Archive for February, 2013

Three threads came together in my life about this topic:

First, I need to think through what are wrong reasons for choosing a home birth (for one of my midwifery assignments). So, is money a valid factor?

Second, I read a great explanation by David Stewart in the book The Five Standards of Safe Childbearing (“Appendix A”).

Third, financial considerations did play a part in my last birth.

Initially, I used to think, well, wow, of course finances shouldn’t be an issue at all when it comes to something as important as birth!

But . . .

My last birth was unattended (we did have some verbal/informational assistance at various points), and honestly, I didn’t want to pay $1000 to go to the birth house/dr that would be my only possible institutional-birth consideration–why would I want to pay when I don’t want any of their services? Nor did I want to pay $700 to a mw to come when I really didn’t want anything done. . . .

So, finances did have a factor in my decisions, and I was very relieved to read a great  explanation of this, as I mentioned in #2 (above). Stewart’s points gave me clarity, for myself and for serving clients. The whole discussion is found on pp. 412-414 of The 5 Standards book.

1. Finances are a legitimate concern in any area of health care.

2. It’s normal and even good to not want to pay for services or procedures that are unnecessary (at best) or even risk-increasing (at worst).

3. Financial concerns as a factor in choosing health care is responsible, as long as financial concerns don’t become the controlling issue over the concern for safety.

So, if you find yourself thinking about finances, it’s normal! Don’t feel guilty. Warning signs are if money becomes the controlling factor over safety.

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Short answer, not inherently, and you can try to get the same protection without limiting 1) the right to choose a non-licensed but legal practitioner and 2) without limiting the practitioners’ right to practice his/her trade/skill.

Does licensing protect us from incompetence? Does it assure us of minimum competence?

Since there is a big campaign going on to get legalized mandated licensing for all 50 States, one of the campaign tactics is to highlight stories such as “an unlicensed midwife did THIS” or “an unlicensed midwife did THAT.” As if licensed midwives don’t do such questionable, even dangerous things.

They do.

It’s just that, during the campaign for mandatory licensure, we want the public to believe that it doesn’t happen, so we keep those stories quiet. And we also don’t tell the stories of things licensed midwives do because they are licensed and want/need to keep their clients within their practice bounds, for example (like pushing for inductions . . . strangely just like doctors!).

Licensing is not the optimal system for protecting consumers. In fact, it ends up working against consumers. Because the licensing organization is now heavily invested in maintaining the profession, regardless of compromises and the costs to consumers, and those licensed face frequent choices about, for example, dealing with a variation of normal in a client and the mandated protocols they must practice under.

(Well, when a profession starts on the road to licensure, sure they believe they will not compromise. But the more heavily invested (time, money, reputation) they become in licensure itself, the more compromises shrink in size in comparison.)

Solares says that a system should establish “freedom of choice in health care as a constitutional right, and implements it through a regulatory system that is educational rather than restrictive” (p. 401, emphasis mine)

So, yes, there should be a system, but not patterned after the medical model’s.

Also, mandatory licensing, in practice, doesn’t really assure us of competency. Licensing gives a minimum of experience and knowledge. It then issues a paper that tells the person that the standard has been achieved. Just assuming best case scenarios where applicants did not lie or cheat (which has been done), you now have minimally trained person out practicing. Will the parents be informed that one person with a license has caught 20 babies, another with a license has caught 300 (in a high-risk foreign setting), and another, who has no license, has caught 2000  in her 30 years of practice . . . ? As a consumer, I would like to know these things, not just if he/she has a license.

Now the question of giving consumers recourse to protest, be compensated for wrongs that a practitioner does, be able to remove a dangerous practitioner, etc.

Solares says that if consumers choose a non-certified practitioner, they have taken responsibility for outcomes unless fraud or criminal assault occurs.

This seems fair. Fraud would give me legal recourse if my caregiver lied or misrepresented him/herself to me. One definition is as follows:

A false representation of a matter of fact—whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury.

So yes, there should be some type of legal recourse when not using a licensed or certified caregiver, and several recourse elements of the licensing method should be kept in place for those who choose to do that.

What I’m saying is, mandatory licensure isn’t the best answer for protecting consumers. In fact, it’s a terrible answer.

Coming up next: The 2 legal battles we really should be fighting.

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Midwifery will succeed only if we see that the attainment of freedom of choice is synonymous with our survival.

~Allen Star Solares

First, I want us all to back up a step and realize that this conversation is really not only about midwifery, nor is midwifery the first and only group facing these important issues (regulation of practice, practice of medicine laws, etc.)

Be aware: This issue concerns all non-allopathic forms of health care. Homeopathy, osteopathy, naturopathy, chiropractic, etc.

One system, that of allopathic medicine, has created almost a monopoly on the right to “practice medicine.”

The first response is to say, aha! so we also need to follow the same path allopathic medicine has taken in order for us to be free to practice, have validity, and professional acceptance.

But what we need to realize is that those who practice allopathic medicine are not free. For an infraction against protocols, rules, preferences, biases, peer strength, etc., the allopathic practitioners license can be revoked. (Like revocation for assisting or supporting home birth families and midwives.)

Those inside the system of mandatory licensing are not free to practice in a way other than what their oversight allows.

So, that is one fact about creating a monopoly of legalized-by-license midwifery (or any other alternative-care profession): if you do it the way the allopathic system has done it . . .  watch out. Those things we criticize about them will soon be true of us (. . . no matter your resolution or assurance right now).

The system of mandatory licensure is flawed. It should not be what we are striving and sacrificing to attain.

There is a much better goal for you to root for, sacrifice for and strive to attain for the good of all.

Midwifery will succeed only if we see that the attainment of freedom of choice is synonymous with our survival.

~Allen Star Solares

 But don’t we need licensing to protect women from harmful, unlicensed midwives? . . . stay tuned.

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OK, I’m sticking my hand into a hornets’ nest, I know.

I want to write a little series about licensing American midwives, which is a hotly debated topic right now. I also modestly hope this little series will change the world . . . 😀

I will say, up front, that most of these ideas come from a midwife named Allan Star Solares, chapter 34, “Midwifery Licensing: Pitfalls, Problems, and Alternatives to Licensing,” in the gem of a NAPSAC book Compulsory Hospitalization: Freedom of Choice in Childbirth?

I don’t know if Solares is still alive or if I can get the whole chapter reprinted for distribution, but I will look into it.

Just so I don’t automatically polarize people who are pro-licensing, I will say, after reading Solares, I think voluntary licensing is a great idea. That means that all midwives, licensed or not, are equally free under the law to practice and they can simply choose to be licensed or not.

The theme of my series is a sentence from Solares’ conclusion:

Midwifery will succeed only if we see that the attainment of freedom of choice is synonymous with our survival. ~Allen Star Solares

Stay tuned; there’s lots to come!

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I think I’m winding down on this series, but who knows?

I’d like to mention perineal massage, specifically during pushing stage, done with the intent to help mom not have a vaginal tear.

In the States, this means that the midwife or OB applies downward pressure of some form on the lower edge of the vagina. On the edge of the inside of the vagina downward.

Here, I’ve seen the opposite thing done to protect the perineum. Instead of downward pressure, the midwife (not totally accurate translation) will place her hand/fingers in a “U” and use her fingertips to cup the perineum/lower edge of vagina upwards. Not exactly at moment baby is emerging, but slightly before and around crowning.

This is just yet another interesting detail of difference 🙂

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The Dark Side

There is/was a lot of bullying and cruelty during birth in post-Communist countries.

I have friends here, my age, from another city, and in their birth house, one form of bullying was throwing water in the woman’s face (yes, during labor). This was done, for example, if she stared pushing before they saw the baby’s head at the introitus.

Denise Thompson, a deceased American midwife, a friend and mentor to me, came here and sometimes worked in a birth house here and she observed many cruel things. She wrote a brief article about it in Midwifery Today magazine, Autumn 2009, Number 91, p. 39 “What I Have Seen.”

I do not know the young woman strapped to the table. .. She cries out in pain. The nurse throws water in her face. … The doctor then climbs onto the delivery table and straddles the woman’s chest. He begins pushing on her fundus with all his might. The nurses are yelling at the girl. … [The baby is born.] … The nurses whisk the baby away…. The woman is screaming in agony. I can’t see what the doctor is doing, but he is standing between her legs now. He has large instruments in his hand. [And she is stitched with no anesthetic.]

[Another birth, after the baby has been born.] The doctors and nurses take over and bring in what look like long shoe horns and barbecue tongs. They take the “shoe horns” and insert them into the woman’s vagina. Stretching her open, they grab her cervix with the tongs and pull it out of her body to inspect it. Although the woman is heavily drugged she is screaming and flailing…. Then they take the “shoe horns” and scrape out her uterus thoroughly. …

I found more information in Barbara Harper‘s book, Gentle Birth Choices. In this section she is talking about waterbirth around the world, and she comes to Russia. They visited birth houses in Russia, Ukraine, and Georgia. Here is what she says:

They displayed the most terrifying conditions for childbirth that I had ever witnessed. Almost all women were drugged or unconscious, and physical brutality was common, with women being beaten or struck while in labor. p. 166

She goes on to mention the forced separation of mothers/babies for several days, and that husbands were not even allowed in the birth house the entire duration of the mother’s stay.

. . .

I don’t know what to say now.

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blaming God for our sins

Otherwise entitled: One more perspective on the “Why does a good God let bad things happen?” question.

Bad things happen, things that cause us deep personal pain, or just becoming more aware of the amount of daily suffering going on around the globe.

And we struggle with why. Because the Bible tells us God is all-powerful, and that He is all-good.

Sometimes asking why is pretty innocent; it’s  a natural question, not really asked in doubt even, and we ask in the trust that one day God will show to us the “why” of His whole plan.

But some “why?” asking is angry and accusatory. And I want to insert a little perspective that came to me, I think as I was reading the Book of Psalms.

Angry, accusing “why” is often us accusing God for our own sins. We’re looking for someone to blame, and rather than look at the suffering of the world and own the guilt of our sins and its consequences, it’s natural to find a reason to point our fingers at God. Surely He is guilty for this mess. He’s all powerful; He lets the innocent suffer.

It’s more comfortable than owning the wretched woe that we ourselves have brought down upon this now-groaning planet.

Instead of being the angry why-ers, it’s more true to thank God, even in the face of what seems to be deep and senseless pain, to thank God that He is not, even now, letting us have the full consequences of our sins. He is, even now, being merciful. We cannot imagine how much worse the pain and suffering we would bring upon ourselves would be if the all-powerful, all-good God had abandoned us.

Instead, He controls, He doesn’t sin in response to our sins, and He redeems every evil. He buys it back and makes it something good.

Righteousness and justice are the foundation of your throne. Unfailing love and truth walk before you as attendants. Happy are those who hear the joyful call to worship, for they will walk in the light of your presence, Lord. They rejoice all day long in your wonderful reputation. They exult in your righteousness. Psalm 89:14-16  

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