Midwifery On The Internet and Rallies on the Ground


The International Day of the Midwife has come and gone – with a special focus on celebrating this day virtually – and there’s a lot to round-up as the push to improve women’s access to midwifery and to license and support those midwives who offer this access continues!

With that in mind, I thought I’d round-up some of what’s happening around the country and on our computers related to midwifery.

Online Midwifing, Sorta

The International Day of the Midwife Virtual Conference was a smashing success! Gina Crosley-Corcoran quotes Sarah Stewart (organizer of the conference, and a midwife and social media consultant herself) in an article on the 24 hr. virtual conference:

“Within a few minutes it became obvious that the conference was going to be a great success, especially compared to last year’s conference – last year we had an average of 6 participants per session – this year we had an average of 50 participants per session. So what made the difference to the success of this event this year?”

Sarah’s blog is an amazing resource, by the way, for anyone seeking information on the organizing power of social media. And the fact that a screen capture featuring my face is up on her site in this post about facilitating an event using social media tools is not at all why I’m linking to this.

For a full range of the online discussions and events that occurred in honor of the day, check out this incredible listing for information about midwifery, first-hand accounts of out-of-hospital birthing, an update on women’s health in Haiti, a discussion of the “art of midwifery”, an exploration into maternal and newborn health globally and more.

“The Mother of All Rallies”

In Ohio, midwives and midwifery advocates, as part of the group Ohio Families for Safe Birth, are rallying at their state capitol today to lobby for a law that would license CPMs (certified professional midwives) in the state. As readers of RH Reality Check no doubt know by this time, The Big Push for Midwives is a national, grassroots lobbying effort to pass laws state-by-state licensing and regulating CPMs, thereby making the option much more accessible and ultimately more affordable to all women. If CPMs are covered as licensed practitioners, they are then eligible to be covered by Medicaid, and to partner with physicians in local hospitals for easier transfer should that be necessary (though finding midwife-friendly OB/GYNs who are working at hospitals is another issue I’ll take up later on in this post!).

Ohio is one of 24 states which does not currently license CPMs. Still, over 1000 babies are born at home each year, in Ohio, with the help of a midwife. More and more women with healthy pregnancies are searching for a less invasive, less clinical, more empowering birth experience – the kind of birth they’re likely to get in an out-of-hospital setting, with a midwife in attendance. Ohio joins many states at this point in the push to license and regulate CPMs, as studies are released which consistently show the safety and benefits to women and newborns of midwife-attended birth.

As a reproductive justice issue, it’s critical that we break down the barriers to safe, evidence-based, empowering options for women who wish to choose with whom they want to birth and where and who do not want to be automatically exposed to a range of medical interventions without cause.

Dr. Biter Gets Bitten?

With the recent closure of the midwife-friendly hospital St. Vincent’s in New York City, and the decision, in California, to inexplicably (or without good cause) bar midwives from a local hospital, it’s hard not to wonder whether hospital administrators and some of the physicians who work at these hospitals aren’t feeling the fear of the rising tide of midwifery? Now it’s not only midwives who are in the bulls-eye but midwife-friendly Ob-Gyns who practice with a woman-centered, less-is-more approach to birth for healthy women.

Dr. Robert Biter, a “beloved” Ob-Gyn practicing at Scripps Memorial Hospital in Encinitas, CA lost his hospital privileges last week with no explanation at the time of this writing. Dr. Biter is legally unable to comment on the issue. But according to birth blogs around the web, as well as the local television news, Dr. Biter is “dedicated to allowing birth to happen naturally” and is currently offering to attend his patients’ births as an unpaid doula (wow, just wow). One local childbirth educator speculates that,

“I think it’s a smear campaign by Scripps to get rid of Dr. Biter because he doesn’t make enough money for Scripps because he doesn’t do enough C-sections and he doesn’t do enough interventions. And I think it makes a lot of other doctors uncomfortable…”

Natural and home birth advocate and actress Ricki Lake will join others for a rally on Friday to protest the suspension of his privileges.

As always, if you’ve got stories related to midwifery, natural birth, home birth or other similar issues, please email me: amie AT rhrealitycheck DOT org.

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  • melgarvey

    I hadn’t heard about Dr. Biter. That’s horrible.

  • julie-watkins

    I hope Ohio can get a law that would license CPMs; I think that should be every state. I have been getting very angry at all the treating-pregnant-women-as-public-property reports about Doctors doing things for their convience and the hospital administration mandating things for insurance reasons and not caring about long term effects of unnecessary cesarians and unnecessary drug use to hurry on a labor that isn’t going “fast enough” for the accountants bottom line. Phooey.

  • amie-newman

    may or may not be common but I think the more those of us online and using new media tools get the word out, the less these sorts of things can be “swept under the rug.” So, I hope bloggers are writing about this, spreading the word and keeping tabs on what’s happening!

    As for Ohio, Julie, I hope it happens and that the other 23 states which do not license CPMs, thereby seriously hampering women’s childbirth options, follow suit. But, as you write, it’s about more than just access to midwives. It’s about addressing some of the extremely serious issues surrounding hospital birth, the increase in unnecessary cesarean sections, and other medical interventions putting womens’ and newborns’ lives and health in danger.

  • ruminator
    omg, how can you even think that you have enough information to post comments like this??! Peer review is a serious committee where busy physicians volunteer their time and energy for one purpose: to insure patient safety. This is not a political committee or a financial committee. Trust me, the only thing these physicians got out of this decision was to lay their heads down at night knowing they made a decision that would protect patients and possibly save a life. If it has gotten to this point then Dr Biter has missed or ignored multiple opportunities and warnings to remedy complaints about him regarding patient safety. This committe only asks that any physician or midwife adhere to the medical, ethical and moral codes that any community deserves and those set by hospital bylaws and organizations such as the American College of OB/Gyn. Be confident that to get to this point, lives have been put at risk and standards of care not met. This whole “natural birth and midwifery” offense is a smoke screen. Scripps decision has nothing to do with the sound philosophy, art and science of birthing babies as naturally as we can, but more likely with patient safety issues that have less to do about epidurals and more to do about outcomes of this doctor. Please keep your facts straight and if you don’t know the facts, be careful what you defend.
  • amie-newman

    These protests have occurred precisely because of this lack of transparency. If, as you say, we should just “be confident” that Dr. Biter has “missed or ignored multiple opportunties and warnings to remedy complaints about him regarding patient safety” then:

    a) Why wouldn’t the hospital say so? They have thus far released nothing (to my knowledge) in the way of an explanation. Surely, if Dr. Biter was such a threat to patient safety the hospital would release a statement which clarifies the reasons for suspending his ob privileges?

    b) Why in the world we anyone just “be confident” that “…to get to this point, lives have been put at risk and standards of care not met” if Dr. Biter’s Gyn privileges have not been revoked?! He is still allowed to continue with his Gyn practice which is a sure sign that he couldn’t have been such a threat to patient safety that they are still allowing him to practice medicine!

    c) As I understand it, there has never been a malpractice case against Dr. Biter. Surely, you are not meaning to say that the hospital has just let complaint after complaint after complaint pile up while doing absolutely nothing about it? If Dr. Biter had been clearly practicing dangerously, there would have been complaints and malpractice suits – as I understand it, there have been no malpractice cases with Dr. Biter as the target.

    d) Your claim that popularity has nothing to do with it is absurd when it comes to health care. Of course it does! If women and their families are thoroughly happy with the job Dr. Biter is doing then it stands to reason that he’s NOT putting their health and lives in danger. An obstetrician does not become extremely popular by lobbying for it – she or he gains popularity by facilitating safe and healthy births with positive outcomes for mother and baby.

    I wholeheartedly disagree that patients should just “be confident” with ZERO information and a complete lack of transparency in the process, that Dr. Biter was released from his OB practice with good cause.

    If the facts come out that he, in fact, was not at all who he appears to be – that he was endangering patients health and lives consistently, that there are many complaints leveled at him, then of course his privileges should be suspended. But in the absence of any of that evidence, I hope that patients – past and present, natural birth supporters, all consumers of health care will stand up and demand an explanation as well as some transparency on the part of the hospital.

  • mommy

    “These protests have occurred precisely because of this lack of transparency”

    The doctor is the only one contributing to the lack of transparancy.  

    Hospital peer-review is bound by confidentiality regulations.  The doctor is perfectly free to speak in general terms that don’t violate his own patients’ privacy.  To invent such a self-serving, completely ridiculous meaning for the hospital’s silence reveals extreme ignorance and the fanaticism that is typical of the midwifery groupies.

     

    It is the midwifery groupies that want no transparancy.   They want to bully some hospital into resume endangering women without their doctor revealing the facts for the public to review.

     

    “if Dr. Biter’s Gyn privileges have not been revoked?! He is still allowed to continue with his Gyn practice which is a sure sign that he couldn’t have been such a threat to patient safety that they are still allowing him to practice medicine!”

     

    Again, ignorance.  Peer review can only limit him based on the actual incidents and evidence.   Unless there is an underlying global problem, like substance abuse or mental illness, they can only limit based on what he has demonstrated incompetence on.  (I guess that nixes the rumor that it was sexual abuse of patients)  Docs have a fair amount of rights to hospital privileges and it isn’t supposed to be revoked willy-nilly.  You see, peer-review is a very poor patient protector.  It is one of last resort.   It only weeds out the very worst behavior.  Perhaps, it is no more than his malpractice carrier dropped his OB coverage and the hospital responded by scaling him back to what he was covered for, like it would for everyone.   

     

    “As I understand it, there has never been a malpractice case against Dr. Biter”

     

    Other blogs make reference to media reports of 4 malpractice cases currently active.    Why don’t you try and check things out before you type for a change?  You seem to know a lot about him.    Look up the court docket in the county or counties where he practices and has practiced.  Get back to us with your findings, please. 

     

    “I think it’s a smear campaign by Scripps to get rid of Dr. Biter because he doesn’t make enough money for Scripps because he doesn’t do enough C-sections and he doesn’t do enough interventions. And I think it makes a lot of other doctors uncomfortable…” (quote with the post)

     

    This wins the grand prize of ignorance.  Hospital make money by NOT having c-sections.   You see, the midwifery crowd is about 20 years behind the rest of the world.   Reimbursement for maternity care has been flat for the last umpteen years.   READ: hospitals and docs do NOT get paid much more for a section.  Given how much more work and resources it takes, the hospitals make LESS MONEY ON SECTIONS!!!!!    These ridiculous out-of-date arguments just mark your so-called movement as the dinosaur that it is. 

     

    “If women and their families are thoroughly happy with the job Dr. Biter is doing then it stands to reason that he’s NOT putting their health and lives in danger”

     

    Obviously, not all of them, since something triggered a review. 

    This game played by midwifery fanatics is embarrassing.   Dragging every unemployed soul you can find to a street corner in an attempt to fight for??   patient endangerment?  perinatal child abuse? 

     

    Just demanding what worked for you without any regard for the harm it could cause others.  Without getting an statement from the doctor of why his privileges were revoked and why he thinks the reason was invalid. 

     

    What if your self-righteous, explanation and implication inventing, ignorance-based interpretations of events rantings could lead to the restoration of his privileges?  If a baby or mom died afterwards, or was neurologically devastated would that make you proud?  No, you would just claim it would have happened anyway.  So, pro-woman.  So empowering.

     

    If there is such a harmed family (or two or three) behind this action, have you ever thought about how they would feel if they read your words or of your protests?   

     

    The lady in BOBB has a kill rate about 10 times as high as hospitals have for patients with similar risk profiles, but the midwifery groupies love her too.   The rest of the female population tries to avoid these types like the plague.   Still, any pregnant women could end up at any hospital, with any staff physician, in an emergency.   That’s why it is especially important for hospitals to monitor the quality of physicians in these roles.      

     

    Why don’t you “Demand An Explanation” from the doctor before your next protest.  Print it here.

  • mommy

    It took about 2 seconds to google this info.  The poster includes a link to the appropriate court for malpractice claims.  The Facebook stuff I can’t verify.   The CA medical board?  They may publish sanctions and actions on the web.  Maybe he lost appeals and this was the trigger?

     

    Maybe you should do a little research before taking to the streets to defend your right to endanger others, hmmm?

     

    “Perhaps there is another side to the story. Dr. Biter’s facebook page indicates “legal issues” and a letter writing campaign to the hospital dating back to Jan 2009. Since April of 2009 there have been 4 NEW malpractice cases filed against him. (Search by Party Name at:http://www.sdcourt.ca.gov/portal/page?_pageid=55,1056871&_dad=portal&_schema=portal). On March 19, a facebook posting by his clinical psychologist mentions negative ramifications with the California Medical Board, and “his current process”. Perhaps Dr. Biter was misleading his patients that he would “be there” for them while knowing that these legal problems were ongoing. Mysteriously absent from the blogosphere is any comment or disclosure from Dr. Biter himself. Calls for transparency should be directed to Dr. Biter. He is not an institution bound by confidentiality regulations.”

    Read more: http://www.sdnn.com/sandiego/2010-05-14/lifestyle/biter-suspension-leaves-pregnant-patients-in-the-lurch#ixzz0oV4qFtQI

  • mommy

    “Dr. Biter is legally unable to comment on the issue.”

     

    He is perfectly free to comment on his own situtation.  Only the hospital is bound by confidentiality.

     

    What is his explanation?

     

    What about the four malpractice suits this past year? (and a few others in earlier years) 

     

     

  • mommy

    http://heinonline.org/HOL/Page?handle=hein.journals/jlah7&div=13&g_sent=1#198

     

    Here’s a link on peer review.  It states California has no state law mandating confidentiality.  Therefore, it has to be by contractual agreement of the parties involved.

     

    If he legally can’t talk, anymore, it is because he wanted it that way apparently.

     

    Again, why don’t you demand the doctor violate the agreement instead of the hospital?  Why don’t you invent negative implications about his silence, instead of the hospital’s? 

  • amie-newman

    I see no reason to respond to your name-calling, anger and clear bias.

    Dr. Biter’s ob privileges have been reinstated and he is now happily at work again.

    http://www.bringbiterback.com/2010/05/rally-cancelled.html

    Dr. Biter is now back at Scripps, delivering babies and doing the work for which so many families are so grateful.

     

  • mommy

    “I see no reason to respond to your name-calling, anger and clear bias.”

     

    You mean, you have no logical explanation for your embarrassing blind defense of a clearly troubled physician who poses a threat to women’s well being.   Some reproductive rights you promote here.  The right to substitute New Age hippie philosophy for actual medicine and ignore the victims for the entertainment of a few wealthy white women.

     

    Explain why you proffered a bunch of propaganda favorable to him that clearly fly in the face of fact and logic?   You just made up things without knowing anything about how hospitals work or his background.   You falsified excuses for him.    Why not explain how he was “legally” not allowed to speak.    Yet, you turned right around and indicted the hospital for doing the exact same thing.    

     

    How about explaining how an OB who doesn’t do many sections is supposedly being kicked off staff for being “unprofitable” when SECTIONS MAKE LESS MONEY for hospitals.  (Insurance pays about the same for all deliveries, sections take way more resources.  Do the math, oh, that’s too hard isn’t it?  And it doesn’t fit the agenda. ) 

     

    Explain why a physician whose way of practicing is unprofitable, somehow poses competition.      I always thought unprofitable operations took care of themselves.

     

    And explain why if childbirth is so safe and overmedicalized, that he needs hospital privileges anyway?

     

    “Dr. Biter’s ob privileges have been reinstated and he is now happily at work again.

    http://www.bringbiterback.com/2010/05/rally-cancelled.html

    Dr. Biter is now back at Scripps, delivering babies and doing the work for which so many families are so grateful.”

     

    http://www.signonsandiego.com/news/2010/may/21/natural-birthing-advocate-resigns/

     

    He resigned the same day.    He wasn’t worried about families.  He left them in the lurch.  He cut a deal to cut his losses.    It was the hospital’s easiest way to get rid of him.  He’s out asking for money too.  How about sending him a big check?