Do you think midwife deliveries are less safe than doctor deliveries?

missjennmb · Oct 17, 2008

I think that, for low risk women, a midwife attended birth is SAFER than a doctor attended birth. As someone else mentioned, look at the statistics for infant mortality rates in industrialized countries. We have mostly doctor "run" births, and the infant mortality rate is WAY up compared to more midwife friendly places.

Another reason for this, is that midwives do not do cesareans, so they don't automatically hit the c-section button every time they run into a potential issue without trying other alternatives. I think that many doctors do not see the benefit of things they cannot control (like imaging for relaxation, position changes to help HR and progress etc). Even many nurses I have spoke with who love their doctors, admit that many of them are "quick on the knife" as it were.

Every intervention has its own set of risks, and while I don't think that its black and white what so ever, I think that trusting in birth, unless something happens to truly prove otherwise, is where midwives succeed and doctors do not.

To the PP who mentioned having to deal with the aftermath of "lay midwives" I just wanted to say how sorry I am that you had that horrible experience. Unfortunately, as the rules for midwifery are so different in so many areas, its not monitored, or its so overmonitored that its done under the radar by people who have zero licenses and instead risk persecution to provide women with birth options.

I know a midwife who is the most incredible woman I have ever known, native of Sweden or Norway (its been awhile since I talked to her about it), has formal direct entry midwifery training, tons of births "under her belt" who I would trust any day of the week over anyone else. She is incredibly knowledgeable and trusts birth, but is still a realist, and has always been very straight forward when she felt there was a need to bring in another provider/head to the hospital/take something seriously, whatever. She is just truly incredible.

I also know of midwives who have zero training, and just call themselves a midwife because they delivered someone's baby and read a few books and suddenly are toting themselves as a "midwife". They scare me. These are the ones who have no infant CPR training, no tools to assist in the event of too much bleeding, and just really are not any more qualified to deliver babies than a lay person.

If midwifery, as a profession, was more supported, and people believed in the NATURAL process of birth, then I think we could come together to set up rules and regulations that not only give more women access to midwifery care, but also make it a SAFER profession for everyone involved. Currently, in my state, the only people who make decisions about what midwives can do... you guessed it... is the OBs who don't agree with the practice at all. Talk about a conflict of interest!

suzy253, RN · Oct 17, 2008

Folks--we've got a person here who created a profile to ask two questions:
"Do you think that having a delivery performed by a midwife is less safe than one performed by a doctor?"
and
"How can nurses tell their patients the importance of not smoking or quitting when they themselves are smoking!! It decreases a nurses credibility when they walk into a patients room and do teaching on the importance of not smoking when they reek of cigarette smoke. "
The cynic in me is wondering if someone is bored and wanting to stir the pot a bit.

.......or a homework assignment

HeartsOpenWide, RN · Oct 17, 2008

If anything, midwife deliveries are safer for low risk women. They use less interventions that lead to complications. Why do you ask this question?

Neveranurseagain, RN · Oct 17, 2008

.......or a homework assignment

Slippery Seal is the posters name....hmmm!

But my observations support that with all the interventions MD's do to "manage" birth that midwives deliveries are more safer than an MD's!

moongirl · Oct 17, 2008

with lay midwives- absolutely

with CNM's- no

zahryia, LPN · Oct 17, 2008

with lay midwives- absolutely
with CNM's- no

It really depends on how you define a 'lay' midwive. If it's anything other than an CNM, I would disagree as there are different levels:

Apprenticed (truly 'lay' in my opinion)

LM

CM

CPM

Neveranurseagain, RN · Oct 17, 2008

It really depends on how you define a 'lay' midwive. If it's anything other than an CNM, I would disagree as there are different levels:
Apprenticed (truly 'lay' in my opinion)
LM
CM
CPM

An apprentice midwife is one who is a student, working under the direction of a CPM. They complete classes and serve an apprenticeship before the can test as an CPM. CPM's are well trained, well educated people who focus on one aspect of the medical field. Google CPM and check out their qualifications and training. LM and CM is slowly getting phased out and replaced with the standardized CPM.

MIcrunchyRN · Oct 17, 2008

Midwives are becoming more and more popular these days. Do you think that having a delivery performed by a midwife is less safe than one performed by a doctor?

Ummm no. In a normal low risk pregnancy... exactly what does a doctor do in delivery that is so special? In cases where patients are high risk or true emergency then no. If anything midwives can be safer for babies and mothers. They don't generally do interventions that aren't truely necessary. Like AROM, pit, epidural etc. They usually don't do episiotomies, and know little tricks for preventing tears some OB's may not know. They also provide emotional support of the laboring mom in a way that an OB doesn't. There is something about having a MW with you your entire labor or most of it.

I could keep going lol

slippery_seal · Oct 17, 2008

Not really trying to still the pot just getting input for a Nursing school project...

Baby Catcher, CNM · Oct 17, 2008

there was just a recent cochrane review on this subject! here is part of it. you can look up the whole thing on cochrane. i've always thought cnm's are the way to go. that's why i became one.

cochrane review on midwifery care

midwife-led versus other models of care for childbearing women

abstract

background

midwives are primary providers of care for childbearing women around the world. however, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care.

objectives

to compare midwife-led models of care with other models of care for childbearing women and their infants.

search strategy

we searched the cochrane pregnancy and childbirth group's trials register (january 2008), cochrane effective practice and organisation of care group's trials register (january 2008), current contents (1994 to january 2008), cinahl (1982 to august 2006), web of science, biosis previews, isi proceedings, (1990 to 2008), and the who reproductive health library, no. 9.

selection criteria

all published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy, and where care is provided during the ante- and intrapartum period in the midwife-led model.

data collection and analysis

all authors evaluated methodological quality. two authors independently checked the data extraction.

main results

we included 11trials (12,276 women). women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (rr) 0.90, 95% confidence interval (ci) 0.81 to 0.99), the use of regional analgesia (rr 0.81, 95% ci 0.73 to 0.91), episiotomy (rr 0.82, 95% ci 0.77 to 0.88), and instrumental delivery (rr 0.86, 95% ci 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (rr 1.16, 95% ci 1.05 to 1.29), spontaneous lady partsl birth (rr 1.04, 95% ci 1.02 to 1.06), to feel in control during labour and childbirth (rr 1.74, 95% ci 1.32 to 2.30), attendance at birth by a known midwife (rr 7.84, 95% ci 4.15 to 14.81) and initiate breastfeeding (rr 1.35, 95% ci 1.03 to 1.76). in addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (rr 0.79, 95% ci 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% ci -2.15 to -1.85). there were no statistically significant differences between groups for overall fetal loss/neonatal death (rr 0.83, 95% ci 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (rr 1.01, 95% ci 0.67 to 1.53).

authors' conclusions

all women should be offered midwife-led models of care and women should be encouraged to ask for this option.

VICEDRN, BSN, RN · Oct 18, 2008

I was delivered by a midwife when I had my first. I believe she gave me top rated care on a highly professional and personal level.

My breech baby (second) was delivered by a surgeon (ob) and that's how I view OBs: surgeons.

Given my choice, I would never set foot in a hospital again to deliver a baby and would be midwife attended. OTOH, I wouldn't hesitate to make the same call as I did with the breech baby: C-section all the way.

In sum, midwife is safer. Anything less invasive is safer.

Good luck in nursing school.

AOX4RN, MSN, RN, NP · Oct 18, 2008

Midwives are becoming more and more popular these days. Do you think that having a delivery performed by a midwife is less safe than one performed by a doctor?

Speaking as a midwife... no! :)