PA-C's on L&D

Dave ARNP · Feb 22, 2004

A midwife can barely get, let alone pay for insurance these days.

HOW ON EARTH is a PA-C getting it and paying for it?

Dave

nekhismom · Feb 23, 2004

Never seen a PA do a delivery around my way. My OB had one in the office, she did rounds, etc, but did NOT do deliveries.

Scary thought, really.

I would prefer a CNM anyday.

L&D_RN_OH · Feb 23, 2004

We don't use PA's here in L&D. I don't even think any of our docs have one for office staff, since they use CNM's and NP's. I would think there would be some serious liability issues involved. Even our FP docs have to have OB back up, and no, the FP's do not do Csections. They are not surgeons. I'm not sure how it would work with PA's. Does the attending OB have to be present for delivery? I know our attendings have to be present for our FP resident deliveries.

Dayray, RN · Feb 23, 2004

I don't think an PA would need an attending present. The thing about PA's is that in most states they aren't independent practitioners. They work on an extension of the MD's license kind of like EMT's. CNM's on the other hand are in most areas independent.

So a PA can practice without a doctor being present only that it it assumed that they are acting as the doctor would and within the guidelines set by the doctor.

I don't know why a doctor would choose the liability associated with PA's when they could hire a CNM. It would seem PA's would place the doctor in a position of liability more so then a CNM who acts as an independent practitioner.

Dave ARNP · Feb 23, 2004

No PA can perform any function without the supervision of a physician. For those PA's who deliver babies, they either have their supervising MD/DO in house, or work under the "supervision" of the doc's in house.

If there is no doc in the building, they ain't catching babies.

If the entire OB staff was in the building, they ain't catching MY baby.

-Dave

L&D_RN_OH · Feb 23, 2004

No PA can perform any function without the supervision of a physician. For those PA's who deliver babies, they either have their supervising MD/DO in house, or work under the "supervision" of the doc's in house.
-Dave

That makes more sense. I know someone said for uncomplicated vag deliveries, but sometimes, even those become complicated. It would seem a PA would have to have an OB present just "in case".

Dave ARNP · Feb 23, 2004

Just as FP's do. OB/Gyns just have more expeirence in emergency situations.

They let FP docs do c-sections at my hospital, but that scares me too.

Do you want a FP doc sectioning you when the uterus decides not to clamp down, mom starts bleeding out and the FP can't perform a ceserean hysterectomy?

Not exactly what I want for my wife.

-Dave

L&D_RN_OH · Feb 23, 2004

I guess that's the difference at my facility. Our FP's have to have OB back up, andcan only attend uncomplicated vag deliveries. They can assist in a csection with their pt, but an OB performs the surgery. If at any time their cases become "complicated", they consult with the OB.

Dave ARNP · Feb 23, 2004

I would say part of it has to do with your hospital, and part of it has to do with the training of your FP docs.

Not a whole lot of FP docs learned C-sections in their residency. I'm thinking there are only about a dozen schools which teach surgery as part of their FP residency. Even then, most hospitals want the FP to have been head surgeon on atleast 50 procedures before they will credenital them to actually do it.

The FP residencies I know of teach C-sections, Tubals and D&C's as part of their rotation. There is one in California which (if the resident really wants to learn) will teach them appendectomies and chole's.

I could see a need for this in an extremely rural area, but I really wonder if the standard of care is or even COULD be met.

-Dave

nekhismom · Feb 24, 2004

If the entire OB staff was in the building, they ain't catching MY baby.
-Dave

I don't know why this was so funny to me this am, but it was HILARIOUS for some reason. ITA!

Dave ARNP · Feb 24, 2004

What can I say?

There are THREE people I would trust to deliver my child.

My wife (who is going to obviously be busy)

Her Ob/Gyn (whos also one of my best friends and the BEST Ob/Gyn I know)

The guy who is the director of the practice my wife's Ob/Gyn is at, who's rarely there as he's quite good and does alot of teaching in different states.

-Dave

gotosleep · Feb 28, 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

Useless? That strikes me as quite ignorant. I've worked with PAs in the Army and the ED who were quite good. I question anyone's judgment who makes rash generalizations like that.

randy srna