Peer review is a process that exists in many disciplines, usually ones with high stakes decision making like medicine or science. The purpose of peer review is to verify the truth, and sometimes to recommend a disciplinary action (if the peer review arose out of an incident that ended poorly). Peer review can be very scary for those who are going through it, since the idea is to be critical of a person’s actions or ideas. No matter how scary peer review is for the person being reviewed, it is absolutely essential to everyone else that it be done. Drugs cannot be put on the market because the researcher’s feelings might be hurt if someone points out a flaw in their study of its safety. Doctors cannot be allowed to keep practicing in a negligent manner because the peer review board thinks doctors should stick together. Everyone recognizes that patients and the public in general are the reason for peer review.
…everyone except direct entry midwives of course.
I found the utah midwive’s association’s peer review protocols, and they are an absolute joke. You aren’t allowed to question why a midwife performed a certain action. You will be asked to leave if you ask why someone chose the course of action that they did- this means even if someone died or was disabled because of the action, other midwives aren’t allowed to be critical of it. You are only allowed to ask if they considered a different course of action. You aren’t allowed to hurt another midwife’s feelings, that seems to be the main concern throughout the document. They do peer review for “educational” reasons, although I don’t know how much education can be gleaned from a discussion where critical thought (which generally involves asking hard questions) is not allowed.
Interestingly enough, you also aren’t allowed to be honest about your case if it involved anything illegal. Here is what the practice guidelines say:
Please do not present cases in which there has been or may have been illegal conduct, such as an unlicensed midwife administering medications or a licensed midwife acting outside her scope (delivering twins, for example). We want the review to be a safe place where we can learn from each other. Announcing that you have engaged in illegal or questionably legal activities as a midwife puts you and each participant in an emotionally, ethically and legally perilous situation. Just don’t do it!
How are the midwives who are doing illegal things supposed to learn about the dangers of it if they aren’t allowed to discuss it in peer review? The utah midwive’s organizaton has lobbied to make it so that unlicensed midwives can take on any client they feel comfortable with, regardless of the risk level involved, and now they refuse to even let these women learn the error of their ways through a peer review instead of by personally maiming or killing someone. Its deplorable. It is worth noting that the majority of midwives in utah do not decide to become licensed, likely so they can practice outside the state’s guidelines. The Midwive’s College of Utah and Community School of Midwifery both teach skills for homebirths that fall outside the license midwife’s standard of practice (such as twins and breech births at home). These practices are encouraged in the name of “trusting birth”, and bragging rights of course. I’m sure its wonderful to be the breech expert in town like Melody Pendleton claims to be.
You can contrast their joke of a peer review process with an actual hospital peer review protocol.
When the findings of the assessment process are relevant to an individual’s performance, the medical
staff is responsible for determining their use in peer review and/or the periodic evaluations of a
licensed independent practitioner’s competence, or in connection with any corrective action, in
accordance with the procedures and standards set forth in the Medical Staff Bylaws, Credentialing
Procedures Manual and Corrective Action and Fair Hearing Plan.
Peer review is the review of the clinical activities of members of the Medical Staff by other qualified
practitioners with comparable training and experience who can render an unbiased opinion on the quality of
Peer review is supposed to be about improving the care provided. Advising participants to lie about their activities or to avoid hurting anyone’s feelings is just another piece of evidence that direct entry midwives aren’t professionals, they just pretend to be to deceive more Utah families into hiring them.
If your baby dies or is injured in a home birth, if your midwife fails to show up or lies to you about the safety of your pregnancy, if your midwife does ANYTHING she isn’t supposed to, these are the people you are supposed to be able to turn to. But they will do nothing to help you, they turn their backs on anyone who does not aid them in the goal of hiding the deaths and injuries caused by home birth midwives in our state.