ACOG has created a survey, now members only, asking OBs to tell them if they have had homebirth transfers and what their outcomes were. I wish I’d copied the exact wording, but it was something to the effect of, “We know that we have to take homebirth transfers, but it puts us in an unfortunate place of cleaning up the midwife’s mess and is including our being sued when the midwife should be the one being sued, not us. Please fill out this short survey so we can demonstrate how pervasive this problem is.”
The questions included gravidity, parity, how long the woman was in labor before the transfer, what she was transferred for (prolonged rupture of membranes, meconium staining, fetal heart tone problems, uterine rupture, etc.), how it was resolved by the OB and who the care provider was in the home (CNM, CPM, unlicensed midwife or no one but the family [UC]).
When us crazy natural birth folks got wind of this, we dashed to the website during its brief public moment and filled it out for our own births. As a midwife, I also filled it out for my July baby, a wonderful home-waterbirth. I know the HBAC women flocked there, too. While I wish we’d had longer to make an impact, I love that we did make one so graphically that they felt they had to block us out. We are some noisy women! Hurrah for us!
Some women in Facebook were summarizing the request as trying to show the negative outcomes of homebirths, but I believe the goal was slightly different.
Doctors and nurses have long felt midwives bring in “train wrecks” that they are then responsible for cleaning up. Using me as an example, when I transported the surprise breech baby and they had to do an emergency cesarean, in the woman’s records, it said it was a failed attempt at a breech delivery. They never let me give report, never asked me what happened; they didn’t care. They saw it as a completely negligent action of a Licensed Midwife. Of course, I saw it as asking for help with a situation that was out of my scope of practice and skill level. When I had the 11-pound HBAC that hemorrhaged and I transported her, I could see the doctor tsk tsking off to the side, feeling, “Here I go again with the mop soaking up the blood that midwife caused.”
I can see the doctors’ point of view on several levels. What has happened is some of the women who have transferred to the OB’s care have had negative outcomes and sued the doctor. That has to be incredibly frustrating for them. Where does the line between midwife negligence and doctor negligence lie? If a midwife transfers for thick meconium and the OB monitors the baby, doing a cesarean after a few hours, only when the baby showed signs he was having some distress… and the baby has Meconium Aspiration Syndrome (which we know now happens in utero more times than out)… and the parent decides to sue, who gets sued? Whose responsibility was the MAS? If you believe as I do that no one was responsible, that isn’t the point. A mother with a sick baby tends to want to blame someone; who gets it?
What I think happens is that doctors are sued much more because of the relationship aspects a midwife develops with her clients. It has long been known that women rarely sue their midwives. If anyone sues midwives, it is the State. But, for a homebirth family, the doctor is an unwilling scapegoat.
Is there anything a midwife can do to keep these types of lawsuits from happening? They really tarnish the homebirth community. Of course, if the doctor was negligent, that is one thing, but is a midwife big enough to say, “I don’t think anyone could have seen this happening,” or even “I’m sorry this happened; I did exactly what I knew to do and transported you as soon as I saw things were outside the realm of normal.” Is it a midwife’s responsibility to help her client-family see the truth of the situation?
I wish they would have put some of their examples up. I haven’t yet seen one of these lawsuits, one that straddles the responsibility of midwife and OB. I’d love to hear any so we can take it apart and see the dilemma the OBs speak of.
While we all are thrilled with our wonderful homebirths and so many of us got our voices heard on their site yesterday, it is important to remember they have a reason, a valid reason, for wanting to hear from their constituency. Perhaps a midwifery organization could do something similar, asking, “When you transfer a client to the hospital, what do you transfer for? How were you treated by the nurses? OBs? How was your client treated? What was the outcome? Did the nurse or OB say anything directly to you or your client regarding this being a complication of homebirth? How does your client feel about her complete transfer experience?”
I’m sure there are more questions that need to be asked. Let’s ask them. It isn’t only ACOG that can do surveys.