In home breech VBAC anyone?

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nimbus said:

I can’t tell who’s dumber. The parents or the “midwife”.
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Unfortunate outcome.

The "midwife" is a quack but the parents are just as culpable.

This is what they wanted. A natural delivery.

They just forget the devastating mortality and morbidity that obstetrics caused on women and babies before it became "medicalized."

This is the kind of stuff you see on sub Saharan Africa due to lack of resources.

She charges a pretty high rate to boot. Medicaid only reimburses me $1500 for total OB care including delivery.
 
People today just confuse me. They hire a woman whose credentials include being present in a room where vaginal births occurred for a 2nd time after the first time the “midwife” told them to go get a c-section. And they pay her $4k!

So sure, the “midwife” is advertising services she is not qualified to do, and should be held accountable. But the parents should to. This wasn’t some couple that had no access, nor the money. They actively went against thought and reason, they even went against the advice of their charlatan, and a baby paid the price.
 
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:wtf:
 
If you read the article, it seems as though the “midwife” made it clear she is not a medical provider. It also seems she warned the family of the risks of a breech birth. As long as she made her credentials clear and got TRUE informed consent, how is the “midwife” at fault?

This was a terrible outcome. But every bad outcome doesn’t need to result in a payout and jail time. Sounds like this family was explained the risks and elected a home birth. Yes, the outcome could have been prevented, but the family has the right to choose whatever “foolish” (in my opinion, but I respect their right to choose) decision they want in terms of their medical care. How was this child abuse/neglect?

This case should be used to educate the public on the risks of home birth, but also doesn’t need to blame or cast shame on people who choose to pursue it.
 
MoMoGesiologist said:
If you read the article, it seems as though the “midwife” made it clear she is not a medical provider. It also seems she warned the family of the risks of a breech birth. As long as she made her credentials clear and got TRUE informed consent, how is the “midwife” at fault?

This was a terrible outcome. But every bad outcome doesn’t need to result in a payout and jail time. Sounds like this family was explained the risks and elected a home birth. Yes, the outcome could have been prevented, but the family has the right to choose whatever “foolish” (in my opinion, but I respect their right to choose) decision they want in terms of their medical care. How was this child abuse/neglect?
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In my opinion, a fee for service was provided, and that service by any stretch of the imagination (especially when talking about the different obstetric maneuvers she tried to perform) was "midwifery." Nebraska state law makes it clear that midwives need to be licensed, midwifery can't be practiced totally independently, and sure as sht can't be practiced at home. If that quack wants to collect 4 grand illegally, then she needs to deal with the consequences of what happens when things go bad.

This case should be used to educate the public on the risks of home birth, but also doesn’t need to blame or cast shame on people who choose to pursue it.
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They should be blamed and shamed, just like the parents who don't give their kids vaccines.
 
MoMoGesiologist said:
If you read the article, it seems as though the “midwife” made it clear she is not a medical provider. It also seems she warned the family of the risks of a breech birth. As long as she made her credentials clear and got TRUE informed consent, how is the “midwife” at fault?

This was a terrible outcome. But every bad outcome doesn’t need to result in a payout and jail time. Sounds like this family was explained the risks and elected a home birth. Yes, the outcome could have been prevented, but the family has the right to choose whatever “foolish” (in my opinion, but I respect their right to choose) decision they want in terms of their medical care. How was this child abuse/neglect?

This case should be used to educate the public on the risks of home birth, but also doesn’t need to blame or cast shame on people who choose to pursue it.
Click to expand...


Apparently she holds the view that childbirth is not a medical event. It was probably God’s will and nothing could be done.

“I believe that we were created to birth without invention and that women possess the God-given wisdom and intuition to birth their babies free from regulation,” Ms. Hock wrote on her website.“

“Please remember that everything found on this site is for educational and informational purposes only. Nothing contained in these pages should be considered legal or medical advice; birth is not a medical event.”
 
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This is like midlevels practicing medicine and calling it "advanced nursing". This was practicing midwifery without a license. She deserves to go to prison, together will all the other idiots providing home birth "services".
 
MoMoGesiologist said:
If you read the article, it seems as though the “midwife” made it clear she is not a medical provider. It also seems she warned the family of the risks of a breech birth. As long as she made her credentials clear and got TRUE informed consent, how is the “midwife” at fault?

This was a terrible outcome. But every bad outcome doesn’t need to result in a payout and jail time. Sounds like this family was explained the risks and elected a home birth. Yes, the outcome could have been prevented, but the family has the right to choose whatever “foolish” (in my opinion, but I respect their right to choose) decision they want in terms of their medical care. How was this child abuse/neglect?

This case should be used to educate the public on the risks of home birth, but also doesn’t need to blame or cast shame on people who choose to pursue it.
Click to expand...

Don't know if the rules for lay midwives, but for us...there is no such thing as being able to consent to substandard care. You are still screwed if you do something substandard. Even if the patient wants it after being throughly informed of the risks.
 
dr doze said:
Don't know if the rules for lay midwives, but for us...there is no such thing as being able to consent to substandard care. You are still screwed if you do something substandard. Even if the patient wants it after being throughly informed of the risks.
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I argue this is not always so clear cut. Patients can refuse treatment. A JW can refuse blood transfusion even if they die. That is substandard
 
The parents will likely be held accountable as well. We had a similar event in my intern year but it resulted in a uterine rupture and severely compromised baby. The parents had to give up custody temporarily (not sure to whom) and take parenting classes. Don’t know what the right thing to do for parents in these situations; there is. 99.9% chance that they were doing what they thought was best but were led astray by the lay midwife. I think people that preach a natural approach and forget that “childbirth without invention” carries some of the highest mortality and morbidity around of any human condition and safe home birth on a large scale in this country will never be safe until there is a reliable prehospital system that can get someone to a hospital and provide appropriate interim intervention to prevent needles injury and loss of life
 
eikenhein said:
I argue this is not always so clear cut. Patients can refuse treatment. A JW can refuse blood transfusion even if they die. That is substandard
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Acts of omission are often different than acts of commission. Doing something to a patient that you know is stupid just because the patient wants it is a different situation than the patient stupidly refusing good care that you specifically recommended.
 
eikenhein said:
I argue this is not always so clear cut. Patients can refuse treatment. A JW can refuse blood transfusion even if they die. That is substandard
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a competent patient making an informed decision to refuse treatment is always acceptable. The problem in this situation is withholding appropriate care from a minor (fetus) that cannot consent to it. It's similar reasoning to why JW patients cannot refuse their child to receive a blood transfusion.

Although as noted I think it's hard to argue that any consent for this would have been informed. It's like the super speed talking quiet volume mention at the end of a drug advertisement on TV about how this is not medical advice and you should talk to your doctor and there can be side effects and on and on and on.
 
MoMoGesiologist said:
The parents already lost their child. You really think they should go to jail? what would it accomplish?
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I think they need to understand they are complicit in this. They cannot stand back and point fingers at the fake midwife and think they do not have blood on their hands.
 
eikenhein said:
I think they need to understand they are complicit in this. They cannot stand back and point fingers at the fake midwife and think they do not have blood on their hands.
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I definitely agree with you. In fact I think they shoulder the majority of the blame. They were warned and actively sought out a home birth. Midwife just took advantage of a couple dum-dums and gave them what they wanted. Just not sure how sending them to jail helps anyone. It’s just punishing them more after they lost their child. Plus it’s our tax dollars giving them free room and board, right guys?!
 
MoMoGesiologist said:
I definitely agree with you. In fact I think they shoulder the majority of the blame. They were warned and actively sought out a home birth. Midwife just took advantage of a couple dum-dums and gave them what they wanted. Just not sure how sending them to jail helps anyone. It’s just punishing them more after they lost their child. Plus it’s our tax dollars giving them free room and board, right guys?!
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Maybe 5 years community service and the community service is speaking at high schools about the result of being brainwashed against science. Maybe they could encourage vaccination while they’re at it.
 
caligas said:
I doubt they were really “explained the risks” in a meaningful way. I mean, is there ANY chance of a healthy birth at home in this situation. “Explaining the risks” is nonsensical.
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Yeah I agree with this, there’s no reasonable real “provider” out there that would engage with a discussion of a home birth in this situation. It’s a hard no.

But, if you get some quack who says sure and glosses over or, at worst, doesn’t even mention the risks then patients can be fooled into a very high false sense of security. My human sensibilities hope that’s what happened here - no one wants to carry a baby for 9 months and then have such a situation happen. I’d wager the parents made the decision to deliver at home with minimal to false information which invalidates any consent as well as culpability. Patient autonomy is important but not at the expense of extreme risk, particularly during deliveries.
 
So here’s a question for all of you sort of in the same vein.....What (if anything) should happen to moms who drink or do drugs during their pregnancy that harms their baby?
I can’t tell you how Upsetting it was seeing these women deliver on the OB floor. We had many frequent fliers, women who birthed baby after baby born addicted to various drugs or damaged by alcohol.
 
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Man o War said:
So here’s a question for all of you sort of in the same vein.....What (if anything) should happen to moms who drink or do drugs during their pregnancy that harms their baby?
I can’t tell you how Upsetting it was seeing these women deliver on the OB floor. We had many frequent fliers, women who birthed baby after baby born addicted to various drugs or damaged by alcohol.
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Norplant
 
Man o War said:
No they prefer that men don’t have an opinion on the reproductive habits of female drug addicts.
To hell with these poor children I guess
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I think that was sarcasm, didn’t come through well.

How dare you to have an opinion on community health and well-beings as a man-doctor?! /s
 
caligas said:
I doubt they were really “explained the risks” in a meaningful way. I mean, is there ANY chance of a healthy birth at home in this situation. “Explaining the risks” is nonsensical.
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This lay "midwife" could have simply refused to go along with the home birth. By accepting payment, she's on the hook.
 
Man o War said:
So here’s a question for all of you sort of in the same vein.....What (if anything) should happen to moms who drink or do drugs during their pregnancy that harms their baby?
I can’t tell you how Upsetting it was seeing these women deliver on the OB floor. We had many frequent fliers, women who birthed baby after baby born addicted to various drugs or damaged by alcohol.
Click to expand...

Ill share an interesting recent story,

I'm called in the middle of the night for a stat c section. AA lady laying on the OR table surrounded by nurses, doctors, refusing care. Tocometer is on, baby is known breech, having late decels. The OB team can not consent her to put an IV in. She fights them away. She speaks creole. Interpreter is called, a discussion goes on for 20-30 minutes where she describes the team as "menacing" and trying to hurt her and her baby. Eventually she relents after about an hour and several requests by her to leave and come back a different day ( keep in mind this is an acute emergency and delivery is impending) . It was hard to stand by for that hour or so knowing that the baby is in danger and the crazy mom is just rambling on and on... So she goes to sleep, GETA obviously. Baby comes out fine somehow. During her hospitalization it comes out that she is a sex worker brought into the country illegally and forced to work for some crime network in the area - horrible. She see social work etc..

Less than 1 year later I meet this same patient. She is causing problems in the holding area prior to her thyroid surgery for goiter. Apparently she developed this after the baby was delivered and now needs surgery. She now has a conservator with her who signs consent and answers some questions. This time she takes an IV and is more cooperative having obviously had some success with her mental illness..

When I tell the surgeon about how I know her from before, from the terrible episode up in OB, she goes on to tell me that the baby had in fact died. The mother brought the baby into the ER multiple times with vague complaints of the baby "being sick" and then once brought the baby in dead - found to have had aspirated details unclear. I still cringe at how she possibly left our hospital in full custody of that poor baby, she was clearly NOT OK for home with the baby.
 
Hoya11 said:
Ill share an interesting recent story,

I'm called in the middle of the night for a stat c section. AA lady laying on the OR table surrounded by nurses, doctors, refusing care. Tocometer is on, baby is known breech, having late decels. The OB team can not consent her to put an IV in. She fights them away. She speaks creole. Interpreter is called, a discussion goes on for 20-30 minutes where she describes the team as "menacing" and trying to hurt her and her baby. Eventually she relents after about an hour and several requests by her to leave and come back a different day ( keep in mind this is an acute emergency and delivery is impending) . It was hard to stand by for that hour or so knowing that the baby is in danger and the crazy mom is just rambling on and on... So she goes to sleep, GETA obviously. Baby comes out fine somehow. During her hospitalization it comes out that she is a sex worker brought into the country illegally and forced to work for some crime network in the area - horrible. She see social work etc..

Less than 1 year later I meet this same patient. She is causing problems in the holding area prior to her thyroid surgery for goiter. Apparently she developed this after the baby was delivered and now needs surgery. She now has a conservator with her who signs consent and answers some questions. This time she takes an IV and is more cooperative having obviously had some success with her mental illness..

When I tell the surgeon about how I know her from before, from the terrible episode up in OB, she goes on to tell me that the baby had in fact died. The mother brought the baby into the ER multiple times with vague complaints of the baby "being sick" and then once brought the baby in dead - found to have had aspirated details unclear. I still cringe at how she possibly left our hospital in full custody of that poor baby, she was clearly NOT OK for home with the baby.
Click to expand...

Geez... a disruptive patient refusing care and risking baby... what a nightmare. Not only can u not force needed medical care on this person (what if she’s competent and sues for assault?), but what if she’s mentally sick and can’t consent so you should’ve forced her to get an IV and surgery or else family comes in later and sues for bad outcome.

God I hate the histrionics on OB
 
MoMoGesiologist said:
The parents already lost their child. You really think they should go to jail? what would it accomplish?
Click to expand...
Well, it’s negligent homicide in my eyes. They refused to listen to advice about their high risk and in the process killed their baby.
When parents abuse their kids and in the process they die do they go to jail?
 
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The poser midwife is guilty because she took payment and was in the patients home. No way any medical provider should have entered the parents home or participated in any way. Tell them to dial 911 if they want to do this at home.
 
Hoya11 said:
Ill share an interesting recent story,

I'm called in the middle of the night for a stat c section. AA lady laying on the OR table surrounded by nurses, doctors, refusing care. Tocometer is on, baby is known breech, having late decels. The OB team can not consent her to put an IV in. She fights them away. She speaks creole. Interpreter is called, a discussion goes on for 20-30 minutes where she describes the team as "menacing" and trying to hurt her and her baby. Eventually she relents after about an hour and several requests by her to leave and come back a different day ( keep in mind this is an acute emergency and delivery is impending) . It was hard to stand by for that hour or so knowing that the baby is in danger and the crazy mom is just rambling on and on... So she goes to sleep, GETA obviously. Baby comes out fine somehow. During her hospitalization it comes out that she is a sex worker brought into the country illegally and forced to work for some crime network in the area - horrible. She see social work etc..

Less than 1 year later I meet this same patient. She is causing problems in the holding area prior to her thyroid surgery for goiter. Apparently she developed this after the baby was delivered and now needs surgery. She now has a conservator with her who signs consent and answers some questions. This time she takes an IV and is more cooperative having obviously had some success with her mental illness..

When I tell the surgeon about how I know her from before, from the terrible episode up in OB, she goes on to tell me that the baby had in fact died. The mother brought the baby into the ER multiple times with vague complaints of the baby "being sick" and then once brought the baby in dead - found to have had aspirated details unclear. I still cringe at how she possibly left our hospital in full custody of that poor baby, she was clearly NOT OK for home with the baby.
Click to expand...

DCS in general is a system that protects the bio parents first. This is a horrible story and one of the top reasons I hated working on OB. We had a “free” clinic service and seeing some of these folks take kids home was truly disturbing.
 
Man o War said:
So here’s a question for all of you sort of in the same vein.....What (if anything) should happen to moms who drink or do drugs during their pregnancy that harms their baby?
I can’t tell you how Upsetting it was seeing these women deliver on the OB floor. We had many frequent fliers, women who birthed baby after baby born addicted to various drugs or damaged by alcohol.
Click to expand...
Mandatory sterilization. And maybe they need some sort of punishment as well.
 
Hoya11 said:
Ill share an interesting recent story,

I'm called in the middle of the night for a stat c section. AA lady laying on the OR table surrounded by nurses, doctors, refusing care. Tocometer is on, baby is known breech, having late decels. The OB team can not consent her to put an IV in. She fights them away. She speaks creole. Interpreter is called, a discussion goes on for 20-30 minutes where she describes the team as "menacing" and trying to hurt her and her baby. Eventually she relents after about an hour and several requests by her to leave and come back a different day ( keep in mind this is an acute emergency and delivery is impending) . It was hard to stand by for that hour or so knowing that the baby is in danger and the crazy mom is just rambling on and on... So she goes to sleep, GETA obviously. Baby comes out fine somehow. During her hospitalization it comes out that she is a sex worker brought into the country illegally and forced to work for some crime network in the area - horrible. She see social work etc..

Less than 1 year later I meet this same patient. She is causing problems in the holding area prior to her thyroid surgery for goiter. Apparently she developed this after the baby was delivered and now needs surgery. She now has a conservator with her who signs consent and answers some questions. This time she takes an IV and is more cooperative having obviously had some success with her mental illness..

When I tell the surgeon about how I know her from before, from the terrible episode up in OB, she goes on to tell me that the baby had in fact died. The mother brought the baby into the ER multiple times with vague complaints of the baby "being sick" and then once brought the baby in dead - found to have had aspirated details unclear. I still cringe at how she possibly left our hospital in full custody of that poor baby, she was clearly NOT OK for home with the baby.
Click to expand...
So given the fact that she’s a trafficked sex worker, does not speak the language, and most likely doesn’t look like the nursing and medical staff, can you see no reason why she doesn’t trust you people? It may not be necessarily because she is “mentally ill”.

Were the police notified at all? Or was this just dumped all on the poor social worker? How did some legal authority not jump in somehow in a known sex trafficking case if true?
 
chocomorsel said:
So given the fact that she’s a trafficked sex worker, does not speak the language, and most likely doesn’t look like the nursing and medical staff, can you see no reason why she doesn’t trust you people? It may not be necessarily because she is “mentally ill”.

Were the police notified at all? Or was this just dumped all on the poor social worker? How did some legal authority not jump in somehow in a known sex trafficking case if true?
Click to expand...

believe me she was mentally ill, certainly as a result of what happened to her, but definitely mentally ill
 
Man o War said:
DCS in general is a system that protects the bio parents first. This is a horrible story and one of the top reasons I hated working on OB. We had a “free” clinic service and seeing some of these folks take kids home was truly disturbing.
Click to expand...
In this situation the parent was a sex slave who was held against her will.
Shouldn’t the cops be notified here?
 
AdmiralChz said:
The lesson here is to interact with OB RNs as minimally as possible, especially if you’re a male.
Click to expand...
Not just OB nurse, but any pregnant patient.

I got trouble once I asked a patient how many weeks pregnancy when she came for a d/c. She burst into tears and filed a complaint about my insensitivity.
 
narcotics999 said:
Not just OB nurse, but any pregnant patient.

I got trouble once I asked a patient how many weeks pregnancy when she came for a d/c. She burst into tears and filed a complaint about my insensitivity.
Click to expand...

D&C or D&E?
I think it’s even worse when we had to put epidural on fetal demise patients, but I digress.
 
eikenhein said:
How is that insensitive. It is important information.
Click to expand...

At my old hospital all doctors, NPs, PAs, etc had to undergo obesity sensitivity training. They basically told us all that when we see an obese patient we are biased and therefore treat them differently. Apparently this was because obese patients were getting offended when we spoke with them about their obesity and how it was affecting their health. So we were basically told to tap dance around it to protect the patient's feelings.
 
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