why are Utah midwives learning breech births?

found this photo awhile back, but didn’t have time to write about it until now.

breechesThis is from the community school of midwifery.

Here is utah state code regarding breeches:

(2) Mandatory Consultation:

(a) incomplete miscarriage after 14.0 weeks gestation;

(b) failure to deliver by 42.0 weeks gestation;

(c) a fetus in the breech position after 36.0 weeks gestation;

 

Direct entry midwives should not be attending these births, ever. Oregon learned the hard way that direct entry midwives aren’t equipped to deal with breeches. They have recently changed their legislation to reflect the problems caused by direct entry midwives in out of hospital birth.

The owner of the community school of midwifery (Tara Tulley) believes that the legislation against doing breeches at home is a problem:

The problems I see with having a state with two levels of direct-entry midwives are that midwives are less united. When there is a proposed change to the rules or statute both licensed and unlicensed midwives are more willing to compromise. There is an out. We saw this a few years ago when we compromised to not let licensed midwives to any twins, breeches, or deliveries before 36 weeks. The licensed midwives felt like they were safer to compromise, and then decided it was a mistake. The unlicensed midwives stayed unlicensed because they could maintain their rights in those situations. So now we have a larger problem. There are very qualified midwives to are licensed, who know by many years of experience and education how to appropriately screen when these women present, how to monitor, and when to transfer out of care who are not able to attend them.

According to her, the problem isn’t the danger inherent in taking on high risk cases, its that midwives are less united. The problem isn’t that patients are getting false information about the safety of out of hospital birth for breeches and twins, its that a dangerous midwife might not feel comfortable calling another midwife for help (instead of EMS).

One thing that I agree with Tara Tulley about is that unlicensed midwives cannot access the drugs that licensed midwives can, but they are the only ones who can take these high risk cases legally. This situation makes zero sense. Of course she believes the answer is probably less accountability, while I think licensing should be absolutely mandatory, with harsh consequences for people who break the law.

Its no wonder she feels comfortable teaching breeches at her school. After all, Tara Tulley started practicing when midwifery was illegal in Utah, so she has no problem circumventing the law to serve her natural child birth ideology.

The bottom line is that these practices are dangerous. Tara Tulley knows that, but thinks she has a better solution than legislation:

Yes, there are some scary ways of practicing. But I know if I have a relationship of trust with someone I am both more willing to go to them for help, and to also accept and consider feedback. I believe I am a good midwife, but my seasoning was not innate! I had to learn out to communicate. I had to learn that scaring my clients with the interventions of hospitals was not helpful when they became necessary.

She calls this solution “responsible inclusion”, as if there is anything responsible about accepting people who practice outside their actually competency as a midwife. Having another midwife to call isn’t worth anything in countless dangerous situations.

Tara Tulley isn’t an anomaly, she mirrors the position of MANA, the professional organization for midwives in north america. They have declined to define a ‘low risk’ birth as well, feeling more comfortable to leave it up to individual midwives to decide.

She talks like these choices have no real outcome, that no one will grieve a child or mother or their functionality when mistakes are made by midwives with “scary” practices. Making a choice because you feel it is safe, rather than having objective information to demonstrate its safety, is extremely negligent and should not be encouraged in any profession.  She talks so much about how its wrong to make fun of midwives who are young or stupid and have ridiculous ideas about birth, so you can imagine how she would feel about actually trying to stop women like that from practicing. Instead of deriding dangerous practices, Tara Tulley expresses that she thinks that serially negligent midwives should be wooed into safer practices by having trusting relationships with older midwives:

 

Regardless of how another midwife practices, or what her training is, if she is unlicensed then she does have the right to practice, and the parents have the right to choose her. If it is legal, then ostracising her will not make it illegal for her to practice, and she may decide that asking for help is too risky. She may be angry, and may not know how to forge relationships in hospitals. Perhaps, part of the reason the obstetrician was angry when you came in with your responsible well-charted transport. Perhaps he had just taken the client of a newer midwife, who transported, but did not know how to communicate in a way that was effective. Perhaps she offended him because she didn’t know how to see things objectively, not react to emotions, and validate and support him in order to foster a working relationship.

 

If a midwife decides that asking for help when a patient needs it is too risky for the midwife, and doesn’t call because of that, she has extremely poor judgment and should not be a midwife. Safety should overcome pride without any hesitation.

She lists several scenarios where midwives, who are tasked with delivering a baby and ensuring the safety and health of the child and mother, lack basic skills needed to perform their job adequately. The obvious answer to that problem is to change the law so that there are serious penalties for being a threat to public health and safety by endangering the lives of women and infants. Its deplorable. Midwives have always resisted common sense laws to protect consumers because they don’t want to be held accountable for their behavior.

The hardest lesson I had to learn about natural child birth is this: midwives don’t care about you. They don’t. They sell their services on acting as though they care, but when they are talking among themselves, or dealing with a death caused by someone in their community, their true colors come out. They couldn’t care less. Death is natural so its okay to them. That is the only way I can explain the blase and self-centered attitude of the midwifery community when it comes to safety of mothers and infants.

 

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