with her, and then after the baby started crying and everything seemed ok she talked the parents out of transporting! She told them that if they took the baby to the ED the doctors there would force them to admit the baby and wouldn't let them take it home that night, even if nothing was wrong. Said it was "impossible" to get the baby out of the hospital once it was brought there.

We did everything we could to try and talk the parents into transporting, but they listened to the midwife. In retrospect we should have asked her to leave, and then made her leave very early on. 

It is essentially like any other provider on scene. If you are helpful you can stay, if you are not you're going, even if I have to get the police to make you go.


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## Aerin-Sol (Jun 20, 2011)

Can you legally force control from a midwife? I can see making the case for a lay-midwife, but wouldn't a certified nurse-midwife be considered a more advanced level of care? Could you have the police help you take over a RN's patient? I'm not being snarky.


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## firecoins (Jun 20, 2011)

Call medical control and put the MD on with the parents.


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## Aidey (Jun 20, 2011)

Police don't care about level of certification. In most places it is illegal to interfere with EMS, period. If I tell the police officer that the midwife is preventing me from administering appropriate care that is all there is to it. In my case there were multiple paramedics on scene who disagreed with the midwife, which I think matters in these cases.


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## JPINFV (Jun 20, 2011)

Aidey said:


> It is essentially like any other provider on scene. If you are helpful you can stay, if you are not you're going, even if I have to get the police to make you go.



Can you demand that a provider who the patient wants present to leave just because their advice is conflicting with yours? If you're at a doctor's office, for example, can you demand that the physician leave his own patient and exam room? Would this not put the other provider at risk for patient abandonment as well?


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## JPINFV (Jun 20, 2011)

Aidey said:


> Police don't care about level of certification. In most places it is illegal to interfere with EMS, period. If I tell the police officer that the midwife is preventing me from administering appropriate care that is all there is to it. In my case there were multiple paramedics on scene who disagreed with the midwife, which I think matters in these cases.




Is the patient actually preventing you from administering appropriate care, or advising the patient on what they believe is appropriate care? Ultimately, isn't it the mother's choice to determine what care is actually appropriate? 

Are you going to seriously consider putting your education and experience with childbirth up against a certified midwife?


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## the_negro_puppy (Jun 20, 2011)

I have had one bad experience with a home birth/midwife.

We were called lights and siren to a house in a semi-rural area (40 mins from hospital) initially for a home delivery gone wrong. The job description was a birth with the baby's shoulder stuck, and midwife on scene. We got halfway there before the midwife called back and tried to cancel us. But our supervisor told us to proceed and do a quick checkup.

When we arrived i noticed a large car in the driveway, with political midewife bumper stickers all over it such as pro breast feeding and pro home birth.

We went inside and found mum and baby, both doing ok. Baby APGAR 10 and this was mum's 5th child. She still had minor bleeding but the midwife was very defensive and by her demeanour didnt want us there or near the patients. We checked mum and baby quickly before leaving. I couldnt help but notice the midwife had no resus or other gear just some oxytocin injections.

We drove the 20 mins back to station only to be called back to the house, due to the mother continuing to bleed. By the time we got back, the mother was pale, diaphoretic, BP 90 systolic, HR 120, increased RR. All the signs of hypovolemia. We ended up oxygen, loading, IV access, small amount of fluids and driving code 1 to hospital with the shocked mother on the stretcher, the father on the spare seat in the back holding the 1 hour old baby, and the placenta swishing around in an icecream tub on the floor.

In this case we nearly had 2 patients die (baby from shoulder dystocia, mother from primary post-partum haemorrhage. All in the name of homebirth. This was particularly bad in that the midwife had no resus gear, and failed to recognise the signs of post-partum haemorrhage early on. Her oxytocin injections and fundus massages didnt really do the trick.


I am against homebirths, and there are recent studies indicating the mortality of infants is much higher born in home than hospital. It is of my opinion that the mother is putting her own comfort ahead of the possible risks to the baby. There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.


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## bstone (Jun 20, 2011)

It wasn't long ago that 100% of humanity was a product of homebirths. Our rates of survival weren't too great back then. Midwives, as they existed then, were trained by apprenticeship. If the master (mistress?) was good then the future midwife might also be. They weren't really good at emergencies. 

Modern midwives are usually RNs with specific midwifery training. Some states view them as Nurse Practitioners/Advanced Practice Nurses. They can write prescriptions. They have graduate degrees. That's more than what we EMT and medics have.

When called to a homebirth gone wrong don't assume you'll immediately take over care and push the CNM (certified nurse midwife) out of the way. Work *with* with CNM, keep the patient comfortable, say 'you have a beautiful baby'. Things like that will keep tachycardia down. 'Offer' the CNM a ride to the hospital in the back of the bus. She'll likely refuse and want to follow in her car. 'Suggest' she does not tailgate the bus but instead ensure the CNM you'll take very good care of mom and baby and see her at the hospital whenever she can safely make it there.

Do the above and you'll find your patient and CNM much happier.


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## Aerin-Sol (Jun 20, 2011)

the_negro_puppy said:


> I am against homebirths, and there are recent studies indicating the mortality of infants is much higher born in home than hospital. It is of my opinion that the mother is putting her own comfort ahead of the possible risks to the baby. There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.



So do you think home birth should be criminalized?


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## lightsandsirens5 (Jun 20, 2011)

the_negro_puppy said:


> There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.



This is an excellent statement. I wholeheartedly agree. The vast majority of births go off s a hitch. However, when something does go south, you need help and you need it yesterday. 40 mins away from the ER via amb is just too long. 

I am all for people having kids outside of the hospital if that is your thing. But common sense must be exercised. Not only that, aren't there clinics where a midwife can deliver the kid s going to the hospital?


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## Shishkabob (Jun 20, 2011)

When I was at AMR we got called to a Midwife after the mom lost a crap load of blood.


The midwife completely overloaded the patient with NS and skyrocketed the BP, and looked at me like I was an idiot when I shut off the IV.


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## usalsfyre (Jun 20, 2011)

Don't speak for anyone else, but as a husband standing at bedside for two somewhat complicated vaginal births, I think the thought of homebirth is insane. Find a hospital that will honor whatever cultural/religious/completely made up rituals you want and have the kid there. But for God's sake, have some people who know what to do when things go bad close at hand. At home, an hour away from an L&D department is NOT the time to find out you CNM is an idiot.


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## Aerin-Sol (Jun 20, 2011)

usalsfyre said:


> Don't speak for anyone else, but as a husband standing at bedside for two somewhat complicated vaginal births, I think the thought of homebirth is insane. Find a hospital that will honor whatever cultural/religious/completely made up rituals you want and have the kid there. But for God's sake, have some people who know what to do when things go bad close at hand. At home, an hour away from an L&D department is NOT the time to find out you CNM is an idiot.



As opposed to being in the hospital and finding out that your OB/GYN swears by pitocin & c-sections regardless of what the patient actually wants? Going by horror stories of bad practitioners as a way to declare something "insane" is in itself insane.


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## usalsfyre (Jun 20, 2011)

Aerin-Sol said:


> As opposed to being in the hospital and finding out that your OB/GYN swears by pitocin & c-sections regardless of what the patient actually wants? Going by horror stories of bad practitioners as a way to declare something "insane" is in itself insane.


Why did I figure you were a rabid home birth person 

If you had taken the time to READ my post, you'll see I indicated to find somewhere that will honor your wishes. It's not a couple of horror stories, it's the thought of having a complication that requires a section/blood/hysterectomy/complicated resus to prevent fetal and/or maternal demise in the boonies without help available that is insane to me. It's a personal opinion. Someone being willing to put their own and their kids life on the line for what essentially amounts to a personal statement doesn't sit well with me.

If your hell bent on no pit/drugs/sections/touchy-feelly natural birth stuff, perhaps the time to discuss that with you OB is PRIOR to being in a delivery situation.


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## Aidey (Jun 20, 2011)

JPINFV said:


> Can you demand that a provider who the patient wants present to leave just because their advice is conflicting with yours? If you're at a doctor's office, for example, can you demand that the physician leave his own patient and exam room? Would this not put the other provider at risk for patient abandonment as well?





JPINFV said:


> Is the patient actually preventing you from administering appropriate care, or advising the patient on what they believe is appropriate care? Ultimately, isn't it the mother's choice to determine what care is actually appropriate?
> 
> Are you going to seriously consider putting your education and experience with childbirth up against a certified midwife?



Honestly, it depends on the situation. The provider could end up riding in. The chance of something like that happening is very very small. We are talking about situations were the other provider's actions go directly against the standard of care. We aren't talking about the difference between 2lpm of O2 and 4lpm of O2, more like giving someone in anaphylaxis 3mg of epi rather than .3. 


In the case I posted I looked up the midwife later, and that is all she was. She was not an ANP, or RN for what it is worth. In a case like that one, where the baby was not breathing and she is scaring the parents into thinking the hospital is going to steal their child, yes I would be willing to go up against a midwife. 




usalsfyre said:


> Why did I figure you were a rabid home birth person
> 
> If you had taken the time to READ my post, you'll see I indicated to find somewhere that will honor your wishes. It's not a couple of horror stories, it's the thought of having a complication that requires a section/blood/hysterectomy/complicated resus to prevent fetal and/or maternal demise in the boonies without help available that is insane to me. It's a personal opinion. Someone being willing to put their own and their kids life on the line for what essentially amounts to a personal statement doesn't sit well with me.
> 
> If your hell bent on no pit/drugs/sections/touchy-feelly natural birth stuff, perhaps the time to discuss that with you OB is PRIOR to being in a delivery situation.



Something I think is a happy medium are birthing centers. They tend to have a number of options for delivery and multiple midwives/staff on site. I would be WAY more comfortable giving birth in a birthing center than at home. There was actually a VA hospital where I used to work that had a birthing center attached, totally separate from their normal OB floor. It was very popular, and if anything went wrong they were in the hospital. 

I don't really have a problem with home births, but there was a reason mortality rates were high. If parents are going to elect to do a home birth they need to be aware that there is no way to be 100% sure before hand it is going to be an uncomplicated birth, and that there is risk involved. I think OBs end up in a sucky situation because they get blamed for so much more than any other doctor. Their insurance rates are the highest in the industry. I think if more people realized not every birth is going to go 100% perfectly, and not every kid is going to be 100% healthy things would go a lot smoother. 


Besides, who doesn't think it would be a huge mess to set up a birthing pool in their living room? Blech.


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## usalsfyre (Jun 20, 2011)

Aidey said:


> Something I think is a happy medium are birthing centers. They tend to have a number of options for delivery and multiple midwives/staff on site. I would be WAY more comfortable giving birth in a birthing center than at home. There was actually a VA hospital where I used to work that had a birthing center attached, totally separate from their normal OB floor. It was very popular, and if anything went wrong they were in the hospital.
> 
> 
> Besides, who doesn't think it would be a huge mess to set up a birthing pool in their living room? Blech.


I'm good with this. Just some sort of site. Not at the far south end of my district, in a part of your house we can't get you out of, on a night where it's raining cats and dogs.


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## the_negro_puppy (Jun 20, 2011)

Aerin-Sol said:


> So do you think home birth should be criminalized?



Definitely not. I like living in society with many freedoms, but im not so sure we should suddenly outlaw home births.

At least in Australia:

http://ama.com.au/node/5275/

"_A retrospective population-based study has added to previously published evidence showing that planned home birth in Australia is associated with a higher risk of intrapartum related perinatal mortality (death during labour or after birth owing to problems occurring during labour)._

..._Prof Keirse said that while the data showed that planned home births had a perinatal mortality rate similar to that of planned hospital births, they had a sevenfold higher risk of intrapartum death and a 27-fold higher risk of death due to intrapartum asphyxia (lack of oxygen during childbirth). This was despite the finding that women with recognised risk factors, such as nulliparity, Indigenous status, lower occupational status, and residence outside metropolitan areas, were less likely to plan a home birth. _

I am personally against home births but respect peoples choices to have them. Why take the chance? For the sake of some temporary comfort and one midwife with little to no gear/drugs vs a team of neonatal specialists (if required) I know which i'd prefer to have nearby.


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## fortsmithman (Jun 20, 2011)

I have no experience with home or planned unassisted home births.  I do however have experience with midwives.  The midwives here in town work at our local hospital where midwife assisted births are common.   As well the midwives also train and certify us in Neonatel Resuscitation.


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## abckidsmom (Jun 21, 2011)

Aidey said:


> I think what I would do would depend on the midwife.
> 
> We were called for a newborn not breathing and when we arrived the midwife was bagging the baby. I don't remember the exact APGAR, but the baby's color wasn't great, pulse was over 100 and he wasn't very active. Midwife told us he was agonal when born.
> 
> ...



Perhaps she had education in newborn assessment, and the baby, slow to start but now crying and pink, really didn't need to go to the hospital?  Choosing to treat midwives like interference could influence them to be more hesitant to call EMS next time.  Y'all got the baby going, but you didn't mention being concerned about his breathing afterward, or being suspicious of a murmur, or whatever.

If the baby had a healthcare provider at home to monitor for any issues, why would he need to go to the hospital?

She was a healthcare provider, hired by the family, providing care to them in their own home.  I would be extremely hesistant to involve police with kicking her out if she was just having a different opinion than you.

If you really felt that strongly, I think the medical command talking to the parents option would be the one I would go with.

Maybe the parents really wanted to have their baby in their arms, and not feel like criminals from a homebirth transfer with a baby who


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## abckidsmom (Jun 21, 2011)

Aerin-Sol said:


> Can you legally force control from a midwife? I can see making the case for a lay-midwife, but wouldn't a certified nurse-midwife be considered a more advanced level of care? Could you have the police help you take over a RN's patient? I'm not being snarky.



Just to clarify, there are several types of midwives:

Lay midwives, or Direct-entry midwives (LM, DEM):  People with no medical training who apprentice with a midwife for a time (usually a couple of years or so), learning how to provide prenatal care and assist with births.

Certified Professional Midwife (CPM):  Midwife who has followed a course of study prescribed by the state and passed written and practical testing, and is registered with the state board of health.

Licensed Midwife (LM):  Some states license their midwives instead of certifying them.  They're basically the same as CPM.

<<CPM and LMs both are supposed to associate with a local OB to back them up in the event of a late-term triage out.>>  They usually have the patient see the physician once in the third trimester or sooner if there look like there might be issues.

Certified Nurse Midwife:  An RN with a graduate degree in CNM, who works like a CRNA or a NP with a supervising physician.  CNMs almost NEVER do homebirths, they usually work on OB floors, or maybe birth centers.  People who seek out homebirths usually do not want a CNM because she would still likely follow the pitocin/continuous fetal monitoring "medicalized" standard of care that they seek to avoid by being home.

Just thought I'd help with some of the terminology.


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## abckidsmom (Jun 21, 2011)

Aidey said:


> Police don't care about level of certification. In most places it is illegal to interfere with EMS, period. If I tell the police officer that the midwife is preventing me from administering appropriate care that is all there is to it. In my case there were multiple paramedics on scene who disagreed with the midwife, which I think matters in these cases.



Half a dozen paramedics combined don't have 20% of the newborn assessment and neonatal experience that a single midwife has.  Imagine being surrounded by 18 EMT-Bs who think that your guy having an MI who is satting 100% on RA need a NRB.  Majority does not rule.

As sure as there are idiot paramedics out there, there are idiot midwives out there, but you have to give them the benefit of the doubt, especially when the emergency is over, and you're back to their specialty again.


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## abckidsmom (Jun 21, 2011)

the_negro_puppy said:


> I am against homebirths, and there are recent studies indicating the mortality of infants is much higher born in home than hospital. It is of my opinion that the mother is putting her own comfort ahead of the possible risks to the baby. There is a big difference in having a home birth living 10 mins from a hospital compared to 40 mins.



I'll show you mine if you show me yours.  (Studies, that is.)  I think you're way off.

Just so you know, I'm not a militant home-birther.  I had 4 hospital births, with epidurals and pitocin, and one homebirth, an hour from the hospital.  All of them turned out fine.  I think it's maternal morbidity and mortality that's higher in the hospital, with equal or better numbers of infant morbidity and mortality in homebirth because the hospital has much, much higher numbers of complicated pregnancies.  People rule out of homebirth all the time for complications. 

If healthy women are giving birth to healthy infants at home, it is no surprise that the numbers support homebirth.


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## CAOX3 (Jun 21, 2011)

abckidsmom said:


> Half a dozen paramedics combined don't have 20% of the newborn assessment and neonatal experience that a single midwife has.  Imagine being surrounded by 18 EMT-Bs who think that your guy having an MI who is satting 100% on RA need a NRB.  Majority does not rule.
> 
> As sure as there are idiot paramedics out there, there are idiot midwives out there, but you have to give them the benefit of the doubt, especially when the emergency is over, and you're back to their specialty again.



This.

You better have dam good reason to dismiss the only expert in the room.

How many OB call does the average EMS provider treat, out of those how many immanent delivery, limb presentations  and overall complicated delivers do we see?

It all boils down to knowing what you don't know, I'm not going elbows deep because my ego wouldn't allow me to overlook to some hostility, she stays I'll assist because I'm not doing CPR on a mom an infant because I pissed through the clock arguing about whos the boss.


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## Aerin-Sol (Jun 21, 2011)

usalsfyre said:


> Why did I figure you were a rabid home birth person



You should learn to present your opinions without ad hominem attacks.


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## Sasha (Jun 21, 2011)

I wouldn't dismiss a midwife unless she was being grossly negligent or ignorant.. That's like telling a cardiologist "We'll take it from here, Doc." for a chest pain patient.

The midwife has a lot more experience and education in child birth and hopefully neonatal resus that I do, and it wont hurt my ego to admit that she is more specially trained than I am for the subject at hand.

That being said I think at home births are stupid. MANY pregnancies are uncomplicated with normal delivery but do you really want to chance your and your babie's LIFE on that? what if something goes wrong? Now you've got to sit around waiting for EMS to respond, which even in some metro areas can take a LONG time depending on their call volume that night.

Yes "women have been having babies in fields since the dawn of time" but just look at the infant and maternal mortality and morbidity rate for those field births! 

And besides: I've seen the delivery rooms at our hospitals, they are waaaaaay better than my tiny cramped little house and

Also: At the hospital/birthing center you don't have to clean up the ick left behind by birth.


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## Smash (Jun 21, 2011)

Aerin-Sol said:


> So do you think home birth should be criminalized?



What a bizarre thing to say! Puppy posted his/her opinion that he/she is not in favor of homebirths, and some quite understandable reasons why based on his/her experience and some published research.  It was done so in a very calm, rational manner that certainly doesn't warrant such a paranoid response.


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## Archymomma (Jun 21, 2011)

CAOX3 said:


> This.
> 
> You better have dam good reason to dismiss the only expert in the room.
> 
> ...



ITA. 

I know many home birthing families. I know many midwives. I would NEVER assume with my EMT training & Doula training that I know more about birth than the midwives I know. The midwives I know have gone through, not only class room training, but thousands of hours of assisting births before ever becoming a lead midwife. From talking to my friends who are OBGYNs, the midwives have attended and assisted on more vaginal births before going into practice than they have attended. (yes all this is just based on conversations I've had with people I know)

I am not against OBs or some hospital births, both of my children were c/sec babies, but I do believe (based on the people I know personally) that home birthing families are "generally" more informed and knowledgeable about birth and birthing processes than a lot of people that go to their OBs every scheduled appointment and assume everything their being told it the "only" and "right" way.


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## Farmer2DO (Jun 21, 2011)

abckidsmom said:


> Half a dozen paramedics combined don't have 20% of the newborn assessment and neonatal experience that a single midwife has.  Imagine being surrounded by 18 EMT-Bs who think that your guy having an MI who is satting 100% on RA need a NRB.  Majority does not rule.
> 
> As sure as there are idiot paramedics out there, there are idiot midwives out there, but you have to give them the benefit of the doubt, especially when the emergency is over, and you're back to their specialty again.



No.  Not the same thing.  Basic common sense in a medical provider says that a baby that needed to resuscitated at birth needs to go to the hospital.  This is a supposedly experienced medical provider (midwife) using scare tactics to push her WRONG opinion on the parents.  Your example is basic EMTs that are doing what they were taught to do, and that, in some areas is still considered the standard of care.  I will respect the midwife and her level of training/education, but she's going to respect mine too, or she'll leave.



Aidey said:


> I think what I would do would depend on the midwife.
> 
> We were called for a newborn not breathing and when we arrived the midwife was bagging the baby. I don't remember the exact APGAR, but the baby's color wasn't great, pulse was over 100 and he wasn't very active. Midwife told us he was agonal when born.
> 
> ...



^^^This^^^

I've had RNs removed from scenes by police before.  Several probably could clawed my eyes out without any qualms.  Luckily, in New York, in the field, an RN carries no more weight (legally) than a non-trained bystander.  

Don't get me wrong; I've used RNs a lot, too.  I have been grateful for their help.  But if you get in the way or make my job any harder, you will be leaving.


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## Farmer2DO (Jun 21, 2011)

Oh, and the people that keep bringing up physicians:  not the same thing.  A physician has a license to practice medicine.  If they choose to use that license in a manner that puts them at risk, that's their business.  We have protocols here that allow us to deal with on scene physicians.  Comparing a physician with a nurse, midwife, NP, PA or any other non-physician healthcare provider is comparing apples to oranges.


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## JPINFV (Jun 21, 2011)

Farmer2DO said:


> We have protocols here that allow us to deal with on scene physicians.  Comparing a physician with a nurse, midwife, NP, PA or any other non-physician healthcare provider is comparing apples to oranges.




I think that context matters. There's a difference between a random physician being on scene, the patient's physician being on scene, and your medical director being on scene, and hopefully the protocol differentiates between the three ("Hi, medical control? My medical director wants to provide medical direction on scene, can he do that?" just looks stupid). Similarly, there's a difference between a random RN, an RN assigned to the patient at a hospital or clinic, and an advanced practice nurse who is caring for the patient directly. The advanced practice nurse is essentially practicing medicine (I don't buy that this is just "advanced nursing") under supervision/collaboration (the difference is, what, again?) with a physician and, for all intents and purposes, is acting as the patient's physician. So the patient's advanced practice nurse is in a completely different position than an RN or some random nurse (advanced practice or regular RN) off the street.


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## CAOX3 (Jun 21, 2011)

Jp I agree.

Farmer:   Bad example we are not talking about some random rn on scene we are talking about a specialized provider.  I think every effort should be made to work together.

I think ego plays a major role here with some providers, you have to be willing to swallow your pride to ensure  thepatient receives the best care possible.

I don't have a problem with that.


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## Farmer2DO (Jun 21, 2011)

JPINFV said:


> Similarly, there's a difference between a random RN, an RN assigned to the patient at a hospital or clinic, and an advanced practice nurse who is caring for the patient directly. The advanced practice nurse is essentially practicing medicine (I don't buy that this is just "advanced nursing") under supervision/collaboration (the difference is, what, again?) with a physician and, for all intents and purposes, is acting as the patient's physician. So the patient's advanced practice nurse is in a completely different position than an RN or some random nurse (advanced practice or regular RN) off the street.



Nope, I have to disagree with you.

In New York State (and I understand different states may be different) the only one who can give orders to EMS is a physician, or if the supervising physician approves, a PA.  That's it.  I don't take orders from nurses, NPs, or midwives.  In the eyes of our state, a nurse has no legal authority in the area of EMS, unless you're talking inter-facility transfers, with a nurse acting under physician orders, which is a totally different ballgame.

No, the advanced practice nurse is not practicing medicine.  They are practicing nursing.  In many states, they can be independent practicioners, and require no physician oversight.  The APN is NOT acting as the patient's physician.  This is exactly the line of BS the nursing lobby wants us to believe: that they can do it all as well as a physician, but better, b/c they _care_ like a nurse.

Don't get me wrong, there is a very important place for mid-levels.  I was married to one, and she's an excellent patient care provider, and my parents see an NP at the PMD's office.  But, make no mistake; that NP collaberates with the PMD on their care.  What that means, is that the NP gets to spend more personal time with my parents.  Example:  detailed foot exam on my diabetic mother.

NPs and PAs are physician extenders, not physician replacements.





CAOX3 said:


> Jp I agree.
> 
> Farmer:   Bad example we are not talking about some random rn on scene we are talking about a specialized provider.  I think every effort should be made to work together.
> 
> ...



I'm all about the patient getting the best possible care, and if a provider wants to work as a team, then we'll have no problem getting along.  But, the example in the beginning was a midwife scaring parents into not having their freshly resuscitated newborn evaluated at a hospital.  So no, I wouldn't swallow my pride.  I would pull out all of the stops to see that that baby gets the attention it needs, up to and including getting medical control involved, and telling the parents that if they listen to this quack, they may just end up with a dead baby.  I really don't give a damn if I offend the midwife.

Working together goes both ways.  I'm not going to kiss a$$ while someone else acts superior because I'm just an ambulance driver, so that no one gets offended.


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## JPINFV (Jun 21, 2011)

Farmer2DO said:


> Nope, I have to disagree with you.
> 
> In New York State (and I understand different states may be different) the only one who can give orders to EMS is a physician, or if the supervising physician approves, a PA.  That's it.  I don't take orders from nurses, NPs, or midwives.  In the eyes of our state, a nurse has no legal authority in the area of EMS, unless you're talking inter-facility transfers, with a nurse acting under physician orders, which is a totally different ballgame.



There's a difference between taking orders from another provider (being a physician, nurse, or someone else) and working with another provider. I might not take orders from a nurse, but (and especially as an EMS provider) if a nurse at a facility or a home health nurse suggests something, I'm not going to just throw it out the window because, "Well, it's a nurse not a physician." Additionally, it is not my job to decide who the patient takes advice from, and ultimately, my job at any level, be it an EMT or a physician, is to act within the bounds of my patient's requests. Sure, I won't engage in inappropriate treatment because my patient wants it, but I certainly must, under the vast majority of conditions, refrain from engaging in treatments that my patient does not want, regardless of how appropriate said treatments are. So, sure, you can't take orders from the nurse, but if the patient is following the nurse's advice I'd be remissed to not have a private conversation with the nurse about the nurse's concerns in order to better treat our patient.  




> No, the advanced practice nurse is not practicing medicine.  They are practicing nursing.  In many states, they can be independent practicioners, and require no physician oversight.  The APN is NOT acting as the patient's physician.  This is exactly the line of BS the nursing lobby wants us to believe: that they can do it all as well as a physician, but better, b/c they _care_ like a nurse.


I never said that they can do it as well as a physician. I said that in reality what they are doing is not "nursing" under any concept of the word "nursing" except what the nursing lobby's definition in order to keep advanced practice nursing under the board of nursing instead of the board of medicine. 




> NPs and PAs are physician extenders, not physician replacements.


...and no one is making that argument. Should I provide links to threads about my issues with noctors? 






> I'm all about the patient getting the best possible care, and if a provider wants to work as a team, then we'll have no problem getting along.  But, the example in the beginning was a midwife scaring parents into not having their freshly resuscitated newborn evaluated at a hospital.  So no, I wouldn't swallow my pride.  I would pull out all of the stops to see that that baby gets the attention it needs, up to and including getting medical control involved, and telling the parents that if they listen to this quack, they may just end up with a dead baby.  I really don't give a damn if I offend the midwife.


...and what do you do when the patient tells you to get the heck out of her house? 



> Working together goes both ways.  I'm not going to kiss a$$ while someone else acts superior because I'm just an ambulance driver, so that no one gets offended.


Don't act like "just an ambulance driver." To steal a quote from Rogue Medic as reported by Ambulance Driver (Kelly Grayson), "_We spend half our time in EMS demanding respect, and the rest of the time proving that we are not worthy of it."_

[my head exploded writing introducing that quote]


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## LucidResq (Jun 21, 2011)

On the subject of how selfish it is for a woman to want to deliver at home or in a birthing center... 

I have seen long-term complications of c-sections and episiotomies and such. Although rare, they can be painful disfiguring and even life-threatening (accreta). Having your baby delivered by a surgeon in a hospital carries its own risks as does delivering out-of-hospital. 

Babies are not the only humans involved in the birth process. Although unfortunately it seems some would disagree with me... the mother is not just a child-delivery-shell and has a right to deliver in a situation she is comfortable in. We're not talking about women enjoying their delivery as in drinking tequila and laboring on a rollercoaster... we're talking about stuff like being able to get out of bed and deliver in a more advantageous and comfortable position than lithotomy, maybe even in some nice warm water. 

And as ABC mentioned, there are statistics that show both sides of this story so it's not so cut and dry, and the numbers definitely don't show an inordinate amount of risk. I would also never assume that the political side of this issue doesn't affect the research.


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## MagicTyler (Jun 21, 2011)

If the baby comes out safe and everything is OK, no matter wht you did, the midwife gets all of the credit. If the baby comes out apenic and dies, the paramedic is the one who winds up with the law suit. 


The parents have spent the last nine months geting to know and trust their midwife. They've devloped a plan on exactly how they wanted this to happen. As soon as the medics were called the mom and dad are upset that its not working the way they wanted. Odds are they are going to blame you for the birth not going right.


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## firetender (Jun 21, 2011)

*A piece of a bigger picture*

Here's an article for you all to consider, it's from the New Yorker and entitled "The Score; how childbirth went industrial."




> the degree to which birth has been transformed by medicine is astounding and, for some, alarming. Today, electronic fetal-heart-rate monitoring is used in more than ninety per cent of deliveries; intravenous fluids in more than eighty per cent; epidural or spinal anesthesia in three-quarters; medicines to speed up labor (the drug of choice is no longer ergot but Pitocin, a synthetic form of the natural hormone that drives contractions) in half. Thirty per cent of American deliveries are now by Cesarean section, and that proportion continues to rise. Something has happened to the field of obstetrics—and, perhaps irreversibly, to childbirth itself.


Read more http://www.newyorker.com/archive/2006/10/09/061009fa_fact#ixzz1PwqGlvrb​ 
Not much room for midwives is there?

We tend to have blinders on when it comes to understanding how little we know in modern medicine and how much of what was sound, time-tested intervention we're actually losing. The pattern is to de-bunk the past, which includes a whole lot of "art", and embrace technology. That happens to include limiting us to that which goes on in the Institiution, thereby taking the patient away from the home and power away from the common folk.

But who pays the price? That is a lot of the gig -- many people are forced to place themselves in financial jeopardy (at the least!), to be treated by cookie-cutter technology that often misses more than it catches.

But what I'd like you to hear in the article is how head, hands and heart in our most sensitive of life events has been summarily replaced with costly, and often de-humanizing, technology.

Midwives are artists that work with their hands. According to the article, Doctors, once carrying on that tradition, have abandoned it in favor of cookie-cutter procedures designed to limit liability. That does not necessarily protect anyone but the Doctor.


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## the_negro_puppy (Jun 21, 2011)

What about unplanned homebirths? I finding it amusing that people wait until contractions = 2 mins apart before calling an Ambulance. Zipped one lady to hospital in the wee hours of this AM, contractions were 45 seconds apart on arrival.:lol:

Homebirths have 7 times the mortality rate. Considering that all planned homebirths generally involve a healthy mother and foetus with no major complications, the fact that these neonates are 7 times more likely to die is disturbing.

Not just that but many normal births suddenly become complicated.

I am a he/male/man btw


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## JPINFV (Jun 21, 2011)

the_negro_puppy said:


> Homebirths have 7 times the mortality rate. Considering that all planned homebirths generally involve a healthy mother and foetus with no major complications, the fact that these neonates are 7 times more likely to die is disturbing.



Depends on the statistics. If it's 0.01 per 10,000 hospital births to 0.07 per 10,000 home births (note: pulling example numbers out of my butt, not actual statistics), then it's a 7 times greater chance, but ultimately it means very little.


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## Aidey (Jun 21, 2011)

Not to be sarcastic here, but I'm sure ANP midwives _never _use any of that stuff. 

I don't disagree that childbirth has become an industry and that a large amount of the interventions are not truly necessary. However, I disagree with the idea that hospitals are the root of all evil and need to be avoided at all costs, especially after a patient has needed resuscitation.


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## JPINFV (Jun 21, 2011)

I too agree that the hospital is not the root of all evil and (assuming properly equipped), is the best place for resuscitation. However not all health care needs to be delivered in a hospital, even if there is a risk of resuscitation being needed.


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## CAOX3 (Jun 21, 2011)

Farmer2DO said:


> I've had RNs removed from scenes by police before.  Several probably could clawed my eyes out without any qualms.  Luckily, in New York, in the field, an RN carries no more weight (legally) than a non-trained bystander.
> 
> Don't get me wrong; I've used RNs a lot, too.  I have been grateful for their help.  *But if you get in the way or make my job any harder, you will be leaving*.



This is what I was commenting on.

Make your job harder?  Yeah why would you allow true education and years of specialized experience get in you way. (most midwives here ARE CNMs)

See here is the problem, I know some fantastic educated and experienced  paramedics, part of that is understanding your limitations.  In not saying kiss anyones butt or bow down but she is an invited specialty health care provider and in most cases will be a valued member of the team if you have the forsight to recognise this.

Of course if there is blatant disregard for care then by all means remove her however I would guess this is more the exception then the rule.

Listen some EMS professionals are egomaniacal megalomaniacs they question everyone from the tow truck driver to the cardiothoracic surgeon its hilarious and disgusting.


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## LucidResq (Jun 21, 2011)

I'm looking over the research, but I'd like to point out that from what I'm seeing this high infant mortality rate idea everyone keeps citing is based on one study with 20-25 year old data from Australia exclusively:

Perinatal death associated with planned home birth in Australia: population based study

I'm still browsing for more current and global research.


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## abckidsmom (Jun 21, 2011)

firetender said:


> Here's an article for you all to consider, it's from the New Yorker and entitled "The Score; how childbirth went industrial."
> 
> 
> Read more http://www.newyorker.com/archive/2006/10/09/061009fa_fact#ixzz1PwqGlvrb​
> ...





the_negro_puppy said:


> What about unplanned homebirths? I finding it amusing that people wait until contractions = 2 mins apart before calling an Ambulance. Zipped one lady to hospital in the wee hours of this AM, contractions were 45 seconds apart on arrival.:lol:
> 
> Homebirths have 7 times the mortality rate. Considering that all planned homebirths generally involve a healthy mother and foetus with no major complications, the fact that these neonates are 7 times more likely to die is disturbing.
> 
> ...



I wanted to put these two posts together because they are really quite related.  Modern birth has lost some of the key mechanisms that increase interior pelvic diameter and introduces gravitational forces that fight the birth process.  Other biped mammals would NEVER give birth laying down, much less on their back.  

Modern birth frequently goes bad BECAUSE we do not use prehistoric, time tested techniques to assist women in labor.


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## LucidResq (Jun 21, 2011)

Here's one from 2000-2004 in Canada that shows physician-attended hospital births with a slightly higher (but likely statistically insignificant) infant mortality rate than planned home births AND midwife-attended hospital births. 

One from 2009 that has a sample size of over 1/2 a million women from the Netherlands showing no significant difference between hospital and home birth in regards to mortality/morbidity.

With more current research from many other parts of the world with larger sample sizes show opposing information to the one, old Australia study... I think it's hardly sound to state "infants born at home are 7 times as likely to die as those in the hospital". I do understand there are also modern studies from other countries that show a higher mortality/morbidity rate... But I guess the take-home point is statistics are just that - numbers created by people with their own motivations... and looking at the big picture of research and statistics is a weak point in EMS.


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## zmedic (Jun 21, 2011)

I had a bad experience with a mid-wife. She tried to deliver a breach at home, with no resuscitation equipment, and didn't call us until the baby was out and not breathing. Baby died. Responsible midwives have the gear to resuscitate, a plan to get the mother to the hospital when things START going badly, and the humility to recognize when the situation has gone beyond their level of training.


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## Aidey (Jun 21, 2011)

LucidResq said:


> Here's one from 2000-2004 in Canada that shows physician-attended hospital births with a slightly higher (but likely statistically insignificant) infant mortality rate than planned home births AND midwife-attended hospital births.
> 
> http://www.ncbi.nlm.nih.gov/pubmed/19624439



What sucks is that you can't tell from the abstract WHY the women chose the birthing method they did. It may be that the physician attended births were deemed more complicated ahead of time, hence why they were physician attended. 

Here is another study that indicates home births had triple the mortality rate, however it was a meta-analysis and includes no numbers, which makes it hard to assess the quality of the study.


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## LucidResq (Jun 21, 2011)

I'm not trying to get into a study-score-point-board competition - and as I said there ARE several legitimate studies that show higher mortality rates in home births. As you said, some of these patients may have been turned away or chosen NOT to see a midwife due to risks such as gestational diabetes, preeclampsia, etc. The only point I'm trying to make here is that it's a stretch to say home birth is definitely dangerous, or definitely NOT dangerous. 

IMHO the only thing these studies show is a need for more research. It's all very limited right now. 

However, I think completely condemning someone who wants to deliver at home or in a birthing center is taking very limited and aged data way too far. 

Personally, I hope to deliver my children at a birthing center. A strong candidate is one that employs several highly-educated CNMs (including a former coworker of mine who is a highly educated and experienced DNP, CNM and WHNP) and is half a block from a very good hospital. 

I agree, delivering 50 miles out in the sticks from a hospital is a bad idea. As is having a lay-midwife without a back-up plan or a provider not prepared to resuscitate. Don't knock every woman who doesn't want to deliver in a hospital or every midwife, though. 

Although anecdotal my former boss, an experienced OB-GYN, was very skeptical of midwife-assisted births. She spent a day at aforementioned birthing center and totally changed her mind, and said she would much rather deliver at a birthing center than hospital if she had a non-complicated pregnancy.


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## Farmer2DO (Jun 21, 2011)

CAOX3 said:


> This is what I was commenting on.
> 
> Make your job harder?  Yeah why would you allow true education and years of specialized experience get in you way. (most midwives here ARE CNMs)
> 
> ...



I'm an FTO and a preceptor for paramedic students and interns, as well as basic EMT new hires.  I regularly tell my fledglings that there is something to be learned from almost everyone you encounter.  Healthcare is truly multi-disciplinary; I'm all for taking someone else's experience and knowledge into account and using them.  What I'm not willing to do is be treated like a second class citizen, or to blindly let someone else give bad advice or provide bad care without somehow stepping in (even if it's only to offer my opinion).  This thread offers the example of a midwife trying to force a VERY BAD option on a family that might cause a bad outcome to a patient that is not able to offer their input.  Another thread talks about a nurse that didn't even come out from behind the bullet proof glass to evaluate the "psych" patient that had an unexplained altered mental status with significant tachycardia, also unexplained.  She was marginally helpful and only provided limited information when it was dragged out of her.  So yeah, these nurses don't get my respect.  I will try to provide care for the patients in whatever manner I can, which will start with being polite.  But when they actively work against the best interest of the patient, there's a problem.  

The vast majority of nurses (or pick your profession) are professional, competent and caring.  I work extremely well with almost all of them on a daily basis.  I often collaborate with them in regards to patients that will be or were under their care, and I often get compliments for the appropriateness of my care and handoffs.  We all encounter the ones that have no desire to work together though, and routinely make bad decisions.  That's what this thread was started about, and that's what I'm commenting about.


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## Journey (Jun 21, 2011)

Farmer2DO said:


> What I'm not willing to do is be treated like a second class citizen, or to blindly let someone else give bad advice or provide bad care without somehow stepping in (even if it's only to offer my opinion).



The midwife also should not have to abandon her patient to see that your needs are met. Her concern is with the patient and not whether you feel her attention to the patient makes you feel like a second class citizen. 

You mention a multidisciplinary approach but you fail to differentiate that different professions also acknowledge their own strengths and weaknesses. If the midwife called you, she may have realized that more help is needed but that does not mean you force her from the picture.  You also have your own opinion which may be based more on personal or religious beliefs rather than education. Even the posts on this forum give the young, inexperienced and under educated a skewed view of medicine with a mix of very good and  very bad advice or information given. It is not always easy for those who do not have much experience or education in many of these areas to sort out the bs from the good stuff. 



Farmer2DO said:


> This thread offers the example of a midwife* trying to force a VERY BAD option on a family *that might cause a bad outcome to a patient that is not able to offer their input.
> 
> 
> 
> ...


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## Sasha (Jun 22, 2011)

Journey!!  Welcome back!


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## Aidey (Jun 22, 2011)

JPINFV said:


> I too agree that the hospital is not the root of all evil and (assuming properly equipped), is the best place for resuscitation. However not all health care needs to be delivered in a hospital, even if there is a risk of resuscitation being needed.



I agree somewhat. There are a number of people walking around who are ticking time bombs just waiting to collapse in the bathroom of their 3rd floor walk up and we don't encourage them to be transported proactively. More realistically, how many high risk patients are sitting in nursing homes right now receiving care there? I really don't have a problem with that. 

However, a newborn has needed 5-7 minutes of supported ventilations falls into my category of patients that _*REALLY*_ should be transported. Especially when it was an uncomplicated delivery with no obvious reason for the distress. No cord around the neck, no prolonged time in the birth canal, no meconium etc. 

I can understand not transporting a newborn with known complications that will cause it to die shortly after birth. I have heard of at least one couple who knew ahead of time the baby would have anencephaly and chose a home delivery, thus allowing the baby to die at home.


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## Journey (Jun 22, 2011)

Aidey said:


> However, a newborn has needed 5-7 minutes of supported ventilations falls into my category of patients that _*REALLY*_ should be transported. Especially when it was an uncomplicated delivery with no obvious reason for the distress. No cord around the neck, no prolonged time in the birth canal, no meconium etc.



They may not always need to be transported or taken back to the NICU. That is why we do a 10 minute APGAR. If the baby is then not doing what he should be at 10 minutes, we take it back for observation.  If we haven't intubated the baby before that time for any obvious reason, chances are the mother will have him in her arms at the 11th minute.  

This is where those with a lot of experience delivering and assessing babies  should not be kicked to a curb by someone who may never have seen any birthing process and probably doesn't know how to assess a well baby to any great extent.   However, I doubt if any midwife is going to leave the birthing room at 11 minutes like a NICU team does once they are satisfied the baby is breathing and pink.  A midwife should be capable of doing a S.T.A.B.L.E. assessment just like a NICU team may initiate with someone else following through with it.   I think some of the posts here have failed at the "E" where you do not rush in telling everyone or acting like they are idiots and misinformed.  

Maybe if you had offered to do most of the components of S.T.A.B.L.E. (including "E") along with heart sounds and looked like you actually knew a little about babies, you might have made a stronger argument than just the emotional pleading based on you own personal beliefs rather than medicine. 

You may also not be aware of your own anxiety or as some prefer the term "adrenaline rush" at these scenes.   There have been times when turning over a patient to some IFT ambulance crews have been difficult due to the reactions and actions of the team.  I would imagine the RN in the psych thread probably had some of those thoughts.


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## abckidsmom (Jun 22, 2011)

Journey said:


> They may not always need to be transported or taken back to the NICU. That is why we do a 10 minute APGAR. If the baby is then not doing what he should be at 10 minutes, we take it back for observation.  If we haven't intubated the baby before that time for any obvious reason, chances are the mother will have him in her arms at the 11th minute.
> 
> This is where those with a lot of experience delivering and assessing babies  should not be kicked to a curb by someone who may never have seen any birthing process and probably doesn't know how to assess a well baby to any great extent.   However, I doubt if any midwife is going to leave the birthing room at 11 minutes like a NICU team does once they are satisfied the baby is breathing and pink.  A midwife should be capable of doing a S.T.A.B.L.E. assessment just like a NICU team may initiate with someone else following through with it.   I think some of the posts here have failed at the "E" where you do not rush in telling everyone or acting like they are idiots and misinformed.
> 
> ...



Smart words here.


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## johnrsemt (Jun 22, 2011)

Not trying to sound dumb;   but what does S.T.A.B.L.E. stand for?    Never heard of it.   may have heard of it with out the acronym

thank you


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## Journey (Jun 22, 2011)

johnrsemt said:


> Not trying to sound dumb;   but what does S.T.A.B.L.E. stand for?    Never heard of it.   may have heard of it with out the acronym
> 
> thank you



S = Sugar and Safe Care

T = Temperature

A =  Airway

B =  Blood Pressure

E =  Emotional support

http://www.stableprogram.org/

http://www.stableprogram.org/stable.php

It goes more indepth for assessment to what happens after birth than what is covered by NRP which is primarily resuscitation.

The Pre-transport Stabilization Self-Assessment Form  - has interesting information you can include in your report.
http://www.stableprogram.org/docs/pssat_form.pdf

There is also a cardiac module although it probably would not be necessary at a first reponder level.  However, it is interesting.


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## Aidey (Jun 22, 2011)

Journey said:


> They may not always need to be transported or taken back to the NICU. That is why we do a 10 minute APGAR. If the baby is then not doing what he should be at 10 minutes, we take it back for observation.  If we haven't intubated the baby before that time for any obvious reason, chances are the mother will have him in her arms at the 11th minute.
> 
> This is where those with a lot of experience delivering and assessing babies  should not be kicked to a curb by someone who may never have seen any birthing process and probably doesn't know how to assess a well baby to any great extent.   However, I doubt if any midwife is going to leave the birthing room at 11 minutes like a NICU team does once they are satisfied the baby is breathing and pink.  A midwife should be capable of doing a S.T.A.B.L.E. assessment just like a NICU team may initiate with someone else following through with it.   I think some of the posts here have failed at the "E" where you do not rush in telling everyone or acting like they are idiots and misinformed.
> 
> ...




In the interest of not hijacking this thread I gave the very simple rundown of the call. In the long run, I was hardly able to do ANY assessment once the baby was breathing adequately on his own becuase the midwife took him and gave him to the parents and then stood between us as she proceeded to rant about modern medicine. How if he was taken to the hospital they wouldn't let the parents take him home, and how the hospital would force the parents to leave him there with the threat of calling child services even if nothing was wrong with the baby. 

That their other children might be taken away and they would have to go to court to get them back. The word "patriarchy" was used. The entire time this is happening the parents have the baby and no assessment is being done by anyone. When ever we tried talking to the parents directly she interrupted and talked over us. 

It was a cluster and she was totally unprofessional and her opinions/comments seriously made me think she was more concerned about politics than the baby's health.


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## fortsmithman (Jun 22, 2011)

Aidey said:


> In the interest of not hijacking this thread I gave the very simple rundown of the call. In the long run, I was hardly able to do ANY assessment once the baby was breathing adequately on his own becuase the midwife took him and gave him to the parents and then stood between us as she proceeded to rant about modern medicine. How if he was taken to the hospital they wouldn't let the parents take him home, and how the hospital would force the parents to leave him there with the threat of calling child services even if nothing was wrong with the baby.
> 
> That their other children might be taken away and they would have to go to court to get them back. The word "patriarchy" was used. The entire time this is happening the parents have the baby and no assessment is being done by anyone. When ever we tried talking to the parents directly she interrupted and talked over us.
> 
> It was a cluster and she was totally unprofessional and her opinions/comments seriously made me think she was more concerned about politics than the baby's health.



That is not how the midwives in my town operate.  They always display a great deal of professionalism, and only do child births in the hospital here in town.  If the birth is expected to have complications then the expectant mom is flown out to our capital city where there are specialists to deal with it.   Our midwives would not have acted as the one you dealt with did.


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## Journey (Jun 22, 2011)

Aidey said:


> In the interest of not hijacking this thread I gave the very simple rundown of the call. In the long run, I was hardly able to do ANY assessment once the baby was breathing adequately on his own *becuase the midwife took him and gave him to the parents and then stood between us as she proceeded to rant about modern medicine. How if he was taken to the hospital they wouldn't let the parents take him home, and how the hospital would force the parents to leave him there with the threat of calling child services even if nothing was wrong with the baby.
> 
> That their other children might be taken away and they would have to go to court to get them back. The word "patriarchy" was used. *The entire time this is happening the parents have the baby and no assessment is being done by anyone. When ever we tried talking to the parents directly she interrupted and talked over us.
> 
> It was a cluster and she was totally unprofessional and her opinions/comments seriously made me think she was more concerned about politics than the baby's health.



As soon as we are satisfied the baby just needed a push to get started, usually right after the 10 minute mark, the baby can go to the mother. If the baby latches on to the breast, that takes care of a few assessment details or at least they can be deferred for a little while. 

Some of the concerns the midwife stated were not unfounded. There seems to be a religious or some cultural issues here where in another situation, I doubt if the midwife would have been so protective.  Hospitals do have attorneys, judges and CPS on speed dial for these situations. And yes, they can remove the child from the parents for various reasons. It will be the parents then who must prove they are innocent of all wrong because religion is a touchy subject and no one like to address it in a straight forward manner in the courts. Jehovah's Witnesses are definitely examples of what steps can be taken. Once blood is administerd to the baby the parents may voluntarily give up their rights and the baby is placed in the adoption process. The court of course would prefer a nice family with "normal" religious beliefs to take custody.


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