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 ICU/Critical Care.

Elvish, that's exactly what I would not want to happen to me.

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Just curious...are those of you who work in areas where patient's birth plan, etc. go out the window in rural areas?! I have worked in hospitals in a major city and in a large surburban area and the OB there is the complete opposite. They bend over backwards trying to keep mom happy as long as it doesn't put mom and baby at risk. I wondered if location had some bearing on it.

I think it's horrendous that the mother's wishes aren't carried out as long as she or baby aren't at risk. Gotta love 9-5 OBs. Barf. I'm surprised more patients don't fight back but I guess they are scared into submission. What a disgrace.

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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.

I heard that was great. I need to watch it. I'm all for natural births and the least amount of medical intervention necessary as health of mom and baby permits. What a shame that 9-5 OBs have taken over so much of this specialty. Sad.

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Specializes in Community, OB, Nursery.

Batman, I work at a big teaching hospital. It is just a toss-up which resident is on which philosophy you get. And it depends on the attending whether the nurses get backup on their frustrations w/ 'baby factory residents.' It's amazing the differences among residents - some are great and let mom do whatever she wants, and some have their deity complexes.....and you know how well THAT goes over.

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Specializes in Rural Health.

I work in a fairly large area, fast growing but our unit itself is pretty small. We deliver about 75 babies a month. Not a large metro area though and our hospital is a far cry from a teaching facility of any sort. We deal with OB's, no residents, no interns, just straight OB's. Family Practice docs were booted out a few years ago, they were a bit too liberal in their thinking. No practicing CNM's anymore because they were WAY to liberal thinking.

The staff gives the doctors what they want because that is way they think it works. It's a game. They play the game with the doctor at whatever cost to the mom and the baby.

Our manager knows, she claims it's too far gone to fix.

I'm totally miserable where I'm at but I really enjoy my PP and Nursery stuff so I stick it out and I hide from L&D where the trolls live.

I can give you all stories that would make your cry, believe me, they make me cry when I re-live them.

The area in which I work/live has the highest C-section rate in the country. They also banned VBAC's at every hospital in this area. I suppose it guarantees a bottom line. Who knows.

It isn't just a doctor or two that believes this - it's all 6 that practice where I work.

I've been pretty much shell shocked since coming to L&D, it's a far cry from what I ever dreamed it was or could be. I thought this would be a great stepping stone for me as I started back to school to be a CNM.

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Specializes in OB, House Sup, ER, Med Surg.

I work in a small rural hospital, with a CNM who delivers, a Family Practice Doc who delivers and does his own C/s et BTLs, and an OB-GYN. I fI were to have a baby, the CNM would be my first choice, followed by the FP, with the OB-GYN coming in last.

We do support and advocate for natural childbirth. If a mom wants minimal interventions, as long as baby sounds good, we honor that. We do provide massage, labor support, tub, ball, position change, intermittent monitoring, etc...

Unfortunately, most of our moms WANT to be induced, WANT the epidural ASAP, and WANT us to do anything we can to hurry up the process. It is very frustrating for me, but I have to remember that it is HER birth, not mine.

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I thought maybe it was location as then patients really wouldn't have as much of a choice as there wouldn't be other docs or hospital available locally. I'm shocked more women don't cause a huge ruckus or the hospitals haven't been sued more.

Having the highest c-section rate certainly isn't something to be proud of. And no VBACs also should raise some eyebrows. You'd think someone would get it and try to make changes but I guess no one wants to interfere with the almighty buck. Barf.

I live in an area where all this just wouldn't fly and thankfully the vast majority of docs seem to be open to birthing plans, etc. as long as mom and baby are okay. I couldn't even imagine them trying all of this as our patients are ummm vocal shall we say. lol

How tragic that docs put their schedule above that of the health of their patient and baby. I'm really disappointed in the nurses and the CN not being better patient advocates but it sounds like they have been beaten down into submission as well at this point. I hope the patients wake up and smell the statistics. Very sad.

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Specializes in Midwifery.

I am so sad for all of you who have to put up with this crap - how do you keep going when you know there is a much better way of doing things? We whinge here about our system....

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Just curious...are those of you who work in areas where patient's birth plan, etc. go out the window in rural areas?! I have worked in hospitals in a major city and in a large surburban area and the OB there is the complete opposite. They bend over backwards trying to keep mom happy as long as it doesn't put mom and baby at risk. I wondered if location had some bearing on it.

I think it's horrendous that the mother's wishes aren't carried out as long as she or baby aren't at risk. Gotta love 9-5 OBs. Barf. I'm surprised more patients don't fight back but I guess they are scared into submission. What a disgrace.

I agree that its horrendous, but its VERY common place unfortunately. I have had experience now with a big city hospital with a lvl 3 NICU and I think a LVL 4 "Perinatal Center" (not sure what that means exactly but I know there are 3 floors just for birthing/NICU/PICU/Peds). They are as far from natural as can possibly be. There are NO birth balls, birth plans, natural birth friendly resources of ANY kind. Also 2 smaller rural hospitals, both of which are zero natural birth friendly (although one has the great CNM that I mentioned wanting to use in my previous birth) and one other hospital thats just a tad bit larger than those, small city-ish, that claims to be pro-natural childbirth (as long as you have all of your records! agree to do everything as we say, and oh wait... I know we advertise a birthing tub but we decided it was too much trouble...sorry we didnt mention that!)

The midwife that I had wanted to use and used for my prenatal care said that she worked in both rural and large city hospitals and would never advise a low risk mom to go to a hospital that handles high risk deliveries, because once you see too many of those, it becomes near impossible to not treat every mom walking in as a high risk, whether they want it or not. That sentiment has been echoed recently by a nurse on our LD floor that I had the pleasure of meeting. There's also a mom who's baby was in the NICU for 3 months, that I go to school with, who thinks that type of baby trauma is normal, because she saw it all around her with the quite full NICU. Even though that hospital takes cases from the entire 1/3rd of the rather large state, she still sees it only from her perspective.

Hopefull- thank you for sharing what your hospital is like. I think that really makes a difference in understanding your perspective. If the hospitals in my area were like that, I would never have considered going another route (homebirth/non CNM midwife). As I said, its like Alice falling down the rabbit hole. Nobody could ever expect it to actually BE this way.

I think its a state/locality thing. I had to drive an hour and 15 minutes just to find ONE provider who was natural childbirth friendly for VBACs. Yet in other areas, and Seattle comes to mind, its common practice and birth centers are readily available in my understanding. (here, they just open and then get shut down 6 months later because there are so many ridiculous hoops to jump through)

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Unfortunately, most of our moms WANT to be induced, WANT the epidural ASAP, and WANT us to do anything we can to hurry up the process. It is very frustrating for me, but I have to remember that it is HER birth, not mine.

I really think its a lack of education that brings this about, or maybe mis-education. When I was pregnant with my first child, my OB wanted to schedule a cesarean because my bp was a bit high. Ya know why he told me to do it? Because it would "hurt less" and because "the birth process is so painful, you can do this and avoid the whole thing". (thats why it took 8 yrs and a LOT of spiritual growth and support from my husband to have another baby)

Every time I talk to a woman who has had an intervention full birth and regretted it, it goes back to lack of knowledge. You would NOT believe how many women think there is no other way!! (well maybe you would :) ) People think that the birth process is going to kill them. People think that drugs are the way to avoid pain. Nobody ever thinks about the needles in the spine, in your hand, post-epidural headaches, incision pain, episiotimy pain, etc etc. I think our society is just so intervention happy that its hard to think that not taking drugs would be the right choice. Beyond that, people don't think that they can argue with their OB. Atleast in my area, and maybe its something about the "old South" but its nearly unheard of that women argue with their OBs. They all looked at me like I was crazy when they said "you will do x, y, z" and I said, "but how will you handle it if instead I would like to do a, b, c".

I think that the PP really hit the nail on the head when they said that most patients WANT the interventions. Until we can educate enough women to swing the popular vote in a direction where they feel they DESERVE and SHOULD make less interventive choices, this will continue to be a problem, outside of the more forward thinking areas of this country. "Doctors know best" should not be the only deciding factor in how we care for ourselves. People need to take responsibility for their lives and their births, and not just hand it all over to someone because they have a string of letters after their names. Unfortunately, by taking that responsibility, we inherit some of the risk if things go awry, and I think its easier to sleep at night if we just let someone else take that risk. (collective "we" not meaning anyone in particular)

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I work in a fairly large area, fast growing but our unit itself is pretty small. We deliver about 75 babies a month. Not a large metro area though and our hospital is a far cry from a teaching facility of any sort. We deal with OB's, no residents, no interns, just straight OB's. Family Practice docs were booted out a few years ago, they were a bit too liberal in their thinking. No practicing CNM's anymore because they were WAY to liberal thinking.

The staff gives the doctors what they want because that is way they think it works. It's a game. They play the game with the doctor at whatever cost to the mom and the baby.

Our manager knows, she claims it's too far gone to fix.

I'm totally miserable where I'm at but I really enjoy my PP and Nursery stuff so I stick it out and I hide from L&D where the trolls live.

I can give you all stories that would make your cry, believe me, they make me cry when I re-live them.

The area in which I work/live has the highest C-section rate in the country. They also banned VBAC's at every hospital in this area. I suppose it guarantees a bottom line. Who knows.

It isn't just a doctor or two that believes this - it's all 6 that practice where I work.

I've been pretty much shell shocked since coming to L&D, it's a far cry from what I ever dreamed it was or could be. I thought this would be a great stepping stone for me as I started back to school to be a CNM.

:yeahthat:

I think we might work together... I agree with you on everything.

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Specializes in ER.
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).

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.

Thanks for answering and thanks for being an advocate for moms. With my son, the doctor tried to play the dead baby card when my baby's heart rate decelerated for a period after I was asked to move into the back lying position. His heart rate improved after I moved to my side. Interesting to me because I always knew he didn't like it when I lay on my side. Anyway, the midwife saved me from the dead baby card.

I have already mentioned this somewhere on these boards before but providing medical interventions without a patient's consent is ASSAULT in my state (actually battery upon a person but most people understand assault better). It is a crime and you can be arrested for it.

I will spare you any further details. Suffice it to say, I agree wholeheartedly with you, scorpiostudent and I have had too many heartbroken friends on my couch fresh from c-sections. Its too too sad to talk about.:bluecry1:

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