Re: OB: Home births

From: Anna Meenan, MD (annam@uic.edu)
Thu Nov 17 23:11:22 2005

I agree Jamie. In my younger days, I used to provide backup for a couple of direct-entry midwives, but ran into some patients who made some pretty unreasonable demands and weren't willing to accept the responsibility for their decisions. I eventually had to stop backing them up because some of the other guys who covered me weren't comfortable and because of the escalating malpractice situation. FP's have often been willing to provide backup and collaberate with midwives in the past, but I'm guessing that's happening less and less often these days. Laws in this country regarding midwives and homebirth are a hodge-podge and vary from state to state, sometimes depending on something as simple as whether the governor was born at home or in a hospital. 

--
               Anna Meenan, MD, FAAFP


At Thu, 17 Nov 2005, Jamie wrote:
>>
>I completely disapprove of the practice, but I understand how women come
>to such a point.  Birthing options are becoming increasingly limited in
>the U.S.  My state does not recognize homebirth as valid.  There are
>midwives, but there is no provision for licensing or monitoring-the
>midwives I know here were all educated in other states.  Because
>homebirth isn't recognized, it is difficult to get any prenatal or
>postnatal tests done (including newborn screening for metabolic
>disorders).  If a mother risks out pregnancy, she can seek care through
>a physician.  If she risks out during labor, she gets the on-call
>person.  When I had homebirths and wasn't able to obtain backup medical
>care, I knew those were my options.  My last 3 births were with a
>midwife in a neighboring state who has a backup relationship.  I was
>fortunate-the more so b/c I did have to change to physician care and a
>hospital birth at 36 weeks in my last pgcy (anemia).  There are several
>other states in which midwives can not be licensed, or in which they are
>not allowed to attend homebirths.  Birthing centers aren't available
>everywhere.  In the hospital, the constant worry about keeping insurance
>carriers happy and preventing litigation seriously limits choices.
>Listmembers have posted more than once recently that it is near
>impossible to practice EBM d/t the medmal issue.  What does the research
>show about continuous EFM? Does anyone dare not use it? It's next to
>impossible to give birth in a hospital without continuous EFM, which
>makes labor absolutely miserable for a lot of women.  Women who want
>intervention to be used only when clearly indicated are stuck out.  Birth
>plans are laughed at.  The natural birth camp points fingers at
>obstetrics, the OBs point fingers at midwives and Bradley moms.  It's
>the system that's broken.  This type thing is going to keep happening
>unless the system is fixed.  Just don't ask me how to fix it.
>
>--
>JFields, RN, BSN
>



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