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 Rural Health.
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)

This is exactly what my husband thinks. Our patients come in and don't know any better. Whatever the doctor or RN says must be right. Informed consent is a joke. They aren't informed. If they are on the fence about anything, believe me, any of the RN's where I work will be glad to swing them to the side of THEIR comfort and ease, not mom's comfort.

I try and educate my parents the best I can but it's a long, long, long process that should've started with their first OB visit not when they are in L&D, getting ready to have a baby and so excited they can hardly stand it and they have an attention span of a 3 year old on a 4 day sugar rush. A lot of the RN's I work with play that card against the parents. You can convince someone to eat a onion if you sell it like an apply ya know????

And I also agree with a previous poster that some of the patients not only expect it, they demand it. Of course, it's their labor, their delivery and their life choices they have to live with, not mine. This is one area I know I struggle with.

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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 actually called a lawyer during my 3yr old's pregnancy (I have a 13 yr old, 3 yr old and 1 yr old) and was told that unless we could prove harm, we would not have much of a case, legally OR otherwise. (I did not want to sue anyone, but I wanted a lawyer on my side in case I ended up in an unsavory situation due to the lack of options I was being given when trying to discuss my birth plan) Unfortunately, its hard to prove harm when mom and baby end up coming out the other side with minimal issues.

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This is exactly what my husband thinks. Our patients come in and don't know any better. Whatever the doctor or RN says must be right. Informed consent is a joke. They aren't informed. If they are on the fence about anything, believe me, any of the RN's where I work will be glad to swing them to the side of THEIR comfort and ease, not mom's comfort.

I try and educate my parents the best I can but it's a long, long, long process that should've started with their first OB visit not when they are in L&D, getting ready to have a baby and so excited they can hardly stand it and they have an attention span of a 3 year old on a 4 day sugar rush. A lot of the RN's I work with play that card against the parents. You can convince someone to eat a onion if you sell it like an apply ya know????

And I also agree with a previous poster that some of the patients not only expect it, they demand it. Of course, it's their labor, their delivery and their life choices they have to live with, not mine. This is one area I know I struggle with.

Perhaps this is something best posted on the CNM board, but I wonder if, becoming a CNM, we would have a BETTER shot at giving natural birth, or if we would end up with our hands tied even more by having to not only go along with, but actually order the interventions we disagreed with, because our OB/hospital told us to?

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Specializes in ER.
I actually called a lawyer during my 3yr old's pregnancy (I have a 13 yr old, 3 yr old and 1 yr old) and was told that unless we could prove harm, we would not have much of a case, legally OR otherwise. (I did not want to sue anyone, but I wanted a lawyer on my side in case I ended up in an unsavory situation due to the lack of options I was being given when trying to discuss my birth plan) Unfortunately, its hard to prove harm when mom and baby end up coming out the other side with minimal issues.

This is so true and is what we usually end up telling moms who call but it doesn't mean you can't use it to cry FOUL in the hospital setting. You know what I mean?

Its getting ugly in the maternity ward. I think its time to fight back by any means possible.

:wink2:

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Here is a part of another thread on L&D that I responded to. It made me shiver when I read it:

"Our L&D has just implemented a new policy decreasing postpartum recovery time in the LDR from hrs to 1 hr. I was pressured to to finish charting, assess the infant and mom q15 min, put baby to breast, remove epidural, lock IV, get mom out of bed to void (legs still possibly numb from epidural?), teach pericare, and take to postpartum floor in an hour? It was tough enough doing it in 2 hrs if mom was breastfeeding! What is your policy regarding this? I really thought I was doing everything as quickly as I possibly could!" banghead.gif

My response was that it seemed the hospital was moving cows around, not women.

Here is the full link:

https://allnurses.com/forums/f8/post-partum-recovery-time-320451.html

Why would women deliver with an OB instead of a midwive if they were low risk???

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Specializes in Emergency Department.

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.

Oy. It's unfair to all midwives to call this type of person a midwife. And FWIW, it is this type of "midwife" who helps color our profession in a negative light.

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Specializes in Emergency Department.
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.

Just short of utopia it sounds because everything is "her call", except how her baby is treated once it is outside of her body.

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Specializes in Emergency Department.
I try and educate my parents the best I can but it's a long, long, long process that should've started with their first OB visit not when they are in L&D...

Exactly. One of my hospital based CNM friends has said when she's got the deck call and encounters a woman she's never met, she doesn't exhort the energy in serious education. It was the job of the primary caregiver, she's just there for a few minutes. Every now and then she is impressed by someone interested in options and takes the road less traveled with regard to the hospital machine routine.

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Specializes in Midwifery.

"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."

Who has the right to tell a woman she can't take her baby home before its 12 hours of age? Its her baby.......wheres the evidence to support the fact that a newborn "needs" to be observed in hospital for 12 hours post birth? Paeds will tell us it is a fact but it's not !!

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Specializes in Rural Health.
Perhaps this is something best posted on the CNM board, but I wonder if, becoming a CNM, we would have a BETTER shot at giving natural birth, or if we would end up with our hands tied even more by having to not only go along with, but actually order the interventions we disagreed with, because our OB/hospital told us to?

Oh, I would like to think I'll be a more open minded, less intervention kind of gal than my OB counterparts, otherwise I'm about to waste a lot of time in school for nothing. :D

But seriously, I'm going to take a gamble here and say, it probably has to do more with what type of facility you are working in than anything else.

Just like with every aspect of nursing and healthcare, there are some great places to work and some not so great places to work.

I have some great hope though after reading some posts. There are still great OB departments in the world and that makes me happy. :yeah:

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"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."

Who has the right to tell a woman she can't take her baby home before its 12 hours of age? Its her baby.......wheres the evidence to support the fact that a newborn "needs" to be observed in hospital for 12 hours post birth? Paeds will tell us it is a fact but it's not !!

Good point. I hadnt thought of all of the "baby has to..." comments in this post. My babies, born at home, safe and healthy, had none of the above (except PKU at 1 wk after birth at the provider of my choosing). The thought that baby "CANT" leave, as opposed to "baby will be best served by" means that the parents rights are taken away. I guess I've always been so focused on getting the BIRTH right that I never considered these things.

I will say though, that PKU is NOT state law. You can sign a waiver. I chose to have the test for my children, and I think it is a good test, generally speaking (although some states do not require quite as large a panel as others and I'd rather have more than less, if it requires the same amt of blood and trauma)

I don't understand how parents are not the deciding factor for their children? What if the infant is perfectly healthy and the birth went flawlessly? What if mom and baby would prefer to just head home once post partum bleeding was under control and mom and baby were all cleaned up and snug? What if they had no problem with baby being checked out and all faired well? Its one thing if its a crack addict wanting to get back to her fix and obviously unable to care for the baby. I dunno. I guess I just dont feel that healthy babies and mommas are best served by being in the hospital so its hard for me to understand these requirements.

I will say though, that while I don't agree with a lot of the "musts" listed, they are a LOT better than every hospital that I toured in my 5-6 counties of trying to find a good hospital to have my babes at.

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I am another homebirth midwife who went back to school and became a nurse (Neuro ICU) because of money and also schedule. I became a mother myself and no longer wanted to be gone at a moments notice for unspecified days in a row and on call 24/7. I have specifically avoided the OB nursing setting because I doubt I can psychologically handle participating in what I see as abuse of women and babies as my area has only large resident run teaching hospitals and few to no real options for low risk women to have normal births. The section rates are 40-50% and the induction rates are 70-80%.

I have seen many infants damaged and even killed in hospitals, it just doesn't end up in the papers when it happens. Recently, a friend who is a homebirth midwife delivered a baby who had a completely normal course of labor, but was clearly in resp distress at birth and was discovered to have aspirated mec in utero, the neonatologist believes long before labor as is the case with most cases of MEC aspiration. The nurses were total jerks to this family and midwife, called the birth a trainwreck, turned the midwife into the state on and on. The irony is that there were two hospital delivered infants also in the same NICU wth the identical diagnosis who were managed and delivered by OB's. NO one seemed to notice the hypocrisy or irony in the situation except te neonatologist who repeatedly told the parents and staff that the location of birth would have in no way affected the outcome. The midwife acted responsibly, stabilized the baby and transported for care. The baby is fine now, but the experience for the family was made so much worse by the nurses and their ignorance.

My childhood friends baby has CP from a botched hospital delivery where they bagged her baby following delivery without working wall 02, and my cousin had a baby with permanent nerve damage to his arm from an overzealous resident who refused to allow her to push her own baby out. He was pulling too much on the babies neck. I personally wached a resident snap a babies neck during an overly involved manual "delivery" of an infant. The baby died of course, instantly. And those are just some of the more extreme stories that don't take into account the infants with run of the mill hospital aquired infections, the moms with necrotizing fascitis of their c-section wounds and so on. My hospital has seen 3 women in their 20's and 30's die from this exact scenario in the last two years, flown in from community hospitals and none of these sections emergent.

I don't believe hospitals are bad places to have babies, because as awful as these stories are they represent a fraction of the total number of births. Likewise, homebirth tragedies also represent a fraction of the total number of births. The major difference is that when a hospital has a bad outcome they often convince the family that it was just an act of god, whereas when it happens at home it is always attributed to the location of the birth.

I have fortunately never had a bad outcome that was preventable. I am an apprentice- trained midwife, and sought out diverse training opportunities that included externships overseas in higher risk populations and low technology settings. I have transported my share of women, and what is always sad is that the family is generally punished for transporting badly enough that it gives the midwife pause about transporting the next woman. That is part of why hospitals in some areas see "trainwrecks" because midwives are willing to try more and longer at home because they fear for their clients safety in the hospital. Ironically the lack of a collaborative relatonship between hospitals and homebirth practitioners leads to more problems.

People often tell me they think I am brave to have had my kids at home. Personally I feel like I took the easy road. I didn't have to worry about superbugs or infections, I never lost ownership of my body, I didn't have to battle policies and protocols designed to protect the hospitals interests at the expense of my and my babies care and I believe that the care I had was actually MORE research based in terms of the screenings, tests and procedures I had done. My prenatals lasted 1 hour to 90 minutes (yet had I transported I would have been documented as having had "no prenatal care" compared to the rest of the women there who had a series of 8 minute prenatals) and my midwives not only knew my name, they knew my whole life story, my husbands, how we live think and operate. They were intimately involved with my dietary choices, health history and baby.

The icing on the cake was that the day before my first son was due, my OB who was my backup provider told me he esimated my baby at 9 pounds and tried to scare me into a hospital delivery. The next day I delivered an ELEVEN pound baby at home in the water without as much as a tear. My labor was 9 hours long, I pushed for under 2 hours with no coaching and caught my own baby. Following this success story I was admonished that I had had a life threatening delivery (????) and should NEVER have a homebirth again, and should perhaps even think about a section for the next one. I just cannot get the logic of that.

For my second baby, I was unable to find backup because of my first babies size despite all evidence that I can deliver a large infant. Despite less weight gain and a closer watch over my diet my second was 11 plus two ounces. He was born in three contractions. Also at home, also no tears. We did have a less straightfoward experience though as I had numerous false labor starts for a week leading up to labor, I had an ultrasound that had show a possible kidney problem with him (which didn't worry me because my mother had an identical diagnosis with my brother that ended up being a flase positive) and we had obvious cord related decelerations in labor- he came wrapped in a mile of cord like a present a few days after christmas.

I am currently on the road to getting my FNP, and still think about geting a CNM to be able to do births again, but it is just so complicated in the current legal and medical climate. The solution seems so obvious to me- an integrated system where midwives, OB's and nursing professionals work in collaboration to support lower costs and better outcomes with increased choice for families.

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