The Business of Being Born

Re: The Business of Being Born

Thanks guys!

I also just wanted to add that I don't think there is anything wrong with seeing an Ob/Gyn for prenatal care and delivery, if anything it is just overkill! Don't want anyone to think I was doctor bashing!

[spotty_dog]

Re: The Business of Being Born

Even the term midwife means something different. So I wanted to go with the 'norm'. In the UK, low risk women see a midwife for their obstetrical care and only see a doctor if there is a problem. That midwife would have had a certain amount of training to be called a midwife. And from my friends experiences, the midwives usually work in teams, so that you may see different ones through your pregnancy, but then would know them all by the time the birth comes.

Certification as a Certified Nurse Midwife requires a Master's in Nursing (following a Bachelor's and an RN) as well as a vast amount of experience attending births. It's a very highly trained position akin to a Nurse Practitioner I think. "Lay" midwives also go through very extensive hands-on training to claim certification as a CPM or LM, but they don't have the years of general nursing training.

Both midwifery practices I saw for Eddy's pregnancy consisted of several midwives in a practice that also had at least one MD in the group. I never saw the OBs but knew they were available and on call. Here in Phoenix, up until recently the group also had an independent freestanding birth center (about 5 minutes from the hospital where they attend most of their births), and a satellite clinic out here in the east valley for routine appointments. Unfortunately both the birth center and satellite have closed due to staffing and insurance problems.

[Michele]

Re: The Business of Being Born

Sucks that they were forced to close, but otherwise sounds like the ideal compromise IMO for obstetrical care, Alison! There really is a varying degree in "midwife" with some being not officially trained, but just having been to many births. I wish there were better accreditation laws/rules that could stand up to the skeptical eye of MDs and insurance companies.

Here in La it's very difficult to be licensed as a midwife....then you have to find an OB to back you which in Shreveport is 99% impossible....the OBs even had a hearing recently to ban midwives all together...which I think is the wrong way to go. Apparently for La licensing they don't require some things that the MDs can't get behind (for example neonatal resuscitation - which any responsible midwife is trained and certified in). I think if the midwives took over even 25% of the normal pregnancies/births....and handled some of the Medicaid prenatal care (nutrition counseling and post natal care like breastfeeding and of course "don't smoke crack")....the OBs lives would be sooo much better here....and maybe some of these women will be reached before they end up drunk and dropping babies out their vag on the ER floor (true story here---so sad!!!!).

[spotty_dog]

Re: The Business of Being Born

I think if the midwives took over even 25% of the normal pregnancies/births....and handled some of the Medicaid prenatal care (nutrition counseling and post natal care like breastfeeding and of course "don't smoke crack")....the OBs lives would be sooo much better here....

Oh, totally. It's akin to having PAs staff the ER for cross-coverage and having NPs in practice with MDs of all flavors. They are highly trained professionals who can take care of a subset of cases that don't necessarily require the diagnostic skills and other physician training, and having more of them in a more prominent role would totally reform our medical system!

It was interesting, I'd read The Thinking Woman's Guide to a Better Birth by Henci Goer before getting pregnant, and it led me to think this practice model would work best for me. And bam, what do you know but the teaching hospital affiliated with DH's university had instituted that very model (and in fact it's pretty much the top teaching program in the country for nurse-midwifery training, as far as I can tell.)

[smiley]

Re: The Business of Being Born

I I'm always one to consider the source of the information. I haven't seen this movie but sounds like they may be more skewed than someone who is neutral on the position of using services of midwives.
One point that came up is that there is greater reimbursement for C-sections. Really common sense here; It means surgery, anesthesia, a ton of equipement/staff/machines/sterile OR, not needed if someone is not undergoing surgery. So yes it costs more, however in many hospitals the reimbursement percentage [vs cost] is lower for C-section (meaning the hospital actually makes more of a profit by doing vaginal delivery). So it sounds like they would have you believe there is some nafarious money making scheme to convince people to have C-sections. Guess what it's surgery, the complication/infection rates go sky high with surgery, so there are always greater risks for Dr's when they operate.