[CarolM]

I am a Pre-Nursing student and have often wondered about the following situation: since Midwives are only permitted to treat and deliver uncomplicated pregnancies and deliveries, what happens if once the delivery begins, something goes wrong and it becomes "high risk" or life-threatening? Does a midwife always have an association with an OB that can be called on in an emergency and what happens if the MD cannot respond quickly enough to save the mother or baby -- is the Midwife held liable?

[kennedyj]

In most settings there should be an OB backup available. Especially in the case a C-section is needed. Usually there are clues early on that hint there may be complications later on. Planning in advance would be the key. Labor can also be stopped with medications in events of fetal problems until a doc arrives.

In most facilities there is a doc in house. However in many rural settings or smaller centers the care provider may not be in house. The nurses do the deliveries when needed.


The term "high risk" seems to be heard often but in reality midwives often co-manage many high risk patients using the doc as a consultant. Patients with severely high risks are turned over to the OB/gyn or perinatologists.

Midwives are trained to deal with complications, however if a C-section is needed they can not do this. If a baby gets stuck, there are many techniques to get it out. Ive seen it happen a lot and the baby always comes out ok (sometimes a little bruising and maternal trauma)

[fergus51]

I don't think it's any safer on the ward because the OB doc usually doesn't come in till the woman's close to birth, so he's not there if any complications develop early and he has to be called in.

[CarolM]

I agree it's not always necessarily safer on an OB ward -- my own OB didn't show up until 5-10 minutes after my daughter was born. She was delivered by an experienced L&D RN and her Nursing Student! What an experience for the student -- she was quite nervous and kept wanting to run out and find a doctor -- any doctor; the RN calmly explained that the baby was coming now and she needed the student to stay by her side and help her and myself as needed. Fortunately, my delivery wasn't complicated and the L&D RN handled everything just fine.

CarolM

[babynursewannab]

I had my son delivered by a midwife, almost by the L&D RN...he was sudden. 6-10cm in 30 seconds. My water broke 5 1/2 weeks early which automatically put my pregnancy and delivery at high risk. The dr. checked on me once a day for the 2 days they held me on hospital bed-rest, but never was my use of a midwife challenged.

I adore midwives and will be one. I just need to get through my BSN program and do my time first.

[jamistlc]

Originally posted by CarolM
I am a Pre-Nursing student and have often wondered about the following situation: since Midwives are only permitted to treat and deliver uncomplicated pregnancies and deliveries, what happens if once the delivery begins, something goes wrong and it becomes "high risk" or life-threatening? Does a midwife always have an association with an OB that can be called on in an emergency and what happens if the MD cannot respond quickly enough to save the mother or baby -- is the Midwife held liable?

It is mandated in the Nurse Practice Act for an Advance Nursing Practitioner, Like a Midwife to have a written set of protocols and standards approved by thier supervising physician (Physician Back-up) in thier file with the board in order to practice with prescriptive powers, this means they must always clear a case with the physician back-up prior to taking the case and it must be deemed low risk. When complications occur as they do then they must at least call the back-up physician for orders outside the protocol(s) and also if they have to then call in the Doc or let a resident take over they are covered and working within thier realm as a Nurse! In almost all cases the Midwife has a resident in house who can take over in case of an emergency!

Now what you may wonder is this if I add a twist to the content of your original question "What about outside the hospital, like a homebirth" anyone have any thoughts? I would think legally if they are practicing under the guidelines set forth in the protocols and standards of care as set forth by the Doc, they are covered regardless of the outcome, and the Doc is liable, but we all know who s/he will be the fall guy, right!

[mark_LD_RN]

our midwives have physican back up, you just look for signs of impending problem if they suspect a problem they let doc know early. ie meconium in fluid, decels etc, they call and give him heads up, he may come out and wait in call room if needed. on the other hand i have delivered numerous babies, have a lot of walkins with no prenatal care come up here complete and pushing.never know what you going to get,

[mother/babyRN]

However mandated it may be, it is often the labor and delivery nurse who is your immediate backup....The scary thing is that the best strip and clear membranes can come out with an apgar of two while the thick mec kid of the pre ecclamptic mom often comes out with an apgar of 9...There are protocols but you just have to make allowances for surprises...Get to know the nurses and their abilities. They are ( can and should be) your closest alliances....Good luck!