Why do we need the docs for delivery?

Specialties Ob/Gyn

Published

It seems to me like the experienced nurses on this board could very easily deliver the normal healthy deliveries. Just wondering if the OB nurses get frustrated with having a doc do the delivery, when all he or she did was catch? In Europe aren't all the nurses also midwives, and they only call the doc for emergencies? Do you guys think this would be a better practice?

Specializes in NICU.
So, some of the medical advances of our time have been for good. There was a dark time when women were knocked out and babies pulled out with forceps. It is not like that anymore and I think our docs totally repect a womens wishes for birth.

That's what happened to me. I was 7 months pregnant when I moved to the US, and I didn't have a clue about having a baby. My mil had made an appointment for me with the only OB in town. He told me that I would be given a spinal and he would deliver the baby. I didn't know that I would have no memory of my delivery. My 9lb 3oz boy was delivered with forceps, and I didn't see him until the next day. He's now 35 years old.

I now attend high risk deliveries, some with an OB, or CNM or sometimes nurse delivered. If the baby's heart rate has been down for a while, and the doc on his way in, I'd still much rather have the baby out and crying. We do have a PEDIATRIC hospitalist at those deliveries.

That's what happened to me. I was 7 months pregnant when I moved to the US, and I didn't have a clue about having a baby. My mil had made an appointment for me with the only OB in town. He told me that I would be given a spinal and he would deliver the baby. I didn't know that I would have no memory of my delivery. My 9lb 3oz boy was delivered with forceps, and I didn't see him until the next day. He's now 35 years old.

I now attend high risk deliveries, some with an OB, or CNM or sometimes nurse delivered. If the baby's heart rate has been down for a while, and the doc on his way in, I'd still much rather have the baby out and crying. We do have a hospitalist at those deliveries.

My mom's deliveries with me and my sister were the same. She doesn't remember anything until the next day as the doc used "twilight sleep" . . .consicious sedation basically.

Pretty barbaric.

steph

Actually, docs rarely just "catch". There is a lot of technique to this and many babies do not just slide out. Believe me, I want the doc or midwife there to take that responsibility. Sure, I can "Catch" if the baby comes shooting out but that is really a rarity. With malpractice rates where they are and in this litigious society, I want the doc there taking the responsibility he pays dearly for!

This is true - docs rarely just catch. Sometimes it takes a couple of hours to push the baby out and he is sitting there on the stool encouraging the mom with the rest of us.

steph

Again it has been interesting reading all the arguements for and against obstetrician lead deliveries only.

As a midwife in the UK I am a practioner of normal childbirth if all is well with mum and baby I care for the womwn in labour and am the professional responsible for the delivery. We are also aware of all potential problems and in these cases even if only for advice we refer to a doctor for their opinion.

I know that health care systems are different here to the US but not that different that maternity care couldn't be made less medical.

I think that may be the key ......... attitude, on the whole midwives are more accepting of doing nothing and allow nature to do what it does best. Doctors, on the whole, tend to prefer intervention and 'helping nature along'.

Litigation also seems to be a high priority in some of the posts from the L/D nurses, I wouldn't say I practice defensivley but I do practice safely, yes the unexpected can happen but I am prepared for that and have the skills and knowledge to recognise those situations and call for medical assistance appropriately.

Specializes in Maternal - Child Health.

If the baby's heart rate has been down for a while, and the doc on his way in, I'd still much rather have the baby out and crying. We do have a hospitalist at those deliveries.

I have to chuckle at the thought of a hospitalist attending an emergency delivery in the absence of the attending OB/CNM. My sister is a hospitalist, an internist, who has not seen or participated in a delivery in her 15+ years of medical practice. She'd be useless as t**s on a boar! Better to have experienced labor nurses in attendance.

Specializes in RN, BSN, CHDN.

Speaking as registered midwife here in uk. No normal births do not need a doctor to deliver them, babies will often deliver themselves, I have been the facilitator at many births where you are there to ensure nothing goes wrong. When at any stage in the pregnancy or during labor things start to go wrong then doctors intervene.

I did 18 months further training, of which part of my training focused in on the abnormal, which allows midwifes to make informed decisions of when and when not to involve a doctor.

Here all women are delivered by midwives unless intervention is required and in one hospital I worked there were a couple of midwives who were trained to do vacum extractions.

There is research to prove that if the woman is delivered by a midwife they are less likely to require suturing. Here in the UK that is probably because Dr's rarely get to deliver babies unless they are having an abnormal delivery and in that case they may require episiotomies for vacum/forcept births.

Specializes in med/surg/tele/neuro/rehab/corrections.

I had a friend, a retired doctor, that delivered 12 babies. He said he loved it until something nearly went wrong and he was so scared the baby would die. The baby turned out ok but it scared him away from becoming an OB/GYN! He was the nicest man.

I have four children and doctors delivered my first three. They were calm and very nice. I liked them a lot. Then I requested a nurse midwife for my fourth and really disliked the whole experience! I remmeber the first thing she said was, "Ok lets get started!" as she clapped and then rubbed her hands together like a man ready to work on a car! LOL! I cried for 7 months afterward the experience was so bad. (Post partum depression too) In my experience I liked the doctors more because they were more sensitive and gentle and yes they were men.

I had a friend, a retired doctor, that delivered 12 babies. He said he loved it until something nearly went wrong and he was so scared the baby would die. The baby turned out ok but it scared him away from becoming an OB/GYN! He was the nicest man.

I have four children and doctors delivered my first three. They were calm and very nice. I liked them a lot. Then I requested a nurse midwife for my fourth and really disliked the whole experience! I remmeber the first thing she said was, "Ok lets get started!" as she clapped and then rubbed her hands together like a man ready to work on a car! LOL! I cried for 7 months afterward the experience was so bad. (Post partum depression too) In my experience I liked the doctors more because they were more sensitive and gentle and yes they were men.

I am sorry you had a negative experience with midwifery. Speaking as a nurse who works with CNM's all the time, having a midwife birth is WONDERFUL, usually, but not always. That's not to say that docs don't do a good job too. It just depends on their approach to the birthing process.

This is true - docs rarely just catch. Sometimes it takes a couple of hours to push the baby out and he is sitting there on the stool encouraging the mom with the rest of us.

steph

Unless you have a really PATIENT doctor!! LOL!

Specializes in Perinatal, Education.
Again it has been interesting reading all the arguements for and against obstetrician lead deliveries only.

As a midwife in the UK I am a practioner of normal childbirth if all is well with mum and baby I care for the womwn in labour and am the professional responsible for the delivery. We are also aware of all potential problems and in these cases even if only for advice we refer to a doctor for their opinion.

I know that health care systems are different here to the US but not that different that maternity care couldn't be made less medical.

I think that may be the key ......... attitude, on the whole midwives are more accepting of doing nothing and allow nature to do what it does best. Doctors, on the whole, tend to prefer intervention and 'helping nature along'.

Litigation also seems to be a high priority in some of the posts from the L/D nurses, I wouldn't say I practice defensivley but I do practice safely, yes the unexpected can happen but I am prepared for that and have the skills and knowledge to recognise those situations and call for medical assistance appropriately.

I practice at a community hospital within a large suburban area--not at all rural. Most of the hospitals around here are small community with a few big teaching ones here and there. None of the community hospitals have MDs there 24 hours. I am there in the middle of the night and to get an MD one must be called from home and woken up to come in. I end up delivering a few of those babies that just come on out, but I am also in the business of deciding when intervention is necessary as the labor progresses. We have a lot of responsibility during the labor process and a very big influence on how the woman's experience goes. We may not be CNMs, but you better believe that we are the ones responsible for the labor process. I don't have MDs reviewing strips at 3am unless I have called them in due to my decision based on my knowledge and experience and co-worker's opinions. So even though we may not be CNMs, I feel we can make a good experience for those who want a 'less medical' birth. Most of my patients, hoever, want epidurals and a quick labor.

Specializes in med/surg/tele/neuro/rehab/corrections.
I am sorry you had a negative experience with midwifery. Speaking as a nurse who works with CNM's all the time, having a midwife birth is WONDERFUL, usually, but not always. That's not to say that docs don't do a good job too. It just depends on their approach to the birthing process.

Thank you for your kind words. Just to clarify further, I was trying to make a similar point. I personally didn't know that a doctor could be so good to me as I expected them to be cold, which they weren't. (guess I had heard too many horror stories? My first was born in 1982 and things were different.) So I expected this same treatment with my fourth and last child born 9 years ago and I guess I was surprised I didn't get it from the women around me. To be fair, afterwards I was heavily affected by PP depression. My son was due July 8 and arrived June 22 (a big surprise) I tore during delivery and he was born with a broken clavical. It happens. minor stuff really. But in that situation everything was magnified. I know CNM's are a great option for the expectant family. I just had that one in a million experience that didn't work for me. I consider it to be an abberation, not the norm.

Thanks for listening. I'm not even in Nursing school yet so this is all from a patient perspective. Hope that's ok.

FW

Specializes in ER, ICU, L&D, OR.

Well Ive worked OB many years ago, but Ive been in this ER for almost 2 decades. While many midwives do excellent work. I have seen quite a few incidents over the years where they have botched deliveries also and Ive recieved newborns come in by EMS with CPR in progress. And poor outcomes.

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