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

[abckidsmom]

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.

 

[abckidsmom]

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.

 

[abckidsmom]

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.

 

[CAOX3]

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.

 

[Aerin-Sol]

Why did I figure you were a rabid home birth person

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

 

[Sasha]

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.

 

[Smash]

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.

 

[Archymomma]

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.

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.

 

[Farmer2DO]

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.

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.

^^^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.

 

[Farmer2DO]

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.

 

[JPINFV]

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.

 

[CAOX3]

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.

 

[Farmer2DO]

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.

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.

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.

 

[JPINFV]

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]

 

[LucidResq]

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.

 

[MagicTyler]

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.

 

[firetender]

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.

 

[the_negro_puppy]

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

 

[JPINFV]

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.

 

[Aidey]

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.