My friends, I want to start this blog post by introducing myself and acknowledgement of the pain and anxiety that some of you carry about an anticipated or an experienced poor outcome. This feeling is real – and the reality is that if you practice long enough, you will experience a baby admitted to the NICU, a birther admitted to ICU, and/or a fetal demise.
Hi I’m Augustine, and I am just such a midwife. I practiced long and hard in the US, battling to change the broken system – I was on the front lines. The thing about being on the front lines of any battle is that we take the first and the most shots. And as bad as these outcomes can be, it becomes infinitely worse if the midwife’s life is also at risk because their charting is not defensive.
My charting was not defensive initially. It was a mess if I’m being honest. I had many colleagues working with me at various stages of education and on various pathways (CPM’s, CNM’s, ND-Midwives, and Students of all persuasions). We had lots of clients, two busy birth centers and a bevy of home birthing families. The opportunity for error was high, but the love and attention we paid our clients was also high. This however is not enough to protect you.
I believe acknowledging the reality of our own risk and our own naivety does not invite bad things to happen, but rather motivates midwives to hone their skills, and prepare for the worst case scenario, so they’re prepared when the inevitable happens.
Here’s the bottom line, Every birth has risks – in the community setting those risks occur without any institutional shielding. You are the only one that can shield yourself from being investigated for the 2% Shoulder Dystocia rate and the 5% rate of Hemorrhage risks. Every year in the US 6 million babies need basic recitative efforts at birth, 150,678 will be breech (of which 35% will be a surprise at labor), and 36,000 babies will be born with a congenital heart defect. Your charting needs to protect you from these statistical risks, but it also needs to protect you from the bias of your obstetrical colleagues and the power of the profit-over-people medical industrial complex. We welcome you in our defensive charting class to learn more, but here’s what to do if you’re faced with a complaint today.
Here are 7 things you should do immediately if you get a complaint on your license or certificate:
1. Do NOT speak to anyone outside your own team about the complaint, especially NOT the family of the case. DO NOT peer review the case unless you are in a legally peer reviewed state.
2. Find a lawyer if you don’t already have one. To find a lawyer, you may have to do some cold calling – make sure you ask the receptionist to do a conflict of interest search before giving any details of the case.
3. Contract with a lawyer within one week of the complaint. Once you have signed their contract, tell them everything about the case, so they can properly advise you.
4. Write down a full account of the case including going through your phone or message systems for dates, times, and content of any phone calls, emails, or messages from your client (and their family), as well as any conversations not documented in the chart. Memory fades, so capture it ASAP (in fact do this for any birth you are worried about, but not until you have slept).
5. Compare this timeline to the existing chart – if there are discrepancies or inaccuracies or missing info, then create a ‘late entry’, ‘correction’, or ‘addendum’. DO NOT ALTER A CHART ONCE IT HAS BEEN SHARED – this is a crime. You can only add to, not take away.
6. Do take steps to turn over the documents requested by your licensing board, but do NOT turn over incomplete charts. Complaints usually give 30 days, some only 14. If its shorter than that, have your lawyer request a continuance.
7. Hire a back up or replacement midwife to cover your practice if you are too pre-occupied, overwhelmed or emotional to provide thorough, balanced, objective safe care to your other clients. Put yourself on a sabbatical until you are ready, cause the only thing worse that this complaint, would be a second one.
And of course, I love to connect with midwives who are stuck in this crazy and lonely part of the job – defending or healing from an investigate or bad outcome. You can sign up for a confidential consult here.
Not currently being investigated, but worried about it?
Take action now before youre in it! Connect with your midwifery crew around the country and locally about changing laws to protect YOU! Midwives deserve the same protections as physicians and nurses. You should have independent and autonomous boards, your investigative and disciplinary processes should be with peers not competition and peer review should be legally protected.
We need a LEGAL DEFENSE FUND FOR MIDWIVES, Midwifery Wisdom is beginning to develop the non-profit structure to create this – know a financial and legally savvy advocate who wants to work with us?
AND finally, please DO NOT attend births where you feel unsafe – for yourself, for your clients or for the baby. Listen to your HOLY NO. Name, build and maintain your boundaries. Detail your process of firing clients in your policy and procedures document and follow it to the letter when needed. And please take care of yourself at least as well as you take care of your clients – you’re worth it!
Augustine – the midwives’ midwife