Homebirth midwife Charlotte Russell, CPM explains how and why homebirth midwives provide bad care.
Russell herself claims she does not follow many of these self-justifications for bad care, but she gives us great insight into what many homebirth midwives do.
The central motivating factor for homebirth midwives providing bad care? Protecting themselves from accountability. For homebirth midwives, it’s all about what’s good for homebirth midwives.
1. Russell is startlingly honest about homebirth transfers:
… Do you think that when you need to transport to a hospital for the safety of you and your baby, I’m going to be eager to call an ambulance and explain what is going on, then follow the ambulance to the hospital and talk to the physician who is on the receiving end of your care and share my name and charts and record of your prenatal care and labor with him so that you have continuity of care? No. I am going to try to find a way to keep you from the hospital. I may keep you home longer than I should and possibly, although I like to think not, longer than is safe. And when it becomes clear that you need to go (and probably needed to go an hour or two ago), I am going to worry about what may happen when we do go…
Instead of thinking about you and your care and your baby, I am going to be thinking about my own four babies, whose mother might be in jail when they wake up in the morning. When given the choice between going to jail for providing you a homebirth and being present to mother my kids, the children are a higher priority.
2. Practicing without a license (this does apply to Russell): some state midwifery boards such as Louisiana, can’t be counted on to dismiss the charges as the midwifery board of Texas will reliably do.
… In Texas, as a licensed midwife, there are rules in place for complaints against midwives to be reviewed by a committee comprised of two licensed midwives, a physician, and a member of the public. This means that consumers and physicians who have a valid complaint regarding their care have recourse. It also means that a midwife who has a complaint filed against her for anything but a valid reason can trust that the committee will treat her fairly with regard to that complaint.
In Louisiana, there is no such process. Out of five Louisiana licensed midwives I have known personally, two had their licensed suspended THE VERY WEEK a physician called with a complaint. Investigation of the complaint began after the suspension of the midwife’s license, which left clients without a midwife to attend them and left her without the ability to contribute to her family financially. In the third case I am aware of, a complaint was initiated and the midwife hired an attorney before her license was suspended. Although the midwife was technically able to continue practicing, she did not continue to practice in Louisiana and the investigation of the complaint took months.
3. Rejection of standards of practice and accountability:
… If you read the laws and rules carefully, a midwifery client is required to see an obstetrician twice in her pregnancy. This obstetrician is required to verify that the client is low risk and agree to be her back-up physician, meaning that this doctor will receive her transport should she need to transport to the hospital…
Russell sees a conundrum:
The fundamental problem I see with the way the laws and rules are written is that midwives are not trusted to determine risk and refer when something risky presents itself. Therefore if the fundamental problem is that midwives aren’t trusted, Louisiana midwives as a group must prove themselves trustworthy in order to have any hope of changing the laws and rules to allow us to be the primary care providers to pregnant women, as is the case in other states. Now, how can I say to the board and the legislature that midwives as a whole are trustworthy and will not “sneak” in high risk women, if I–or any other midwife, for that matter–am breaking the law and practicing in an illegal and “sneaky” way?
She’s right. It’s difficult to prove that you are trustworthy when you have no intention of keeping your word, following rules and transferring patients in a timely fashion.
The ultimate irony? They have a name for this approach to providing care. It’s called defensive medicine. The midwife’s medical decisions are based on what will protect her, not what is good for the patient.
So the same people who claim that hospitals are unsafe because doctors practice defensive medicine by doing everything possible to prevent bad outcomes for the patient and her baby, are cheerfully providing their own brand of defensive medicine, although in their case they are willing to allow bad outcomes for the patients and babies as long as it prevents bad outcomes for homebirth midwives themselves.
