Seriously? Part 2

practicing medicine 2“A client has a pretty sever prolapsed cervix. Any advice?” (this is during a pregnancy, in the 2nd trimester)

Other midwives recommend kegels in a certain position or useless homeopathic remedies. Neither of these things have any evidence backing them as a treatment for a prolapsed cervix.

If I had access to the midwife I would say “Yeah, how about you google “cervical prolapse pregnancy” and look at the first result?”

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of second-degree cervical prolapse during pregnancy. Two women developed prolapse in the late second trimester while one women had preexisting prolapse. Both women with prolapse developing during mid-pregnancy were treated unsuccessfully with a vaginal pessary to maintain cervical placement. Premature labor occurred in both of these women, resulting in one preterm birth. Although cervical prolapse is rarely encountered in pregnancy, the threat of preterm labor and delivery warrants close observation.

Oh wow, sounds like something a lay midwife should never, ever try to manage on her own. Too bad none of the other clueless lay midwives recommended a consultation with a physician as a result. I’m sure they just say its a ‘variation of normal’. When I read this post I immediately thought of ‘incompetent cervix’, a problem where the cervix is unable to hold the weight of a baby and generally ends in either suturing the cervix to retain the pregnancy or a miscarriage or premature birth. The direct entry midwifery law in Utah spells out certain conditions that licensed midwives should never manage, but it is not a complete list. Unlicensed midwives are free to try to manage any condition if they feel up to it. The gap in legislation is evidenced well by these screenshots.

Next up is Utah midwives organization trying to manage a liver problem in a mom:

practicing medicine“Any ideas or experience with preventing the recurrence of cholestasis in a mom”

Cholestasis is a condition where flow of bile from the gallbladder to the liver is restricted. It causes symptoms similar to liver failure or cirrhosis(jaundice, fatigue, loss of appetite, dark urine, light stools, etc). A midwife cannot differentiate between cholestasis and other types of liver disease. They can’t even order the correct lab tests to tell the difference, much less interpret them.

One midwife suggests an essential oil blend called zendocrine. One says “exercize (sic) and a veggie diet”. The rest recommend a ‘liver cleanse’, which generally means a fast with specific allowed beverages or foods.

There is absolutely no scientific evidence that ‘cleanse’ diets do anything beneficial to non-pregnant men and women, much less women who are pregnant and have a history of a liver problem during pregnancy. These midwives don’t know what they are talking about. They spread around rumors and alt-med nonsense as genuine advice for managing conditions that midwives should never try to take on.  Here is what the american pregnancy association says about cholestasis:

How will the baby be affected if the mother is diagnosed with Cholestasis?

Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity.

When lay midwives were discussing their profession with Utah legislators they claimed that it was not the practice of medicine, but from what I can tell they absolutely intend to practice medicine. What is there to know about medicine that other midwives can’t fill you in on via facebook? Nothing, except for the 4 years of intensive study and practical experience that physicians go through before becoming physicians, of course! They have “other ways of knowing“, which basically means ‘trust your gut’ instead of established research. These women like to play doctor, but they are far from qualified. It was only in 2012 that they were burdened with having to obtain a high school diploma before attaining the title ‘midwife’.  Even the midwives college of utah was unable to tell that the (long awaited) release of MANA death statistics actually revealed a 5.5X increased rate of death instead of “evidence that home birth is safe”. How could they make such a massive mistake? Its because they aren’t actually trained in interpreting medical studies, so they are happy to accept the conclusions presented by other midwives instead of understanding the numbers involved. This pathetic excuse for a study is the best case scenario in home birth, and despite the fact that it shows an unacceptably high level of perinatal mortality, it is still better than what the actual numbers are likely to demonstrate. The study has a 30% participation rate, with no explanation of the percentage of participants lost during the course of the study. Midwives with poor outcomes were likely to simply drop out, as to avoid tarnishing lay midwifery in general. The navelgazing midwife pointed out that the description of statistics in the study (that midwives and their patients were enrolled at the beginning of prenatal care) is completely false.

The bottom line is this- roughly 1% of births are purposely performed out of hospital, but these births represent 100% of the profit for home birth midwives (overwhelmingly lay midwives). Would you trust the tobacco industry to tell you the truth about smoking? If not, why would you expect the midwifery lobby to tell you the truth about the danger of out of hospital birth? When midwives in Utah get together to try to influence policy they have to rely on deception to get their way. If the legislature knew about the way that midwives conduct themselves, and had real data about the outcomes of out of hospital birth attended by a non-nurse midwife, I am sure they would want drastic changes in legislation.

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7 thoughts on “Seriously? Part 2

  1. You make a lot of assumptions here. You have no idea whether these midwives researched these conditions first. Also, many professionals ask others for opinions or their experience, there is absolutely nothing wrong with that – it’s a good thing. Someone complaining about midwifery while trying to promote obstetrics as a shining example of evidence based medicine is laughable. We all know a large portion of OB practices are NOT based on evidence but on their own personal experience, which is exactly what these midwives are doing – sharing their own personal experience. While I agree that US midwives need a lot more training (think nurse-midwife level), this post is very hypocritical.

    • When real medical professionals ask their colleagues for assistance they do not do it on a public facebook page. They do not ask for help managing things that are outside the scope of practice. They do not give answers like “pilates” or “essential oils” or “homeopathic medicine” when asked for medical advice from other professionals. The other thing you are missing here is that midwives are not medical professionals when legislators are asking about their scope of practice, but when they recruit pregnant women for services they certainly pretend to be. This post has said nothing about OBs as a ‘shining example’ of anything, btw.

    • I didn’t realize that all midwife practices are based on the experience of thousands upon thousands of births, and are solely evidence based.

      Lemon and liver cleanses are not evidence based treatments for ICP.

  2. This is both appalling and not surprising. I had cholestasis in my first pregnancy, and since I have an extensive family history of it (grandmother, mother, and aunt), I have accepted that I’m most likely going to have it again.

    I have had people suggest that I do a liver cleanse or go vegan before I get pregnant again so I can possibly prevent it. To these people, I have said, “What if I do all of these things to prevent it, and I still get cholestasis? I’ll have wasted my time!” I don’t see any benefit for any normal, otherwise healthy person to do ever do a cleanse.

    Long before I came across your blog, I have been very wary of the OOH midwife situation in Utah, and you have only confirmed my fears. I think voluntary licensure is dangerous and I also think the CPM credential is a joke.

    Thank you for being brave enough to be the whistle blower here, though words cannot describe how sad I am for what you have gone through. I sincerely hope it won’t be for nothing.

  3. Your information about the cause of ICP is incorrect. There is no known cause. The restriction of bile into the liver is commonly caused by gallstones, but even women with no gallbladder can develop ICP. There may be a genetic link.

    ICP is a very serious condition with a high risk of sudden still birth. Women with this condition should only be followed by a maternal fetal medicine specialist, and definitely NOT a midwife. Especially since pre-term labor is very common with moms with ICP, and an induction at 37 weeks is the standard of care. Twice weekly BPP’s and thrice weekly NST’s are also recommended, in addition to lab tests keeping a close eye on bile acids. Ursodiol is also recommended.

    The only cure for ICP is delivery. Not liver clenses, or diet changes, etc. It’s amazing that they know something that hepatic specialists are puzzled by. Or maybe they don’t.

  4. Pingback: unlicensed midwives and their dangerous practices | Safer Midwifery in Utah

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