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

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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?

Specializes in Emergency Department.
Personally, I think of a lay midwife as one who has apprenticed under a midwife without any formal education related to midwifery.

My understanding (correct me if I'm wrong) is that an apprenticeship (solely)-with an acceptable # of hours-was an acceptable pathway under NARM.

I attended an accredited midwifery school to become a CPM. There is a pathway for students to become CPMs without attending a school per se, but they are required to complete equivalent educational requirements. Here is a link to NARM's educational requirements for this pathway called the Portfolio Evaluation Process and the documents referred to in the outline are available for viewing on the website. I don't know how an apprentice could graduate as far as the CPM exam without completing an educational plan (and don't know any who didn't).

I think midwives are a great resource and they are very valuable. However, I am one of those folks that do not believe in home deliveries.

Believe in like the belief of Santa Claus and fairies? ;) I think advocate or support would be better words to describe this philosophy.

Any hospital delivery can be as "medical" or "non-medical" as Mom wants it to be.
I think we can all agree it is not as simple as stated.
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I think we can all agree it is not as simple as stated.

Amen to that! Unless you have been through the "system" and have had the opportunity to see the conflict between what a provider wants for you and what they are forced to do to you to keep their job...well lets just say I have walked that walk, and it has given me new respect for CNMs who stand up for natural birth and a profound thankfulness that I am done having children because its not an effortless system to work through.

Even the most natural birth friendly OB would be forced out of a hospital if he did not follow their protocols. Hospitals make a LOT of the rules that OBs are villianized for. Not saying they dont agree with them, just saying that while there is wiggle room, there is not always room to

be as "medical" or "non-medical" as Mom wants it to be.

Informed Consent and Patient Choice is a great thing, but it is not nearly as cut and dried as we are taught in nursing school, particularly when it comes to this field.

Apgar10 - I'm curious, why did you chose to leave your midwifery practice to become a nurse? I have spoken to many midwives over the past 4 years, both CNM and non-nursing based midwives, and it always seems to come back to financial issues. That was my original "career goal" but my area is a legal/political minefield when it comes to midwifery, and I did not feel comfortable walking through that on a daily basis, when the laws could change in an instant and take away my livelihood.

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Specializes in Emergency Department.
Apgar10 - I'm curious, why did you chose to leave your midwifery practice to become a nurse?

I am currently in practice as a midwife attending home births (on the waiting lists for ADN; finishing BSN transfer reqs). As a CPM I've hit the "glass ceiling" so to speak. I have a limited scope of practice, which is low-risk normal births by default. While this sounds like a dream, I'd like to have an expanded scope to reach more women and to be able to retain them in practice but with change of venue. So it's sort of financially motivated and while it is more politically correct to be a CNM even in my area I'm not so concerned with that aspect of it as my credential is legally recognized.

I'd like to be a CNM-FNP, birth 'em and keep 'em in my practice with their whole family! :yeah:

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Specializes in ER.

Scorpio student:

I am the mother of two myself and I agree that this statement"

be as "medical" or "non-medical" as Mom wants it to be.

is an ideal. Its one we should stop selling to mothers because frankly, its not reality in a clinical setting.

I can't understand what this means:

Informed Consent and Patient Choice is a great thing, but it is not nearly as cut and dried as we are taught in nursing school, particularly when it comes to this field.

Can you explain this to me because it sounds kind of scary when I paint my picture of it but I don't want to jump to conclusions.

Thanks

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Specializes in Rural Health.
Any hospital delivery can be as "medical" or "non-medical" as Mom wants it to be.

I wish it was that simple but in my experience the hospital is protecting themselves from the lawsuit happy world we live and work in. So they create 500 pages policies and procedures that medicalizes the birth process to protect their orifice from future litigation. Not only that, they are a business first and foremost, always. An OB department that can crank out the babies is a sure thing money maker. You can not crank out a baby and get mom delivered and home within 24 hours without it being all about medicine (according to them, TOTALLY NOT MY BELIEF!!!!)

My parents have ZERO say in what they want. Birth plans are thrown out the window when you come in. You want the tub, intermittent monitoring, walk the halls. Forget it. NOT allowed where I work. Don't want an epidural? Don't expect to find an RN that will tolerate you then because most of the nurses I work with despise the patients who don't want an epidural. Want a birth without Pit? Forget it, it won't happen. If if your doctor doesn't order it, the RN's I work with will eventually start in on their own. Don't want an AROM, forget that too, most of the staff with "accidently" break your water when they are tried of waiting on you to deliver.

We used to have a CNM who not only delivered patients but she was the DON there. This was before my time but I guess people used to travel 200+ miles to have a baby there because the quality of care was unbelievable. Parents got what they wanted, what they needed. Then the "medical" people stepped in after one of our 10 or so buy outs in the last 5 years. They told her she no longer had delivery privileges there. Then they started firing on the doctors that went "against the grain". Soon all the great L&D nurses moved on to better things and now it's we are probably one of the worst places in a 4 state area to deliver a baby at. It became about money.

I have a very love hate relationship right now with the L&D side of my OB department thanks to the aforementioned items. I guess it's like this pretty much everywhere around me too, so no sense in finding another hospital somewhere else......sigh. :cry:

So, I really wish it was a simple to say - if you want a non medical birth your hospital will give you one cause I really don't think that's possibly anymore in a hospital, at least not where I live. :banghead:

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How horrible Mom2michael, it is like that in my area as well. Not all hospitals are the same, but its definitely seemed that way from a patient's perspective (and from the perspective of a support person/friend of patients).

I can't understand what this means:

Informed Consent and Patient Choice is a great thing, but it is not nearly as cut and dried as we are taught in nursing school, particularly when it comes to this field.

Can you explain this to me because it sounds kind of scary when I paint my picture of it but I don't want to jump to conclusions.

Thanks

When I first started to transverse the "birth process" as a patient, it was akin to Alice falling down the rabbit hole (alice in wonderland reference). Nothing was as I believed it to be. I had always nievely believed that you trust your doctors, and they always have your best interest at heart, and ultimately will respect your wishes and take care of you and try to make you happy and healthy.

I belong to an organization called ICAN (International Cesarean Awareness Network - http://www.ican-online.org/). It is a huge organization with a legal team, support groups throughout the world, and a large portion of their membership is in helping people work through the emotional aftermath of a hospital experience where they felt their rights were trampled.

My last obstetrician told my husband that "sometimes women have to be treated like children and scared into doing whats best for them" as his response after screaming at me and asking me in the hub of his office "do you WANT to kill yourself and your baby???" all because I had asked one of his midwives if there was an alternative to medication because my BP was a bit elevated at my appointment (I have huge whitecoat hypertension and knew that meds would require that I have him as my birth practitioner instead of the wonderful midwife that I was seeing there). I went to the 4 hospitals in my area and did tours of their OB ward during my pregnancy, and asked about natural birth and how the birth process worked at their facility. At one hospital I was told that I would not be allowed to have anything to eat, no intermittent monitoring, no repositioning, and could not even walk around my room or use the restroom without both a doctor's order and waiting for a nurse to come in and "detach me". I responded asking specifically about repositioning and said something light but along the lines of "but I'm an adult and in the end it would be my choice ultimately, right" and she said in no uncertain terms NO, I had no choice in the matter. I asked about the patient's bill of rights and about patient advocacy, and was told again that none of it was up to me, and she said many times "that just is not done here".

I cant tell you how many stories I hear, and women I have met through ICAN that have gone into a hospital and had their birth plans completely thrown out, and their wishes trampled and for no clear reason. In labor, your senses are a bit...off... I mean who's wouldn't? you're uncomfortable, anticipating and concerned with your baby's health, and of course we all want to get to the other side of the event... we want to see our baby. Many medical professionals use that motherly instinct against women. There is even a term for one of the 'tactics'. Its called the "dead baby card". Its when you are told that you have to do x, y, z, and when you falter, they suggest that your baby might die if you don't follow their directions. I'm NOT saying that babies do not die, or that it is true when they say it in some cases, but it is NOT true many of the times that it is said. I have heard it twice now, from two seperate providers, during near flawless pregnancies, and thankfully during times when I had my husband's support and time to walk away and consider their comments (as opposed to during labor in the hospital). I was told that I had to have a cesarean, out of nowhere at about 37 wks, because the paperwork was missing from my prior c-section birth (it was 9 yrs prior w/ an 8 yr limit on having to keep paperwork) even though they knew about it since I was 20 some weeks. I said that I wanted to chose a trial of labor, but that I would agree to monitoring and a hep lock, and I understood the risks, and I was told that NO, I had NO CHOICE. That doesn't sound like informed consent to me. I was not told that I had other alternatives, nothing. I was told that there WERE no other alternatives, that this was what I MUST do. (consequently when I used the provider that screamed at me in my next pregnancy not only was it not an issue for them, but nobody brought it up until I asked about it and I was told that that was "silly" and it made no sense for them to deny my TOL)

I could go on about this forever, lol. I don't have many personal experiences with the hospital (although I have about two dozen more examples from my pregnancies - including being interviewed for a national magazine as a result of the experience), as I ended up using a homebirth midwife after all of what I went through, but there are many many many others who could step up to this discussion and share their hospital experiences, which were much worse than what I experienced. I love birth and I think it is the most beautiful process in this universe, the bringing of another human being into this world. Its unfortunate that it has been tainted by these influences, but make no mistake, it DEFINITELY has.

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I wish it was that simple but in my experience the hospital is protecting themselves from the lawsuit happy world we live and work in. So they create 500 pages policies and procedures that medicalizes the birth process to protect their orifice from future litigation. Not only that, they are a business first and foremost, always. An OB department that can crank out the babies is a sure thing money maker. You can not crank out a baby and get mom delivered and home within 24 hours without it being all about medicine (according to them, TOTALLY NOT MY BELIEF!!!!)

My parents have ZERO say in what they want. Birth plans are thrown out the window when you come in. You want the tub, intermittent monitoring, walk the halls. Forget it. NOT allowed where I work. Don't want an epidural? Don't expect to find an RN that will tolerate you then because most of the nurses I work with despise the patients who don't want an epidural. Want a birth without Pit? Forget it, it won't happen. If if your doctor doesn't order it, the RN's I work with will eventually start in on their own. Don't want an AROM, forget that too, most of the staff with "accidently" break your water when they are tried of waiting on you to deliver.

We used to have a CNM who not only delivered patients but she was the DON there. This was before my time but I guess people used to travel 200+ miles to have a baby there because the quality of care was unbelievable. Parents got what they wanted, what they needed. Then the "medical" people stepped in after one of our 10 or so buy outs in the last 5 years. They told her she no longer had delivery privileges there. Then they started firing on the doctors that went "against the grain". Soon all the great L&D nurses moved on to better things and now it's we are probably one of the worst places in a 4 state area to deliver a baby at. It became about money.

I have a very love hate relationship right now with the L&D side of my OB department thanks to the aforementioned items. I guess it's like this pretty much everywhere around me too, so no sense in finding another hospital somewhere else......sigh. :cry:

So, I really wish it was a simple to say - if you want a non medical birth your hospital will give you one cause I really don't think that's possibly anymore in a hospital, at least not where I live. :banghead:

You have hit the nail on the head....the problem is your facility. The hospital system that owns just about everything around in my area, which is huge, will allow a birthplan...in fact, it's a "selling" point that the hospital pushes in their advertising here.

  • If you don't want an epidural, you don't have to have one.
  • You can limit the number of nurses in your room, not have one at all if you wish...once the pushing starts, you can't be left totally alone...but if the CNM is there, then that's fine with the hospital.
  • You are not required to have lady partsl checks if you don't want them...nurses there don't believe that the water always needs to be broke, and in fact, get pretty irritated when doctor's do it.
  • Every single nurse will stay with you when you have a natural delivery....this is NO different than the drug-mom's that come in where the pain meds flat out...don't work.
  • Heck, they even let you take the placenta home with you if you want! Unfortunately, I witnessed that this summer.
  • You can refuse the K for the baby.
  • You can refuse the eye drops for the baby.

The only non-negotiables are the following:

  • Baby must stay for 12-hours and be assessed....however, baby never has to leave Mom's room if she doesn't want it removed.
  • Mom can sign out AMA if she wants right after the delivery...most don't b/c baby can't leave.
  • Baby has to have a CBC if it cannot maintain temperature.
  • Baby has to have PKU...state law.
  • Baby has to have at least one accu-check before leaving.

But as far as the birth plan...it's her call.

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Specializes in Rural Health.
You have hit the nail on the head....the problem is your facility. The hospital system that owns just about everything around in my area, which is huge, will allow a birthplan...in fact, it's a "selling" point that the hospital pushes in their advertising here.

  • If you don't want an epidural, you don't have to have one.
  • You can limit the number of nurses in your room, not have one at all if you wish...once the pushing starts, you can't be left totally alone...but if the CNM is there, then that's fine with the hospital.
  • You are not required to have lady partsl checks if you don't want them...nurses there don't believe that the water always needs to be broke, and in fact, get pretty irritated when doctor's do it.
  • Every single nurse will stay with you when you have a natural delivery....this is NO different than the drug-mom's that come in where the pain meds flat out...don't work.
  • Heck, they even let you take the placenta home with you if you want! Unfortunately, I witnessed that this summer.
  • You can refuse the K for the baby.
  • You can refuse the eye drops for the baby.

The only non-negotiables are the following:

  • Baby must stay for 12-hours and be assessed....however, baby never has to leave Mom's room if she doesn't want it removed.
  • Mom can sign out AMA if she wants right after the delivery...most don't b/c baby can't leave.
  • Baby has to have a CBC if it cannot maintain temperature.
  • Baby has to have PKU...state law.
  • Baby has to have at least one accu-check before leaving.

But as far as the birth plan...it's her call.

:yeah: what a great place to work :yeah:

It gives me hope that when I graduate from my CNM program I can find a place where having a baby is a normal thing. I know they exist out there. I just knew that somewhere out there one existed...... :D

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:yeah: what a great place to work :yeah:

It gives me hope that when I graduate from my CNM program I can find a place where having a baby is a normal thing. I know they exist out there. I just knew that somewhere out there one existed...... :D

Exactly. Frankly, I don't see how the hospital can refuse to allow Mom to NOT choose her birth plan.

It all boils down to medically necessary...the fact that a doctor wants to go home early and the baby is not in distress, and he wants to break the water to move things along? That isn't medically necessary and Mom should have the right to refuse.

If a nurse won't stay with a Mom b/c she doesn't want drugs...I can't believe there are hospitals that will actually give nurses a choice in this...why should they care? If Mom is ok with the pain...it's not like the nurse has to feel any of it...just as long as Mom thoroughly understands that there is a point of no return...that is what any good CNM should do as well...just educate Mom on pros and cons..let her make the choice.

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Specializes in OB.

When I speak to people, many think of a lay midwife as a non-CNM who does homebirths.

exactly.. and to answer your question, Apgar.. a lay midwife in IMO is exactly that.. ones like in my area who carry no emergency meds (pit, methergine, oxygen) and who are 40 miles away from the nearest help.

the ones who brought a primip into me ONLY after her placenta had been retained for 5 hours and her BP was 60/40 with an EBL of 2500.. the same ones who are responsible for the brain injuries suffered by a friend's newborn.. tight nuchal pushed for 2 hours at home then finally got her to the hospital, where she was crash sectioned . He is now 9 and functions at a level of a 2 year old. If he had been at hospital, distress would have been shown on the monitor and he could have been sectioned earlier with a good outcome.

I had my first with a CNM, but at the hospital, I am GBS +. SHe was awesome and I loved the whole experience.. but very glad that I was there. Being primip, I had no idea that I was a bleeder and after delivery was rushed to OR. In pioneer days, i would have died. You just never know what can happen, even when moms are considered "low risk"

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Specializes in ICU/Critical Care.

I watched the "business of being born" the other night and it just made me think that the whole L/D experience was just something doctors dreamed up. They showed a L/D unit and every woman was on Pit. It's convienent for the doctor, put the patient on pit, scare the patient into having a c-section and the doctor gets to go home in time for dinner. It was disgusting. They showed a charge nurse going over all the patients and her questions were "Is the patient on pit?" or "Up the pit". It's like a baby factory or something.

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Specializes in Community, OB, Nursery.

The whole 'baby factory' thing really bothers a lot of the L/D nurses at my place. They get so disgusted with doctors who want to cut because a primip's been in labor for 13 hours and isn't complete....well, uh, she's a primip.

The notion that birth can be as natural as you want it in the hospital has to totally depend on the hospital, the nurses, and the doctors. In an ideal world, nobody would get pitted, AROMed, episiotomied, or sectioned unless absolutely necessary. But my hospital is not an ideal world.

A couple years ago we had a multip come in at 37+ weeks, 4-5cm dilated and contracting q3-4 min. Instead of letting her do her own thing - she's done it before and no reason to think she won't now - the resident AROMed her and started Pit. So instead of getting a happy baby who gets to stay w/ mom and BF immediately, we get a gray shell-shocked baby who comes in retracting like a turkey. Baby ended up being fine, but the whole thing was so unnecessary....and all because some resident decided that was what was best for her.

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