MIDWIFERY CARE FOR THE VBAC WOMAN

Midwifery Care for the VBAC Woman
by Gloria Lemay
© 2001 Midwifery Today, Inc. All rights reserved.
[This article first appeared in Midwifery Today Issue 57, Spring 2001.]

Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.

Prenatal Preparation

The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.

With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.

The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.

If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.

All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.

Keeping a VBAC normal

Keeping a VBAC normal

We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”

VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”

The Day of the Birth

In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when that would triple her chance of having a uterine rupture.

I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.

We are especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and we do not want to have a uterine prolapse caused by pulling.

Postpartum Differences

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to the gym.” With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).

    Q & A: VBAC

Two Types of Pelvises
by Gloria Lemay

Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?

A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

“Birth with Gloria Lemay” the film

This is the kind of delightful feedback I receive about the DVD. Gloria

From Donna Reicks:
“Gloria, I just have to tell you…..I loaned out your DVD “Birth with Gloria Lemay” as I do to any “English” ladies I serve. These are 1st time parents (after 7 years of trying!) and she loved your DVD and commented her favorite part was the extra features on circumcision!! They were on the fence if they had a boy. Now, their decision is made. Thanks Gloria!! Keep up the good work! Much love to you!”

From Gloria Lemay: “When I made the DVD, it was easy to add a few “extras” besides the footage of 9 home water births. One of the “extras” is a Director’s Cut-type film with me explaining what is going on in the film. The strange thing for me is how many women say, “After watching the version with you explaining what’s going on, my husband is now comfortable with the idea of birthing at home and he feels confident.” The conclusion I’ve come to is that I must have been talking to the back of the sound technician (a man) and that’s why the words seem to affect men. Completely inadvertent but I like it.

Then, there were 2 really good videos that really taught me a lot about the importance of the male foreskin so I requested the use of them from the owners. They were both thrilled to give me their material. Again, so much of the feedback that I get is that those two features have such an impact on people. Both of those intact penis features are available for anyone to watch online but, it seems, a couple sitting on their couch watching a DVD will keep going right to the end of the DVD and THAT has put the information in a lot of people’s hands. It’s so gratifying to know that those DVDs are all over the world. If you have one, don’t leave it on your shelf—get it out and show it or lend it to pregnant families!”

“Birth with Gloria Lemay”

To order the film and download to a thumb drive go to this link
https://birthwithglorialemay.vhx.tv/products/birth-with-gloria-lemay

Placenta Bowl, a family tradition

Lightened photo shows detail on the underside of the bowl.

Lightened photo shows detail on the underside of the bowl.

Copyright Gloria Lemay 2014

The birth of a baby is a time to really consider what family traditions should be kept and what family traditions should be discarded. It can be a time to get creative and design rituals that truly nourish the heart. This wooden placenta bowl was commissioned by a family and carved by a B.C. artist. It is now being used at the second generation of homeborn babies in the family and will be passed on for years to come.

Shared with the kind permission of the family.

Checking Your Own Cervix

How to Check Your Own Cervix- “it’s not rocket science”

“I think it’s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm. Clean your hands well and make sure your fingernails are trimmed and rounded.

“The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet (or if that yoga is too difficult, put one foot up on the bathtub or a stool with your knee bent).

toilet Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.

“What’s in the centre of that opening space is the membranes (bag of waters) that are covering the baby’s head and feel like a latex balloon filled with water. If you push on them a bit you’ll feel the baby’s head like a hard ball (as in baseball). If the waters have released you’ll feel the babe’s head directly.

“It is time for women to take back ownership of their bodies.”
-Gloria Lemay, Vancouver, BC

http://www.gentlebirth.org/archives/birth.html#Self-Checking

    Update

One birthing woman who checked her own cervix described it like this: “I could feel my bag of water bulging down and then later the baby’s head once the waters broke- so cool.”
“How did I do it? I just reached up in all the way to the back and felt. It’s sort of awkward/difficult to reach but if you are familiar with what your cervix normally feels like, sort of like the tip of your nose, it gets shorter and stretchy. I felt it at like maybe 2 cm, about 6, which is when I could feel the bag, and then when it was time for baby to come. When the contractions were getting super intense I pushed a bit and that was enough to break my waters. Babe came shortly after.”
(shared with permission) 2014

“An Unnecessary Cut”, 20 min video on Hospital VBAC

This video is timely and a valuable resource for birth workers. It’s a good length (20 mins) and it addresses that large number of women who are not ready for a home birth for a VBAC. It’s also a very good promotion for hiring a doula. Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, wants to avoid an unnecessary Cesarean. This is the last week of her pregnancy. Enjoy and tell me what you think of it. Gloria

An Unnecessary Cut? How the C-section Became America’s Most Common Major Surgery – The New Yorker

Producer: Sky Dylan-Robbins

Cytotec (misoprostol) injuries or death? Medical records needed.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

    From Jette Aaroe Clausen

I am engaged in the public discussion on induction of labor and misoprostol in Denmark. I and a colleague, Eva Rydahl, have addressed the Health committee in the Danish parliament. They have not banned cytotec but they have announced that they will do more monitoring of this and they issued a new circular making it mandatory for midwives and doctors to report side effects to off-label medication.

Eva and I strive to learn more about hyper stimulation and the way cytotec works. To do so we need patient records. We will of course treat them in confidence and not reveal any names. We will be grateful if we can be allowed to read any medical notes from patients (or their families) who have had adverse reactions to Cytotec (misoprostol). Fetal monitor tracings are especially useful to us. My colleague, Eva Rydahl (who is also on facebook), will also be happy to correspond with families. My e-mail address is jecl@phmetropol.dk I work at the Danish midwifery education in Copenhagen. I am an Assoc Prof of Midwifery and a researcher. Jette Aaroe Clausen, May 21, 2014

Giving birth is another elimination process

It feels so much better when it's all done.

It feels so much better when it’s all done.

Why do I say that birth is an elimination process? Something large is within a body cavity and it must come out. When it’s time, it will come out. It will come out no matter where you are, no matter how smart/dumb you are, no matter if you want it to or not. Even if you want to call the whole thing off and come back to it another day, it will still come out. You’ll be very uncomfortable when the body messages say “It’s time“. You’ll get the right information from the messages of that discomfort and you’ll know exactly what to do. When you’re done, you’ll feel a lot better!

(Now, go back and read what I’ve said and apply it to vomiting, pee-ing, poop-ing or birthing and see how it fits.)

Facebook favourite Updates

I’ve been on Facebook for five years, apparently. These are the most popular updates that I’ve posted there:

They are not “unvaccinated”. . . they have a natural immune system. Women are not “unmastectomized” . . .they have their breasts. Boys are not “uncircumcised”, they are intact. Every word creates a hallucination. When we hallucinate wholeness, wholeness will show up as normal.

Gloria Lemay

October 2013 393 likes

What do I want for my birthday? I want everyone who reads this to take 30 seconds to get up, walk through your place and turn off any lights or appliances that don’t need to be on, OFF. We make the difference in having our Mother Earth work. Thank you.

Gloria Lemay

October 2012 270 likes

If you’re hiring a doula to “enforce your birth plan”, “keep you home as long as possible”, and “protect you”, wake up and plan a home birth with an attendant you trust.

Gloria Lemay

July 2012 359 likes

I don’t know who wrote this but I found it very funny 🙂

If you love something, set it free. If it comes back, it will always be yours. If it doesn’t come back, it was never yours to begin with. But, if it just sits in your living room, messes up your stuff, eats your food, uses your telephone, takes your money, and doesn’t appear to realize that you had set it free……. you either married it or gave birth to it.

July 2011 213 likes

www.pinterest.com

Courage

According to the Merriam-Webster dictionary, courage is a noun meaning ‘ability to overcome fear or despair” The fear has to be present in order for courage to exist. The English word “courage” is derived from the French word for the heart, “cour”. When someone finds the heart to continue on doing the right thing in the face of great fear, everyone around her is inspired to become a nobler human being. This is the source of courage for many midwives. In ourwork, we see women and men facing their fears in birth, we ask them to have faith in the face of no evidence, we demand that they be bigger than the circumstances and, when they conquer, we get a renewed vision of how life can look when our fears don’t stop us.

The paths of parenting and midwifery push me up against my fears and despairing attitude on a daily basis. Luckily, I have found teachers and teachings that have inspired me to keep going despite a rapidly beating hummingbird heart. When my daughters were very young and I was juggling my heart’s desire to be a good parent and make a difference in childbirth, one of my friends told me to use the affirmation “My vulnerability is my strength.” I thought she was insane and argued that if I lived by that slogan my children would surely perish. I was pretty sure that my strength was my strength—and by strength I meant my ability to force and push life to suit my will. I now know that true strength is an elusive quality of being able to strengthen others. At that time, I trusted my friend and, on faith in her alone, began toying with sharing my vulnerability. I tiptoed into revealing my fears and apprehensions to a few “safe” people and slowly began to realize that what my friend had given me as an affirmation worked a lot better than my stoic, stubborn, brave warrior act.

After a few harsh lessons, I began to realize that it wasn’t up to me to conceal information that was worrying me at a birth from the parents. In fact, if I am afraid at a birth, the best thing I can do is name the fear boldly and even ask everyone else present to say what his or her fears are. One of my dear clients released her membranes at 36 weeks in her second pregnancy. Her first birth had been a beautiful, straightforward home birth and I was deeply invested in her second birth being just as great. After four days of leaking, she began having regular, intense birthing sensations and we drove to the hospital for the birth. I drove and the parents were in the back seat of my car. As we approached the hospital, my hands on the wheel were clutched into white knuckles and a ball of fear formed in my gut. I started picturing the cord being whacked off immediately and the baby being taken away from Mom. I looked in the rear view mirror and saw the father with his eyes looking terrified. I said to him “What’s your biggest fear right now, Brian?” He replied, “I am afraid we’re going to have a Cesarean.” I never imagined this would be his fear. A cesarean was not even a possibility, I explained, “Your wife is in strong birthing, she has already had one vaginal birth, the baby is small—for sure it will be born vaginally”. He asked me, then, “What are you afraid of?” I told him honestly “ I’m afraid that the baby’s cord will be cut too quickly and the baby will be taken away from Karen.” This had not occurred to him but he knew that my experience was a better barometer of things to come. He asked me what we could do to prevent this. I was able to tell him that it was very important to take the doctor aside out in the hall and tell him “It means everything to my wife and I that the cord be left to pulse and that the baby be placed on her skin until the placenta comes out.” We did a couple of “dress rehearsals” of what had to be said and then went in. The staff at the hospital respected the parents’ wishes to have the cord left intact. The birth went beautifully. I would have wished that the baby didn’t have as heavy doses of antibiotics as he was given (with resulting colic for months) but having a birth that involved no induction or anesthetics was a big accomplishment in these circumstances.

Nancy Wainer, author, midwife

Nancy Wainer, author, midwife


There was a period in my career when I was unable to divest myself of fear and dread. I wanted to have a breakthrough and so I decided to “import” some courage into my city. I thought about my heroes in the midwifery movement and asked myself “Whose the bravest person I know?” The answer was, of course, Nancy Wainer Cohen. Her book “Silent Knife” had kept my feet in the room at VBAC births where every cell in my body had been screaming “What the h— are you doing here?!!” I was pretty sure that if Nancy came and lived at my house for a few days, I could get some courage. My husband picked Nancy up at the airport and she came into my house and hugged me wracking with sobs. She cried her way through several boxes of Kleenex at the workshop she taught for my students. Her visit was four days of snot, tears and intense passion for healing birth. I learned so much about the vulnerability and strength connection. Nancy is still my hero in the courage department and she continues to live her life with her heart pinned right on her sleeve.

The sharing other midwives have done about their fears has strengthened me to face my fears of birth One midwife wrote in Midwifery Today that “the drive to the birth with all the “what ifs” running through my head is the hard part, when I walk through the door and see the woman, all that disappears”. Another midwife told me “The scariest thing for me is the first prenatal class of a series. Meeting new people who have so much riding on my teaching is enough to give me an ulcer.” An acronym for fear is:

F= false
E= evidence
A= appearing
R= real

When I am most afraid, it is because I have forgotten the truth about how loved and blessed I am. The fear can dominate and stop me or it can be used to alert me to something to which I am deeply committed. Using a journal to write out fears in the morning helps to clear the mind. Once the fears are on paper, somehow they seem less foreboding. Being in action is another antidote to the paralysis that accompanies fear. Any action—cleaning your desk, organizing a drawer, making a phone call—will bring a new perspective and lessen the dread.

My favorite philosopher about fear and courage is the Wizard of Oz speaking to the cowardly lion “Courage is doing what’s right even though you’re afraid.” I have learned courage from birthing women and other midwives. We are there to inspire and raise the bar for each other on what’s possible in the domain of courageous action.
This article by Gloria Lemay was written in 2003 and first published in Midwifery Today, Issue 67, Autumn 2003

College of Midwives of B.C.

Parents, grandparents, children and birth rights activists picketed the College of Midwives offices on Nov. 28, 2012. The College of Midwives conducts secret investigations and flagging operations to undermine the alternative birth workers in the province. By sending negative press releases and spreading half-truths and innuendo, they attempt to claim a monopoly on who shall attend births in the province.

Choice of birth attendant is a woman's right

From the film “Freedom for Birth”: — “One of the home birth mothers supported by Ms Gereb (Agnes Gereb, Hungarian midwife) decided to take a stand.
When pregnant with her second child, Anna Ternovsky took her country (Hungary) to the European Court of Human Rights and won a landmark case that has major implications for childbirth around the world.

Toni Harman, one of the filmmakers says, “the “Ternovsky vs Hungary” ruling at the European Court of Human Rights in 2010 means that,. . . now in Europe, every birthing woman has the legal right to decide where and how she gives birth. . .

. . .And across the world. . ., it means that if a woman feels like her Human Rights are being violated because her birth choices are not being fully supported, she could use the power of the law to protect those rights. With the release of “Freedom For Birth”, we hope millions of women become aware of their legal rights and so our film has the potential to spark a revolution in maternity care across the world. In fact, we are calling this the Mothers’ Revolution.”

Added on June 17 2013: EUROPEAN COURT OF HUMAN RIGHTS Fact Sheet
Under Article 37 § 1(c)of the Convention
Home Birth
Ternovsky v. Hungary
(no.67545/09)
14.12.2010
The applicant complained about being denied the opportunity to give birth at home, arguing that midwives or other health professionals were effectively dissuaded by law from assisting her, because they risked being prosecuted.
(There had recently been at least one such prosecution.)
The Court found that the applicant was in effect not free to choose to give birth at home because of the permanent threat of prosecution faced by health professionals and the absence of specific and comprehensive legislation on the subject, in violation of Article 8
Right to respect for private and family life.
Source: http://www.echr.coe.int/Documents/FS_Reproductive_ENG.pdf

ADDED June 2017: A case involving a member of the College of Midwives of B.C.
MEGAN DOLSKI
VANCOUVER — The Globe and Mail
Published Sunday, Aug. 14, 2016 8:22PM EDT
Last updated Sunday, Aug. 14, 2016 8:24PM EDT

The mother of a boy who was born with severely debilitating brain injuries on Vancouver Island has settled a lawsuit against her midwife and local health authority for more than $3-million, as well as annual payments that could add millions of dollars to the cost of the case.

The annual $400,000 payments outlined in the settlement are rare, but a legal expert says if they become more common they could add an unpredictable liability to the B.C. government’s finances.

Cabe Crossman was born in December, 2011, at the Cowichan District Hospital in Duncan, located about 60 kilometres northwest of Victoria. Due to injuries suffered during the delivery, he now has severe cerebral palsy and intellectual impairment, and will require extensive care for the rest of his life.

His mother, Sarah Corrin, sued her midwife, Selina Boily, the Vancouver Island Health Authority and two unidentified nurses alleging the care she received, first from the midwife and then at the hospital, was negligent. She alleged that her labour and delivery was not properly monitored, assessed or responded to. The defendants admitted liability and a B.C. Supreme Court judge approved a settlement earlier this month.

The boy’s life expectancy could be anywhere from 12 to 30 years, according to the court ruling, meaning the final cost to the provincial government could be well over $10-million. In addition to ultimately being responsible for the health authority, the province also sponsors the Midwives Protection Program, an insurance plan unique to B.C. across the country.

The program provides midwives with legal expenses and covers claims against them alleging negligence while practising, if they pay an annual fee of $1,800 per year.

A separate liability insurance program for midwives is also used in Ontario, Saskatchewan, Manitoba and Nova Scotia. It was not immediately clear about the situation in other provinces.

The Midwives Association of B.C. says the cost of malpractice insurance was halved in 2007 by the Ministry of Health “due to the excellent record that midwives currently hold in relation to large claims,” and reduced again in 2014.

As of this year, midwives in B.C. are required to also hold commercial general liability insurance, which they can get through the insurance provider of their choice

Paul McGivern, a lawyer with Pacific Medical Law who specializes in medical malpractice and infant injury cases, said that over the past decade he has seen a trend in which settlements for obstetric cases in British Columbia have been going up – not in quantity, but in dollar value.

Mr. McGivern, who was not involved in the Corrin family’s lawsuit, has worked on many cases that have involved $3-million claims or more.

“Part of it is that the cost of care is going up. Part of it is that counsel are presenting much more sophisticated analysis of the cost of care – the evidence is getting better as to how much things cost,” he said.

However, Mr. McGivern said incremental payments in the agreement, without insurance backing, is unusual.

“It is very difficult to predict what your ongoing financial obligations are going to be,” he said.

“If you have one case or two cases, you can manage that. If you’ve got 100, 200 or 500 of those cases that build up over time, your finances can become incredibly difficult to manage and predict.”

A recurring payment in a case such as this “is not unprecedented,” said Barbara Webster-Evans, the lawyer who represented Ms. Corrin. “But it’s probably rare.”

Ms. Webster-Evans said the family requested privacy and that agreements are in place that prevent her from discussing the case in detail.

“Any of these cases when they occur are tragedies for the child as well as the family,” she said.
Source: https://www.theglobeandmail.com/news/british-columbia/vancouver-island-mother-wins-3-million-suit-against-midwife/article31403354/

Added July 11, 2017

B.C. College of Midwives demands ‘death midwives’ stop using title
College says midwife title is protected by law; death midwife says her use of it completely different
By Liam Britten, CBC News Posted: Jul 05, 2016 8:51 PM PT Last Updated: Jul 05, 2016 8:51 PM PT

Death midwife Pashta MaryMoon (far right) instructs others on a live model, how to properly wash and care for a dead body at home. The College of Midwives of British Columbia says the title “midwife” is protected by law and has sent a cease and desist letter to MaryMoon’s organization ordering them to stop using it. (Canadian Integrative Network for Death Education and Alternatives)
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The College of Midwives of British Columbia is demanding a group of “death midwives” stop using the term “midwife” when referring to their services.
The Canadian Integrative Network for Death Education and Alternatives is an organization that represents and provides awareness about “death midwives” — people who help a dying person and their loved ones with alternative funeral arrangements, often at home.
CINDEA’s webpage says they use the term “midwife” to “honour and parallel the role of a birth midwife,” but College of Midwives registrar and executive director Louise Aerts says the term is reserved under the Health Professions Act and CINDEA’s use is breaking the law.
“There can be a misperception from the public when a title is being used inappropriately,” she said.
“Part of the idea is to provide a sense to the public of what it means to be a registered health professional, and they know when those terms are being used, that there is a regulatory body overseeing the education and practices and standards of that profession.”
Even though death midwives have the “death” modifier before their title, Aerts says the potential is there for confusion.
“The public could conceive that they have the same level of training, the same level of oversight of their practice as do registrants of the college,” she said.
As a result, the college sent CINDEA a cease and desist letter this week to prevent them from using the term “midwife.”
• Death midwives offer a ‘more authentic’ funeral experience
• B.C. home funeral workshops teach loved ones to care for corpses
• Midwives call for better education and funding
Doubts about confusion
Aerts says she hadn’t heard of CINDEA until the CBC profiled the work of founder Pashta MaryMoon for a radio series.
MaryMoon says the term “death midwife” has been used for over a decade by people like herself, and she isn’t sure why it has become an issue now.
“We’re not talking about being a midwife for pregnant women,” she said. “People who are dealing with the death of a person have no confusion about what kind of midwife we are. So I don’t really see why that’s an issue.”

Pashta MaryMoon, seen here practising on a live model, says using the term “death midwife” has “nothing to do with being equally credible as birth midwives.” (Canadian Integrative Network for Death Education and Alternatives)
MaryMoon questions whether the College has the legal standing to stop death midwives from using the title, but admits CINDEA has no legal representation.
She also says CINDEA’s use of the title is not about claiming the legitimacy of midwifery.
“What we’re doing is reclaiming the ancient word and the ancient practice. It has nothing to do with being equally credible as birth midwives,” she said.
“It has to do with bringing back the original practice of caring for your own dead and the people who would support the families to do that, who were the midwives.”
MaryMoon said on Tuesday she wasn’t sure what CINDEA’s next steps would be besides consulting other group members and similar practitioners in the United States.

View story online (with photos) here:
http://www.cbc.ca/news/canada/british-columbia/college-of-midwives-death-midwives-1.3666406