Future for specializing in infertility and IVF?

caitiecait · Mar 17, 2009

I mean inFertility my bad with the spelling! :banghead:

morte, LPN, LVN · Mar 17, 2009

contact one of the Mods, they will fix it for you..

Elvish, BSN, DNP, RN, NP · Mar 17, 2009

Consider it done. :)

cardiacRN2006, ADN, RN · Mar 17, 2009

Studies have shown that fertility patients take far fewer risks when it comes to delivering their babies. When presented with the "c-section would be safer for your baby talk' they will choose the c-section far more times that regular moms- to-be.

In addition, some women who conceived via IVF or orher means are higher risk.

If you conceive via IVF your RE is your OB for the first 12 weeks or so. Then you transition back to whoever.

I guess what I'm saying is, If I conceived through my RE, I would want to take as few risks as possible and have this pregnancy and birth monitored to the hilt. There is a good reason most of us haven't gotten pregnant through traditional ways, and I would want to make sure that it woudn't affect the prengnacy.

The entire pregnancy started off as medical and non-natural as possible as it is.

So for me, I wouldn't choose a midwife. I'd want the monitors, the hosptial, the whole shebang.

Just my opinion...

CNM2B · Mar 17, 2009

Studies have shown that fertility patients take far fewer risks when it comes to delivering their babies. When presented with the "c-section would be safer for your baby talk' they will choose the c-section far more times that regular moms- to-be.
In addition, some women who conceived via IVF or orher means are higher risk.
If you conceive via IVF your RE is your OB for the first 12 weeks or so. Then you transition back to whoever.
I guess what I'm saying is, If I conceived through my RE, I would want to take as few risks as possible and have this pregnancy and birth monitored to the hilt. There is a good reason most of us haven't gotten pregnant through traditional ways, and I would want to make sure that it woudn't affect the prengnacy.
The entire pregnancy started off as medical and non-natural as possible as it is.
So for me, I wouldn't choose a midwife. I'd want the monitors, the hosptial, the whole shebang.
Just my opinion...

I hardly think that choosing a CNM is considered "taking a risk", especially if you look at the available research. Also, most CNM's do work in hospitals, so the "monitors, the hospital, the whole shebang" that you mention is certainly an option with a CNM (I had all of that with my delivery and a CNM!). I have had several friends who dealt with infertility and ultimately chose a CNM for a variety of reasons. Of course, it is every woman's choice as to the kind of provider they choose--whatever makes them most comfortable!!

cardiacRN2006, ADN, RN · Mar 17, 2009

I hardly think that choosing a CNM is considered "taking a risk", especially if you look at the available research.

Hence the phrase, "Just my opinion". It's just not even an option for me if I were to get pregnant with IVF.

But then again, I'm not getting pregnant anytime soon, so there you go.

Midwife2012 · Mar 19, 2009

So weird that this topic came up. I was reading on Sunday and started thinking about possibilities, my life's purpose, what would be fulfilling...yadda, yadda, yadda. And I would love to work in reproductive endocrinology as well. I will be starting school in May to become a CNM and WHNP, my school has the dual specialty thing. Anyways, I think it would be just great to work with a full spectrum of women to plan families.

This is sort of a personal mission as well. I have had years of trouble trying to conceive and I'm relatively young. And when I tested positive two years ago, made my doc appt, got there and there was nothing. So this whole area really speaks to me. At first I was a little reluctant to become a CNM, I didn't know if all the beautiful babies being born would bother me, but I've been so happy since volunteering in the labor/del area of the hospital. I can't wait to start catching babies.

Also, I understand about the whole being nervous after an IVF procedure. If in the event I have to do it to have my babies, I'm taking every precaution I can. Bells and whistles all the way!! I don't know if it is foolish or what but I would still love to have a natural birth with a midwife.

And I found some really good encouraging info, check out this facility started by a midwife in NJ... http://www.childbirthcenter.net/

cookderosa · Mar 19, 2009

Studies have shown that fertility patients take far fewer risks when it comes to delivering their babies. When presented with the "c-section would be safer for your baby talk' they will choose the c-section far more times that regular moms- to-be.
In addition, some women who conceived via IVF or orher means are higher risk.
If you conceive via IVF your RE is your OB for the first 12 weeks or so. Then you transition back to whoever.
I guess what I'm saying is, If I conceived through my RE, I would want to take as few risks as possible and have this pregnancy and birth monitored to the hilt. There is a good reason most of us haven't gotten pregnant through traditional ways, and I would want to make sure that it woudn't affect the pregnancy.
The entire pregnancy started off as medical and non-natural as possible as it is.
So for me, I wouldn't choose a midwife. I'd want the monitors, the hosptial, the whole shebang.
Just my opinion...

>>

It's too bad your catching flames for your post. I think you'll find women in both camps....but for some to ignore that this specialization of care would be very limiting in terms of our client base- is putting our head in the sand.

My experience is just that, mine, but I had 5 people close to me give birth with the help of infertility treatments. 2 friends, 2 brothers, and 1 postpartum doula client went through infertility treatments- they were all hyper-careful, and not only were they seeing OBs, but absolutely were all considered high risk (in fairness, two were caring multiples) and absolutely considered it essential to the health of the babies. both my sister in laws had WEEKLY ultrasounds (one lives in IL, one in NY) for months. None had spontaneous lady partsl deliveries. I don't want to debate those situations- I'm just sharing what has been my experience.

Additionally, even for months after the births, there was this period that seemed, to me, to be a little more watched than your typical postpartum period. The idea of being "careful" seemed to be a little extreme, even in my client situation.

I think a woman with a strong history of independent thinking, maybe having prior experience with midwives, etc might consider a CNM delivery, but I do agree with CardiacRN, I think that would be unusual. Having had 4 midwife attended births -and obviously being Pro-midwife, I would use a CNM w/ OB back up if it were me....but Women whose pregnancy is given to them by a doctor, have a feeling of indebtedness to him. It's not an issue of if the pregnancy actually high risk, it's perceived high risk by the pregnant woman- and she's the one who gets to pick her provider.

Midwives fill a need, I don't think it's providing highly technical specialized obstetric care inside the medical model of birth (thank goodness).

CNM2B · Mar 19, 2009

It's too bad your catching flames for your post. quote]
I certainly wasn't criticizing anyone's opinion, if that is what you are implying. I was just simply stating that using a CNM is not taking a risk (according to available research). Every woman, regardless of how she conceived, is completely free to make her own decisions about her pregnancy and labor (that is a concept at the very heart of midwifery). I was just pointing out that using a CNM does not preclude a fully-monitored hospital birth (because many people, including a lot of nurses, think that CNM's are hippies who who only participate in un-medicated and un-medicalized births.)
I apologize to CardiacRN, if you in any way think that I was disparaging you or your opinion. That was certainly not my intention. I wish you the best of luck in your journey on this!!

Bree124, BSN, RN · Mar 20, 2009

I think this is a great topic, and a great discussion. I didn't see flames anywhere.

We were just discussing the topic of ART in Ethics this week, and I found some of the statistics really interesting.

A pregnancy conceived by IVF has much higher risks than a "naturally occurring" pregnancy. The stillbirth rate is 60% higher, the baby is 3X more likely to be born before 32 weeks, the baby is 2X more likely to have a major birth defect, and 2X more likely to die before his or her first birthday.

The mom is also at double the risk for a c-section, she is less likely to have an active say about what happened during the birth, less likely to be pleased with the birth experience, and less likely to be able to hold the baby after birth. Furthermore, she is more likely to report severe postnatal pain, and need more help and advice with feeding.

I don't necessarily know what this means for midwifery. We know that midwives provide really high quality care to low-risk women. But can fertility patients be considered low risk? Are the risks and complications inherent to the conception process, or are they from the above mentioned hyper-vigilance when monitoring these pregnancies?

I definitely think that integrative care could be implemented for these moms. I think that so much is focused on the medical aspect of becoming pregnant and maintaining the pregnancy. But is anyone caring for the patient as a whole person? Does the woman have any emotional/spiritual support from her caregivers? I think this is where midwives could play a huge role. Patients who see midwives tend to report feeling cared for as a whole person, and I think this is exactly what fertility patients need. I think that some sort of combination care with an OB/RE could really improve care (and hopefully outcomes) for these women.

adpiRN · Feb 8, 2010

A pregnancy conceived by IVF has much higher risks than a "naturally occurring" pregnancy. The stillbirth rate is 60% higher, the baby is 3X more likely to be born before 32 weeks, the baby is 2X more likely to have a major birth defect, and 2X more likely to die before his or her first birthday.
The mom is also at double the risk for a c-section, she is less likely to have an active say about what happened during the birth, less likely to be pleased with the birth experience, and less likely to be able to hold the baby after birth. Furthermore, she is more likely to report severe postnatal pain, and need more help and advice with feeding.

This is really interesting. Does anyone know why? On my unit we do have a lot of fetal demises related in IVF patients and I've often wondered why there is a connection. I had a patient who had to use IVF 3 times to get pregnant and at 39 weeks her baby died in utero from a tight nuchal x3. Was this related to infertility or just a random accident that could have happened to anyone?