So much can happen in a year...

Okay, the title of the post is a little misleading. It implies that I intent to weave the story of a year gone by, a complex tapestry of change, growth, and regression...

But, that is not the topic of THIS post. Oddly enough, what motivated me to write again after a year has to do with an article I read this morning in the New York Times about an iconic midwife and her teachings.  Because this may be a bit of a rant on my part, I will keep it short, but the need to express is overwhelming.   The article discussed her management specifically on breech deliveries, and I have no disagreement with how she describes delivering a breech vaginally. What I took offense to was the statement that very few practitioners in this country know how to deliver a breech vaginally, and the implication that the medical establishment to which I belong, for better or for worse, just didn't even try. I have done several vaginal breech deliveries in my career, all successful (praise God), and I feel the same sense of satisfaction that this woman does when I can safely deliver a baby with the least amount of birth trauma to the mother.  I know the maneuvers, rescue techniques, and medications that may help should the need arise.  And yet I feel constantly vilified by the midwifery community because I do not seek out the opportunity to use them regularly. At this point, I want to also state that I have had the honor and pleasure of working with midwives both in the United States and New Zealand, and a combined licensed, standardized medical and midwifery system is my ideal practice scenario.  But because of the MD behind my name, it is sometimes assumed that I don't want "what's best for my patients" (there are at least two remember), that I am interested in my schedule, my comfort, my well-being, that I don't want to do things naturally. And that assumption offends me.  Not once do I hear the midwifery community giving credit to the majority of medical practitioners who do their jobs everyday with the same consideration and care they would give their mothers or sisters, or BFFs.  Not once do I hear from them a call for tort reform in the United States or recognition that part of the reason that we practice defensively is because of the high rate of malpractice cases levied against obstetricians. When something goes wrong, it is not the midwife who is sued.  It is not the midwife who pays tens of thousands of dollars a year or more to have coverage against legal action. It is not the midwife who has to pay a malpractice tail, a dollar amount (in my case over $75,000 with no judgements against me) that covers lawsuits that may arise after you leave, just to move to a new place and start a new job.  The price of freedom for an indentured servant...Even more expensive than the financial cost is the emotional cost. I know that when an outcome is bad, a midwife feels that pain just as much as I do, as if that was my child injured or lost, as if it was my sister whose life is forever affected. The midwife can't sleep, can't take joy in their own lives until that pain heals.  But, how often do they pay the emotional price of a lawsuit?  Being accused of negligence and malpractice, with the implication of wanton disregard for other's well being?  A process that is drawn out over several years, with each reminder like a punch in the gut until it is dismissed, settled, or goes to trial?  A process that affects confidence, your daily practice, whether you want it to or not.  Because midwives are not often sued (and don't say it's because they don't have bad outcomes, because they do just the same as medical practitioners), they have a freedom of practice that medical practitioners may never have.

So I said I would keep this short, and although I have not, let me at least make the point I am really driving at.  NOBODY likes it when the other side thinks their way is the only way. Please afford me the respect that I afford you. Please consider that your assumptions about my practice and my philosophies may not be what you think, as I do the same for you. Please be open to WORKING TOGETHER, as we each have something to bring to the table, and driving a wedge between our systems through propaganda and popularity contests is NOT IN THE BEST INTEREST OF THE PATIENTS!  And if we can't do this in this country, well, I am moving back to New Zealand...

Namaste...