Interesting and sad story

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http://healthland.time.com/2012/05/0...ions-in-idaho/

I read this story and just Smh. Just more reason why I am hoping someone can fix this system of no supervision for mid level providers like midwives and nps.....

Originally Posted by Makati2008

http://healthland.time.com/2012/05/0...ions-in-idaho/

I read this story and just Smh. Just more reason why I am hoping someone can fix this system of no supervision for mid level providers like midwives and nps.....

I am thinking they are not nurses? Maybe I missed something? They are not regulated by a board of medicine or a board of nursing.

Originally Posted by prairiedog

I am thinking they are not nurses? Maybe I missed something? They are not regulated by a board of medicine or a board of nursing.

Midwives are under BON. Here is the Indiana midwife info:
http://www.in.gov/pla/2504.htm

Your first link is about "midwives" and your second link refers to "nurse midwives" - not midwives in general. CNMs (certified nurse midwives) and midwives are not the same thing. This article appears to be about midwives not nurse midwives... there's a big difference between the two. Nowhere in the article does it refer to them as nurses, CNMs, having any kind of degree/medical training, etc.

Yup, all you have to do is google the name of the clinic "The Baby Place" and you can look up the midwives there. Shocker, none of them are nurses. They are "licensed midwives" or "certified professional midwives". Nice try bashing CNMs, though.

Originally Posted by Makati2008

http://healthland.time.com/2012/05/0...ions-in-idaho/

I read this story and just Smh. Just more reason why I am hoping someone can fix this system of no supervision for mid level providers like midwives and nps.....

Yet another anecdotal, shoot-from-the-hip attempt at bashing mid-levels, particularly nurse midlevels. And once again, borne out of pure ignorance. Anyone off the street with very little training (weeks or months) can be a CPM. A nurse midwife has 6+ years of training.

Originally Posted by Makati2008

Midwives are under BON. Here is the Indiana midwife info:
http://www.in.gov/pla/2504.htm

Nurse midwives are under the BON, not the off-the-street kind. And your link is to Indiana's BON - the story you posted was from Idaho. Keep trying.

Originally Posted by sarjasy

Nurse midwives are under the BON, not the off-the-street kind. And your link is to Indiana's BON - the story you posted was from Idaho. Keep trying.

lol, nice catch, somehow I missed that.

Originally Posted by AnnoyedByFreud

lol, nice catch, somehow I missed that.

Same debate any midlevel needs to be supervised(and I am a midlevel). To me someone doing obstetrics unsupervised (or any form of medicine) that is a non physician is a midlevel/extender and I will admit I posted the wrong state I read the story initially pretty late and this am when I saw the post I thought it was the correct state sorryyy.

Originally Posted by AnnoyedByFreud

lol, nice catch, somehow I missed that.

Originally Posted by sarjasy

Nurse midwives are under the BON, not the off-the-street kind. And your link is to Indiana's BON - the story you posted was from Idaho. Keep trying.

Lol touché. Still waiting for you to go to med school(you say the cost is too much but if I remember correctly your from Arkansas which will pay for your schooling if you work somewhere rural like you want. Or maybe this has changed....or maybe you want to take the easy way out. I know this is off topic but wanted to say it to you when I had the chance.

Sorry if typos on phone typing

Yes, it is a sad story. I had all of my children outside of a hospital with direct entry midwives, and they were all awesome. I don't recall every hearing any hint of hostility regarding their relationships with local CNMs, physicians or hospitals. It is so disappointing that these providers let their personal bias get in the way of their priorities. It is always a shame when that happens, but even more so in this case.

Originally Posted by Makati2008

Same debate any midlevel needs to be supervised(and I am a midlevel). To me someone doing obstetrics unsupervised (or any form of medicine) that is a non physician is a midlevel/extender and I will admit I posted the wrong state I read the story initially pretty late and this am when I saw the post I thought it was the correct state sorryyy.

The point is that they're not nurses. One can become a certified midwife in a matter of weeks/months and they typically have no medical training whatsoever. You can't lump both midwives with CNMs under the label of "non physician midlevel". I mean you can, but it's intellectually dishonest. Most CNMs I know won't do home births because of the liability.

Yes, that's true. I have a close friend who is a CNM and she and her collaborating physician (family practice) used to attend home deliveries, but their malpractice insurance carrier forbade it a few years ago and they had to stop. Now they refer the families that want home births to one of the direct entry midwives in the area.

Originally Posted by Makati2008

To me someone doing obstetrics unsupervised (or any form of medicine) that is a non physician is a midlevel/extender

Wrong. One, a mid-level, by definition, is "midway" between basic licensed personnel (e.g. RN) and a physician. CPM's are not licensed personnel, have no formal training, and no medical training and therefore rank well below even basic licensed personnel and certainly well below a mid-level.

Two, an "extender" by definition extends the work of the physician, under direct supervision of said physician. CPM's are extending the work of no one.

You are offering a very tortured definition of "mid-level."

Originally Posted by Makati2008

Lol touché. Still waiting for you to go to med school(you say the cost is too much but if I remember correctly your from Arkansas which will pay for your schooling if you work somewhere rural like you want. Or maybe this has changed....or maybe you want to take the easy way out. I know this is off topic but wanted to say it to you when I had the chance.

I have no idea why you are so fixated on me and medical school or where you got the idea I live in Arkansas. And yes, it is off topic, as it has been the several other times you have randomly brought it up.

Originally Posted by sarjasy

I have no idea why you are so fixated on me and medical school or where you got the idea I live in Arkansas. And yes, it is off topic, as it has been the several other times you have randomly brought it up.

Not really fixated moreso challenging you because you act like know all the answers here on the boards and if I remember correctly you brag about your 90ish percentile score on nursing material and I would wonder how you would do on the material at the level of a Physician/Medical student.

Also you have said it here on the board unless you moved away since then? I think you said you were in NWA on a previous post. You say you want to do primary care why not learn it at its full scope instead of a watered down version.

And after a two second glance on the post history-

Originally Posted by sarjasy

I'm in Arkansas, and prefer to stay somewhere in the Northwest Arkansas/Eastern OK/Southern Missouri area. NWA has grown rapidly in the last 10 years, but not sure what the market for OD's is like. NSU is the closest school, about 1.5 hours away. That'd be one of my choices, along with SCO.

I didn't think I was going crazy lol. Anyway at least enlighten me about why you don't want to go to med. school. Just a simple question that doesn't require that attitude you have.

Lots of people don't want to go to med school, including me. What a strange question.

And CPMs do have professional training, I don't recall exactly but I think it takes 3 or 4 years. I don't think they need a college degree though. They have to attend x number of births as an assistant, x number as the primary midwife, do x number of gyn exams, etc etc. I used to know someone years ago who was a "granny midwife." Actually her grandmother was a midwife and she grew up attending births with her and then took over the family business, lol. After she had been in practice for about 30 years the state passed a law outlawing lay midwifery, so she went to nursing school and became a CNM. She was a student nurse when I was. I remember the OB saying how intimidated by her he was because she had attended three times the number of deliveries that he had, and how silly it was to make her jump through all these hoops. I do know she accepted payment in whatever manner people could pay, bartering, crafts, food, services, etc. Someone gave her a cow once. She was about 50 years old 20 years ago, but I just googled her and she is still in practice in the same area. What a gift her services have been to that community! Anyway, end anecdote.

Originally Posted by ChillyRN

Lots of people don't want to go to med school, including me. What a strange question.

And CPMs do have professional training, I don't recall exactly but I think it takes 3 or 4 years. I don't think they need a college degree though. They have to attend x number of births as an assistant, x number as the primary midwife, do x number of gyn exams, etc etc. I used to know someone years ago who was a "granny midwife." Actually her grandmother was a midwife and she grew up attending births with her and then took over the family business, lol. After she had been in practice for about 30 years the state passed a law outlawing lay midwifery, so she went to nursing school and became a CNM. She was a student nurse when I was. I remember the OB saying how intimidated by her he was because she had attended three times the number of deliveries that he had, and how silly it was to make her jump through all these hoops. I do know she accepted payment in whatever manner people could pay, bartering, crafts, food, services, etc. Someone gave her a cow once. She was about 50 years old 20 years ago, but I just googled her and she is still in practice in the same area. What a gift her services have been to that community! Anyway, end anecdote.

Chilly since that question was not for you please disregard.

Originally Posted by AnnoyedByFreud

Yup, all you have to do is google the name of the clinic "The Baby Place" and you can look up the midwives there. Shocker, none of them are nurses. They are "licensed midwives" or "certified professional midwives". Nice try bashing CNMs, though.

I didn't even need to google it. When you see home births, testimonials after eighth or ninth births...it's a dead giveaway that they are midwives, not certified nurse midwives. A midwife in my state got into trouble over some bad births. I'm not sure what ended up happening to her.

Originally Posted by Makati2008

Same debate any midlevel needs to be supervised(and I am a midlevel). To me someone doing obstetrics unsupervised (or any form of medicine) that is a non physician is a midlevel/extender and I will admit I posted the wrong state I read the story initially pretty late and this am when I saw the post I thought it was the correct state sorryyy.

Go back to studying to be a doctor, MS-1.

Originally Posted by fab4fan

Go back to studying to be a doctor, MS-1.

Lol. Actually 72hrs away from MS3 just haven't changed it lol. And you continue to be the great nurse you are

Hope your well fab!

Originally Posted by Makati2008

Not really fixated moreso challenging you because you act like know all the answers here on the boards and if I remember correctly you brag about your 90ish percentile score on nursing material...

No, you are fixated because you are trying to lead to some point based on the assumption I was bragging. If you review the post and read it carefully, I was not bragging at all.

Originally Posted by Makati2008

...and I would wonder how you would do on the material at the level of a Physician/Medical student.

Guess we'll never know, huh?

Originally Posted by Makati2008

Also you have said it here on the board unless you moved away since then? I think you said you were in NWA on a previous post.

That is near where I was then. So what? What is the relevance to this thread, or the three or so other threads in which you have mentioned it?

Originally Posted by Makati2008

You say you want to do primary care why not learn it at its full scope instead of a watered down version...Anyway at least enlighten me about why you don't want to go to med. school. Just a simple question that doesn't require that attitude you have.

Explained thoroughly in previously threads.

Lol not fixated wanted to see what you had to say but oh well. Either way we are not getting anywhere adios and gl

Dude... you're a student..

Originally Posted by ChillyRN

Yes, that's true. I have a close friend who is a CNM and she and her collaborating physician (family practice) used to attend home deliveries, but their malpractice insurance carrier forbade it a few years ago and they had to stop. Now they refer the families that want home births to one of the direct entry midwives in the area.

I am a board certified EM doc. I am male, not married, and have no kids.

If this isn't as clear an indication of the risky nature, then nothing is.

Unattended birth has a reported death rate of 1/5 babies and 1/5 women. Home birth is a step up, because there is someone nominally trained in some manner - however, what about when the person assisting the delivery doesn't know what they don't know? Even 100 years ago, death during childbirth was not uncommon - just 100 years ago, WH Taft was president, Woodrow Wilson was governor of New Jersey, and Teddy Roosevelt was still kicking around. FD Roosevelt hadn't been stricken yet with polio (would be in 1921). "Our Town", written in 1937, speaks of it (although the scene to which is referred is based in 1913).

Childbirth is beautiful and natural and perfect - except when it isn't. When a child is born without breath or activity, or is stuck getting out, or there's a nuchal cord, that's why the obstetricians and other doctors are there. But, then again, that's why I'm there in the ED - most of my job could be done by a tech with a guidebook; hell, it could be done by a machine - except for the 5% that a nuanced, trained, experienced human brain needs to process, that doesn't fit a protocol or a program.

The actuaries in the malpractice industry ran the numbers, and it's a loser; remember "lies, damn lies, and statistics". Nobody thinks that their childbirth is going to be "that one", and everyone expects everything to be perfect, because "it's the 21st century!" However, no one leaves the house in the morning on their respective ways to work expecting to be in an accident on the way, to fall onto the subway tracks, to slip and fall walking into the building, to be assaulted by a coworker or client, or to have crushing chest pain while sitting at their desk. Likewise, for people to go to a lesser provider (and I say that intentionally) because the doctor and CNM were sagely and soberly advised to stop attending home births, it is akin to moving to another state without a helmet law because the first state has instituted one for motorcycle riders. Or, if the last licensed electrician leaves town, a homeowner contracts the guy who once touched a live wire when trying to steal copper. Hey, he knows electricity, right? (<-- sarcastic/hyperbolic example)

Time is brain, and, if the kid comes to me after being anoxic for 10 minutes, there's not a lot I can do. I can't uncook the egg.

Originally Posted by Apollyon

I am a board certified EM doc. I am male, not married, and have no kids.

If this isn't as clear an indication of the risky nature, then nothing is.

Unattended birth has a reported death rate of 1/5 babies and 1/5 women. Home birth is a step up, because there is someone nominally trained in some manner - however, what about when the person assisting the delivery doesn't know what they don't know? Even 100 years ago, death during childbirth was not uncommon - just 100 years ago, WH Taft was president, Woodrow Wilson was governor of New Jersey, and Teddy Roosevelt was still kicking around. FD Roosevelt hadn't been stricken yet with polio (would be in 1921). "Our Town", written in 1937, speaks of it (although the scene to which is referred is based in 1913).

Childbirth is beautiful and natural and perfect - except when it isn't. When a child is born without breath or activity, or is stuck getting out, or there's a nuchal cord, that's why the obstetricians and other doctors are there. But, then again, that's why I'm there in the ED - most of my job could be done by a tech with a guidebook; hell, it could be done by a machine - except for the 5% that a nuanced, trained, experienced human brain needs to process, that doesn't fit a protocol or a program.

The actuaries in the malpractice industry ran the numbers, and it's a loser; remember "lies, damn lies, and statistics". Nobody thinks that their childbirth is going to be "that one", and everyone expects everything to be perfect, because "it's the 21st century!" However, no one leaves the house in the morning on their respective ways to work expecting to be in an accident on the way, to fall onto the subway tracks, to slip and fall walking into the building, to be assaulted by a coworker or client, or to have crushing chest pain while sitting at their desk. Likewise, for people to go to a lesser provider (and I say that intentionally) because the doctor and CNM were sagely and soberly advised to stop attending home births, it is akin to moving to another state without a helmet law because the first state has instituted one for motorcycle riders. Or, if the last licensed electrician leaves town, a homeowner contracts the guy who once touched a live wire when trying to steal copper. Hey, he knows electricity, right? (<-- sarcastic/hyperbolic example)

Time is brain, and, if the kid comes to me after being anoxic for 10 minutes, there's not a lot I can do. I can't uncook the egg.

Good post and I'd like to mention that since you're not married and have no kids now would be a great time for a vasectomy

Let me stir the pot here. I think I've delivered 5 kids..over an intact perineum, but the best was an adult lady who had a choking sensation most of her life. In a shamanic session she started choking so I took her back, had her assist with her own delivery (cord was around her neck) and delivered her "properly." She went and asked her mother about her delivery and sure enough....

And I didn't even have malpractice insurance

Originally Posted by Makati2008

Same debate any midlevel needs to be supervised(and I am a midlevel). To me someone doing obstetrics unsupervised (or any form of medicine) that is a non physician is a midlevel/extender and I will admit I posted the wrong state I read the story initially pretty late and this am when I saw the post I thought it was the correct state sorryyy.

You have some serious issues my friend, after they pointed out the completely misled direction you were going, you still flip it anyways trying to troll them into NP/midlevel argument?

Originally Posted by FCMike11

You have some serious issues my friend, after they pointed out the completely misled direction you were going, you still flip it anyways trying to troll them into NP/midlevel argument?

If you say soooo sir. If you don't like what I say, you are very free to ignore it because I can and will definitely do the same with you(unless you keep making direct remarks at me).

Adios.

Originally Posted by Makati2008

If you say soooo sir. If you don't like what I say, you are very free to ignore it because I can and will definitely do the same with you(unless you keep making direct remarks at me).

Adios.

You have got a couple of self esteem issues. How about we give you a cookie for getting into medical school, will that settle it?

No self esteem issues at all but I won't stoop to your level . Not worth the effort currently

Originally Posted by Makati2008

No self esteem issues at all but I won't stoop to your level . Not worth the effort currently

Originally Posted by zenman

She went and asked her mother about her delivery and sure enough....

25% of births have at least one turn of the cord around the neck.

Originally Posted by Makati2008

Lol. Actually 72hrs away from MS3 just haven't changed it lol. And you continue to be the great nurse you are

Hope your well fab!

Thanks; I didn't know you knew about my status. I found out I am in remission as of the beginning of the month. Unfortunately, due to some complications from the neuropathy, I'm going to need two minor surgeries. They'll be OP procedures, but I just felt like "Dang! Can't you let me just enjoy hearing I was in remission? Oh well, no one ever said cancer was fair.

Life is in no way ever fair. But you have always been nice and I wish you well. I am glad that you are in remission.Keep staying positive. "If you are going through hell, keep going." -Winston Churchill

Oh gosh Fab, I am so sorry. Cancer sucks. Prayers for your recovery.

Originally Posted by fab4fan

Thanks; I didn't know you knew about my status. I found out I am in remission as of the beginning of the month. Unfortunately, due to some complications from the neuropathy, I'm going to need two minor surgeries. They'll be OP procedures, but I just felt like "Dang! Can't you let me just enjoy hearing I was in remission? Oh well, no one ever said cancer was fair.

That sucks but the silver lining is remission. Take care of yourself and stay strong.

One foot in front of the other. (Unless one of those feet is in my mouth.)

Originally Posted by Makati2008

That sucks but the silver lining is remission. Take care of yourself and stay strong.

Best regards fab. Glad to hear the outlook appears positive.

Originally Posted by Makati2008

Lol. Actually 72hrs away from MS3 just haven't changed it lol. And you continue to be the great nurse you are

Hope your well fab!

Woah an MS-3? Watch out guys we are dealing with a badass over here. How many hospital hours have you logged with patients? Oh wait...

I get your claim regarding mid-levels, but at least get your research and definitions straight before you post. Comparing CNMs to the midwives in the article is a joke. Any CNM with sense knows not to take potentially complicated births and always try to locate near a hospital (with a clear route) in case of a delivery gone wrong.

Troll harder

Originally Posted by Dranger

Woah an MS-3? Watch out guys we are dealing with a badass over here. How many hospital hours have you logged with patients? Oh wait...

I get your claim regarding mid-levels, but at least get your research and definitions straight before you post. Comparing CNMs to the midwives in the article is a joke. Any CNM with sense knows not to take potentially complicated births and always try to locate near a hospital (with a clear route) in case of a delivery gone wrong.

Troll harder

Originally Posted by Dranger

Woah an MS-3? Watch out guys we are dealing with a badass over here. How many hospital hours have you logged with patients? Oh wait...

I get your claim regarding mid-levels, but at least get your research and definitions straight before you post. Comparing CNMs to the midwives in the article is a joke. Any CNM with sense knows not to take potentially complicated births and always try to locate near a hospital (with a clear route) in case of a delivery gone wrong.

Troll harder

Obviously you couldn't figure that was to Ms. Fab and was a joke as well as a chance to see how she was. But obviously you don't know my background(Urban and Rural EM/FM PA for quite a while before I went back and I have logged thousands there can you say the same?)

If not get back to me when you work in the hospital for a few years.

Now go play in traffic

Originally Posted by Makati2008

Obviously you couldn't figure that was to Ms. Fab and was a joke as well as a chance to see how she was. But obviously you don't know my background(Urban and Rural EM/FM PA for quite a while before I went back and I have logged thousands there can you say the same?)

If not get back to me when you work in the hospital for a few years.

Now go play in traffic

Thousands? Confidentially over a thousand, but perhaps not as much as you.. I fully take back my assumption about you as a fresh know-it-all med student who has solely been in academia.

However, I still find it disturbing that you as a medical provider taking peanut shots at mid-levels by posting anecdotal articles regarding non-nursing midwives who's credentials are dubious at best. I expect that sort of egregious stuff from 22 y/o MS-Is on a power trip and not a seasoned provider.

Keep it up and you might as well join me in traffic

Originally Posted by Dranger

Thousands? Confidentially over a thousand, but perhaps not as much as you.. I fully take back my assumption about you as a fresh know-it-all med student who has solely been in academia.

However, I still find it disturbing that you as a medical provider taking peanut shots at mid-levels by posting anecdotal articles regarding non-nursing midwives who's credentials are dubious at best. I expect that sort of egregious stuff from 22 y/o MS-Is on a power trip and not a seasoned provider.

Keep it up and you might as well join me in traffic

Lol I feel like playing in traffic daily bro/sis believe me lol. Good luck in your endeavors. The majority of the time I pick for a good debate or to see the shock value. Good thing about the internetis that I can do it discretely/Anon(somewhat).

Originally Posted by Makati2008

Lol I feel like playing in traffic daily bro/sis believe me lol. Good luck in your endeavors. The majority of the time I pick for a good debate or to see the shock value. Good thing about the internetis that I can do it discretely/Anon(somewhat).

Oh you must be from Reddit? Haha. Without shock statements or debates the interwebs would be rather boring anyways. Good luck to you as well, I honestly hope to be in your position as a MS-3 sooner rather than later.