More midwife malpractice
What's worse:
direct entry midwifery malpractice and bad practice?
the fact that direct entry midwives know so little that they post about incidents of malpractice without realizing what they are doing?
the orgy of ignorance that follows from other direct entry midwives who offer inane, bizarre and dangerous "remedies"?
Over on Mama Mid(Wife) Madness (now password protected but cached
here) there is the following astounding post and comments:
You go to the fancy suturing workshops... and the next birth you go to you watch as your midwife can't locate the tear (which bleeds more than 1000cc's when all is said and done) to tie the freakin' thing off!
Oh well. Bleeding stopped. Pressure is truly a wicked good backup for achieving hemostasis. I'm officially a big fan of occasionally packing a vagina.
Hello. Hello. Earth to midwife: If you can't find the tear that has put out a liter (!!!) of blood, you need to call for a REAL medical professional who can find it. You don't ignore it. You don't pack it. You fix it or find someone who can. Packing obstetrical bleeding is grossly inappropriate, except in the case of a last ditch effort to save a hemorrhaging uterus.
This was greeted with astoundingly ignorant "advice". Pamela offers not one, but two gems of stupidity:
have you ever heard of using yunnan paio (chinese herbs) to stop blood loss? a capsule opened up on a wound will slow the bleeding down dramatically!
was this an artery that was severed? was the blood flow pulsing?
Herbs sprinkled on a tear that has already bled a liter? That is frightening in the extreme. Was this an artery? An artery? You have got to be kidding me. Sprinkling herbs on arterial bleeding? Is there any limit to this woman's ignorance?
And then Morag responds:
I have heard of Yunnan paio, my other preceptor carries it, but I've never seen it used. We have all but decided that this bleed was likely a result of a cervical lac but we didn't think of it in the moment. The bleeding certainly looked bright red (suggestive of an arterial bleed) but there was no pulsing, though as far up as it was it may have been at the source. As we didn't go after the cervix with the ring forceps, we will probably never know for sure...
They thought there might be a tear of the cervix but they never bothered to check? A tear of the cervix is a potentially life threatening complication. You MUST check for it if you suspect it, because if you ignore it, the patient will literally bleed to death.
I have a bit of "ancient wisdom" for these scary, incompetent practitioners: "Close enough" is only good enough in horseshoes and hand grenades. It is completely UNACCEPTABLE in hemorrhage (and 1000 cc. of unidentified bleeding is a hemorrhage). Hopefully, these grossly incompetent midwives will see the link and stop by to read this post. If they do, they need to learn a few things about bleeding right away before they kill someone:
If you don't know where obstetrical bleeding is coming from, you MUST find out.
It is NOT acceptable to pack obstetrical bleeding except as a temporizing measure when transferring a patient to real medical professionals.
Hemostatic medications (and the herbs are supposedly a hemostatic medication) are NOT an appropriate treatment for obstetrical bleeding of any kind.
If you think there might be a cervical laceration, it is your RESPONSIBILITY to look for it and make sure that there isn't a cervical laceration. If you don't know how, then transfer to patient to a real medical professional.
Any obstetrical tear that has hemorrhaged is not a superficial tear. The odds are very high that this is a third or even a fourth degree tear. It is quite possible that by failing to properly suture the tear, the patient will be rendered incontinent of stool or develop a rectal fistula where stool comes out of her vagina involuntarily. If you don't know how to determine if there is a 3rd or 4th degree tear, you shouldn't be delivering babies.
This story is chilling. It reveals the ignorance of direct entry midwives in horrible detail. If a midwife cannot identify the source of a hemorrhage and does not know enough to transfer the patient to someone who can figure it out, she should not be out there "practicing". It is only a matter of time before she seriously injures or kills a baby or mother.
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