PA-C's on L&D

CraigB-RN, MSN, RN · Feb 20, 2004

Comments based on ignorance are one of the reasons that no one takes us seriously. I"m hearing comments based on emotion and not fack. Over the past 20+ years there are as many NP's and midwifes that I would let touch me or any family member of mine. For example, I picked up a mother and child from a scene (I work as a flight nurse part time) whose deliver had been totally botched by the Nurse Midwife.

On the other hand, some of the rural hospitals that I respond to have PA's that have probably delivered half the residents in town. And they've got more experience than the FP doc that is only 2 years out of residency.

Dave ARNP · Feb 20, 2004

Um sorry. You will NEVER convince me that a PA with 3 years of medical training is qualified to do a delivery. Correct that. Apply a bandage to a hangnail.

I don't care that they have a masters just as Np's do. 90% of the PA's I know never touched a patient before they entered their program. You don't learn everything in those three years.

Dave

gypsyatheart · Feb 20, 2004

PA's are not used in L&D here. We do about 400 deliveries/mo and only OB's or CNM's do those deliveries. Even in the teaching hospital there are not PA's in the L&D. There are Women's Health and FP NP's seeing pt's in the clinics, but they don't do deliveries.

There are PA's utilized in one of our large hospital sytems in several other areas however.

SmilingBluEyes · Feb 20, 2004

Comments based on ignorance are one of the reasons that no one takes us seriously. I"m hearing comments based on emotion and not fack. Over the past 20+ years there are as many NP's and midwifes that I would let touch me or any family member of mine. For example, I picked up a mother and child from a scene (I work as a flight nurse part time) whose deliver had been totally botched by the Nurse Midwife.
On the other hand, some of the rural hospitals that I respond to have PA's that have probably delivered half the residents in town. And they've got more experience than the FP doc that is only 2 years out of residency.

would that be "FACTS" (not "fack")?

Now EVERYONE has stories how deliveries were botched by all manner of providers, yanno???? So??? And who says "no one takes us seriously"? PUUUHLEEZE!

I have 7 years' L and D experience,and while that is not a ton as compared to some here, I have NEVER heard of or seen an PA in OB, even in the tiny rural hospital in Oklahoma where I first worked out of school. Yep, I have rural nursing experience, too. SO ----I am not ignorant, or uninformed, nor is anyone here. We are answering based upon EXPERIENCE. Take care now.

imenid37 · Feb 20, 2004

I worked in a hospital in Baltimore where PA's worked on the L/D unit. They did not do deliveries (at least not intentionally), but they rounded on some of the pt's, did ve's (nurses did not do VE's at that facility), wrote post-op orders and adm. orders for routine pt's., and assisted w/ C.sections. I also think some of them worked in the OB/GYN clinic, but I am not sure what they did there. They were employees of the hospital, not of private physicians' practices. CNM's took care of the "low risk" clinic patients and some private physicians had CNM's in their practices who did deliveries at the hospital. My GYN doc has 2 PA's in her practice. I saw one last week for a routine check-up. I thought she was thorough and I was pleased w/ the visit (if one can ever be pleased by A GYN visit). I would've had to wait 2 months to see the doc for my yearly, so I was willing to see her this year. The PA's that work in this practice do not have priviledges at the hospital. I went on a google search and here is a link about PA's in the OB/GYN setting http://www.paobgyn.org

fergus51 · Feb 20, 2004

And people say that nurses get catty with one another because they are women? Then the second someone disagrees with me, I am ignorant and responsible for people not taking nurses seriously?

Craig, I have my own experience to draw on, and my opinion stands. Show me some real studies comparing the safety of PAs who do deliveries and the safety of CNMs and OBs or GPs and you'll get me to reconsider. Something tells me there aren't any.....

BETSRN · Feb 20, 2004

Never use PA's in our hospital at all. I know one of the teaching facilities nearby uses them but NOT in L&D. Seems to me that would be out of their scope of practice. We only have MD's and CNM's.

Dayray, RN · Feb 21, 2004

I've never heard of it but I wouldn't be surprised.

I'd take a CNM, OB or even a competent Fp over a PA for delivery. Not because I have anything against PA's , heck I prefer my doc's PA over the doc.

Let's think about why people pick OB's, CNM's or FP's as care providers.

OB- extensive training and experience, this is a doctor that spent a good deal of their life training specifically to care for OB patients.

CNM- years of experience as a nurse then specific training to care for OB patients. Slap on a model of care that supports patient rights, holistic care, compassion and respect for the patient and CNM's have allot to offer.

FP- Someone who the patient has come to trust threw years of check ups, colds and other medical problems, They are familer with the patient and there family and had at least some training in OB during med school.

PA- ? I'm drawing a blank here....

I can see how it would benefit a Doc to have a PA do deliveries but what do they bring for the patient? I'm sure they could be trained to do deliveries but why not hire a CNM?

I would have to admit that I would be troubled by a PA doing deliveries at my hospital.

fiestynurse · Feb 21, 2004

No Ob/Gyn doctor in her right mind would ever allow a PA-C, under her supervision, to deliver babies in L&D. A Physician Assistant is expected to perform with similar skill and competency and to be evaluated by the same standards as the physician in the performance of assigned duties.

Your wife is correct in saying that "they can do just about anything their doc will let them do." But, if I were her I would check with her malpractice carrier to see what they say. It could cause her rates to go up dramatically.

Also, hospitals have a say in the scope of practice for PAs in their facility. No hospital, that I know of, would allow this - some still have problems with CNMs in the delivery room because it is such a high risk area.

It's a bad idea!

Dave ARNP · Feb 21, 2004

Oh trust me, she's not going to let them DO much. But her rationale is this because some MD she talked to SAID that they could.

She agress that PA's are as useless as I do.

Dave

fiestynurse · Feb 21, 2004

I just checked-out the website that "imenid37" found on google search. The Association of Physician Assistants in Ob/Gyn. It looks like they do delivery babies at some rural hospitals. I am amazed!

mitchsmom · Feb 22, 2004

nothing personal to PA's... but just what midwives need, another group of practitioner's encroaching on "their" territory (remembering that midwives were around before docs)... like they aren't having a hard enough time already...