Why do we need the docs for delivery?

ShannonC · Feb 25, 2005

OBs are useful. But they are not our only choice. I don't think most of us mean to say OBs are "useless", here at all.
I have studied some on the history of dhildbirth in America, particularly that of the "grannie midwives" and their role in birthing in the Early American South. To me, it's sad how traditional midwives effectively got squeezed out--------by special interests such as the AMA, by sue-happy people, by insurance companies, hospitals, and by the public at large that has come to believe only doctors can deliver competent care in healthy pregnancy and birth in the "controlled" environment of a hospital. That is all I am trying to say here. It's interesting to me how we women as a group have been so willing to relinquish our choices and the power to make them in our medical situations.

I so totally agree with you! It's interesting what you have studied. It's too bad that this wonderful tradition of midwives got effectively extinguished... I hope it comes back full force! My hope is that everyone have a full range of choices and that women take back the power of choice when it comes to childbirth!

allnurses Guide · Feb 26, 2005

Oh my gosh no way, no how :uhoh3: :uhoh21: :crying2: do I like having to be the one to "catch" the baby. I love our OB docs and they are very low-key and laid back. Not to mention specifically trained to deliver babies. Our deliveries are very low-key and laid back too. One nurse, one doc.

I think if you want to be an OB doc and deliver babies, you should. If you want to be a midwife, you should.

For me, a nurse has a specific role and a physican/midwife has a specific role and I'd rather . .much rather . .not do the physican/midwife role.

I do not not want to be the one to catch the baby thank you very much. :)

steph

ER1010 · Feb 26, 2005

Stevie,

Can you elaborate on why you wouldn't want to catch the babies? I.e. litigation, complications, after-birth, tears, want someone to help, etc? Just curious, as I am a student.

Thanks

JaneyW · Feb 26, 2005

Oh my gosh no way, no how :uhoh21: do I like having to be the one to "catch" the baby. I love our OB docs and they are very low-key and laid back. Not to mention specifically trained to deliver babies. Our deliveries are very low-key and laid back too. One nurse, one doc.
I think if you want to be an OB doc and deliver babies, you should. If you want to be a midwife, you should.
For me, a nurse has a specific role and a physican/midwife has a specific role and I'd rather . .much rather . .not do the physican/midwife role.
I do not not want to be the one to catch the baby thank you very much. :)
steph

I'm with you, Steph. I have delivered some and will I know do so again as I work in the middle of the night and some babies just don't wait. I have seen too many things go wrong at the last minute and prefer for the MD to be there. I have no interest in being a nurse-midwife. I like being "just" an RN. We still have a lot to do. Especially in the education department. I take my job as advocate very seriously. Even to the point of suggesting people go home when they show up for an induction with no idea why or how or what that involves. I even had one show up one time that thought she was having a c/s when she was scheduled for a Cytotec induction!

ayndim · Feb 26, 2005

Hopefully I won't loose my nerve and will be adding one more MW to the ranks. I thought I read a study that CNM and DE MW's were less likely to be sued by pts even when something goes wrong. Anyone else heard that?

And :angryfire would freeze over before I would let anyone but a midwife (or a l&d nurse) assist me with my delivery. Obviously unless there were complications only a dr could handle.

BETSRN · Feb 26, 2005

It seems to me like the experienced nurses on this board could very easily deliver the normal healthy deliveries. Just wondering if the OB nurses get frustrated with having a doc do the delivery, when all he or she did was catch? In Europe aren't all the nurses also midwives, and they only call the doc for emergencies? Do you guys think this would be a better practice?

OB's in this area pay upwards of $120,000/year in malpractice fees alone. Why would we nurses want to take on that responsibility?

James Huffman · Feb 26, 2005

I dont' think most of the American public is educated or prepared to question this (doctors being the primary caregivers of pregnant women), however, James. You are leaving out a huge variable/ contributing factor there. Most people I come across dont' question much of what happens to them in the hospital or what their doctors order. They are often not educated or taught to do anything but comply " for their own good". ESPECIALLY in WOMEN, this can be true.
I can't tell you how many patients I have had to explain EVERYTHING to because their doctors have not the time or patience to do so in the office. So many have come to the hospital for inductions or NSTs or other procedures that have NO clue why they are doing these and what the plan is. They just show up as told to do. Some even have NO idea WHY they are being induced, just told "it was time". That, to me, represents a HUGE lack of education out there. Contrast that situation to that of midwife patients, who can tell ME a thing or two about their bodies, pregnancies, and plan of care. They seem so much better-prepared and educated as to the whole process.
Perhaps if women as a whole were taught to take more charge of their health care and choose more carefully or discerningly their providers--- we might see some things change a bit in how and whom women choose to provide for their heathcare and in what setting. I sure plan to educate my own daughter better than I was.

I don't argue with you in the slightest that there are some women (men, too) who know nothing about their care, and perhaps don't want to know.

However, I think you underestimate the amount of self-education (especially from the internet) and self-direction many patients come to the health care system with these days. That self-education and self-direction is a source of irritation to lots of doctors. Nurses, too. These are people who come in asking, "What about this?," "What about that?," "Does this procedure really do what you're saying it will?," "Why are you doing that?," and "I've heard about this medicine; is it for me?" This trend is only going to increase. Nurses and physicians who are uncomfortable with self-directed clients may want to ponder their future role in the delivery of health care.

But as I said earlier, the final say is with the patient. Whether the patient is right or wrong, whether educated or not, whether self-directed or not, she is paying the bill, and has the right to tell us what she wants. And if she wants her birth done by an OB, that's her call.

Jim Huffman, RN

allnurses Guide · Feb 26, 2005

Stevie,
Can you elaborate on why you wouldn't want to catch the babies? I.e. litigation, complications, after-birth, tears, want someone to help, etc? Just curious, as I am a student.
Thanks

Because even though most deliveries are fine, there are those really scary ones where I don't want to be the one responsible. The physician has been well-trained to take care of babies in distress and I'd rather not be responsible. In fact one of the reasons OB is not my favorite place to practice is just that - I've been in one too many deliveries where things turn on a dime and a baby is in distress.

We are a rural hospital. In order to get a sick baby to a NICU, it takes getting a crew together and they have to fly up here - the flight itself takes about 20 minutes but then the ambulance has to go over to the airport to get the NICU crew. We are sooo happy when they show up and take over . . . .

I didn't go into nursing to be a L&D nurse . . . I work at a rural hospital where we do a little bit of everything. I do L&D .. . it just isn't my first choice. I don't want a brain damaged baby or dead baby on my conscience if, as the nurse, I was all alone with a delivery and the doc was no where to be seen. I'm grateful that our docs have their roles to play and I have mine. I don't want to be a doctor. I want to be a nurse.

steph

jrring1019 · Feb 26, 2005

I have done OB nursing for 7 years and have never delivered a baby (now, you know since I said that I will deliver one the next time I work). our docs/cnms are in house and I couldn't be happier. I think our OBs/ CNMs are great and I am always so happy that they are there when the *&^% hits the fan. So docs took over birth and made it a medical event. It is what it is. I had a midwife for my births and I loved it, but I think docs are getting a bad rap. Wasn't childbirth the leading cause of death of women of childbearing age? So, some of the medical advances of our time have been for good. There was a dark time when women were knocked out and babies pulled out with forceps. It is not like that anymore and I think our docs totally repect a womens wishes for birth.

allnurses Guide · Feb 26, 2005

I think docs are getting a bad rap too. It isn't black or white.

Funny, I had a female OB doc and she was terrible. No bedside manner, only scheduled me for less than 5 minutes for office visits, didn't do any patient teaching and this was my first baby. I came in to the hospital with UC's but no changed in my cervix ... she decided to induce me. Instead of sending me home. It was not pretty. And she was a woman! :rolleyes: I keep hearing how women would change everything for the better and I don't see how gender has much to do with anything. It has more to do with what kind of person you are. My next two babies were delivered by very compassionate men. My last baby was delivered by my female doc's female partner who ended up doing an emergency cesarean on me . . and was way nicer than my regular doc. Go figure.

steph

BETSRN · Feb 26, 2005

I don't argue with you in the slightest that there are some women (men, too) who know nothing about their care, and perhaps don't want to know.
However, I think you underestimate the amount of self-education (especially from the internet) and self-direction many patients come to the health care system with these days. That self-education and self-direction is a source of irritation to lots of doctors. Nurses, too. These are people who come in asking, "What about this?," "What about that?," "Does this procedure really do what you're saying it will?," "Why are you doing that?," and "I've heard about this medicine; is it for me?" This trend is only going to increase. Nurses and physicians who are uncomfortable with self-directed clients may want to ponder their future role in the delivery of health care.
But as I said earlier, the final say is with the patient. Whether the patient is right or wrong, whether educated or not, whether self-directed or not, she is paying the bill, and has the right to tell us what she wants. And if she wants her birth done by an OB, that's her call.
Jim Huffman, RN

Regardless of all the information tha tis out there, I still feel that the general public does NOT question as they should. They still hold those docs on a pedastel (of sorts). If more people did question things would be very different (I am talking mostly about labor/birth here).

ayndim · Feb 26, 2005

I have done OB nursing for 7 years and have never delivered a baby (now, you know since I said that I will deliver one the next time I work). our docs/cnms are in house and I couldn't be happier. I think our OBs/ CNMs are great and I am always so happy that they are there when the *&^% hits the fan. So docs took over birth and made it a medical event. It is what it is. I had a midwife for my births and I loved it, but I think docs are getting a bad rap. Wasn't childbirth the leading cause of death of women of childbearing age? So, some of the medical advances of our time have been for good. There was a dark time when women were knocked out and babies pulled out with forceps. It is not like that anymore and I think our docs totally repect a womens wishes for birth.

I know that the drs that are at the ob/cnm practice I go to have the same mentality towards childbirth as the mw's. However, there are some bad ones out there.

I think handwashing (or lack of it) and not the care provider was often the cause of mom's dying. I know that at one hospital (maybe more) way back when the drs had higher death rates than the mw's because the drs would go from autopsy to delivery w/o washing their hands. One dr did experiments with having his residents wash in a aseptic solution before examining women and that it cut down on the deaths. I think it took a while to catch on. Not sure if the mw's were washing their hands or not.