Why do we need the docs for delivery?

SmilingBluEyes · Feb 25, 2005

It's all about "risk management" and lawsuit/insurance concerns. Not to mention a HUGE lobby on the part of the AMA since the turn of the 20th century to make childbirth their "own." (versus that of midwives since time began prior).

The USA, is not Europe, obviously. Things are different here. We serve an increasingly "entitled" population.

Yes, I feel the frustrations, but this is where we find ourselves in 21st century labor/delivery, where everyone wants and demands a perfect outcome and minimal effort or pain on their parts to get there. The doctors feel they can deliver this type of care to this population---and it's become their domain primarily in the USA. This is the time in which we live.

expatnurse · Feb 25, 2005

It is true that in the UK midwives deal with normal births. I have been out with them as a student nurse and if I had the chance later on I would want to train as a midwife. Over here it is not viewed as an illness, furthermore the woman is given more control of the experience This is way I will never have a child in the USA. Also the midwife does a home visit after you leave the hospital and you can still call upon her/him for up to 28 days. Afterwards a health vistor takes over. I feel that in the USA the doctors control of the labor process has been harmful to woman and made her scared.

fergus51 · Feb 25, 2005

I never minded. I always had enough to do. Plus, I don't stitch up, so for any deliveries with tears, I'd need a doc anyways.

SmilingBluEyes · Feb 25, 2005

I never minded. I always had enough to do. Plus, I don't stitch up, so for any deliveries with tears, I'd need a doc anyways.

But then you get into the incidence of tearing and instrumentation. When midwives were involved, I definately noticed MUCH less tearing and need for stitching up afterward. It's like a chicken and egg situation.

fergus51 · Feb 25, 2005

Sometimes, but really the majority of the OBs I worked with were great. In Canada in particular, I almost never worked with midwives, but I didn't see more tears. (the midwives were actually the ones I feared working with unfortunately). I would definitely prefer not to call the OB if he sucks, but if the OB is good I don't have any desire to catch the baby. I really had enough to do:D

BETSRN · Feb 25, 2005

It is true that in the UK midwives deal with normal births. I have been out with them as a student nurse and if I had the chance later on I would want to train as a midwife. Over here it is not viewed as an illness, furthermore the woman is given more control of the experience This is way I will never have a child in the USA. Also the midwife does a home visit after you leave the hospital and you can still call upon her/him for up to 28 days. Afterwards a health vistor takes over. I feel that in the USA the doctors control of the labor process has been harmful to woman and made her scared.

I wager to say that many of us older nurses would agree with you. he younger ones have never known any differently.

James Huffman · Feb 25, 2005

I think we're leaving someone out of this equation. Perhaps the reason we have docs doing the delivery is because the mother (the patient in this situation) wants them there.

I have seen (and I'm happy that I have) a huge increase in the number of nurse-midwives practicing. However, there are mothers who want a physician to do the job. Or at least be there.

The patient is the one who calls the shots, and she has the final say in this question.

Jim Huffman, RN

Jolie, BSN · Feb 25, 2005

I had 2 high risk pregnancies which I carried to near-term. Both deliveries were expected to be normal and uncomplicated, since the prematurity issues were behind us. Both presented with unanticipated complications at the last minute. My oldest daughter had a complex presentation, with both hands up to her face. The doc had to do quite a bit of maneuvering to get her out. My youngest had an occult prolapsed cord.

I'm a perfect example of how things can get unexpectedly complicated at the last minute. Not that a CNM or experienced labor RN couldn't have handled my deliveries, but I was grateful to have a physician present.

I have known a few docs and midwives who willingly step back and allow a person of the mother's choosing to "catch" the baby when all is going well, usually Dad or a nurse with whom the mother has developed a relationship. I've always enjoyed those deliveries.

SmilingBluEyes · Feb 25, 2005

I think we're leaving someone out of this equation. Perhaps the reason we have docs doing the delivery is because the mother (the patient in this situation) wants them there.
I have seen (and I'm happy that I have) a huge increase in the number of nurse-midwives practicing. However, there are mothers who want a physician to do the job. Or at least be there.
The patient is the one who calls the shots, and she has the final say in this question.
Jim Huffman, RN

I dont' think most of the American public is educated or prepared to question this (doctors being the primary caregivers of pregnant women), however, James. You are leaving out a huge variable/ contributing factor there. Most people I come across dont' question much of what happens to them in the hospital or what their doctors order. They are often not educated or taught to do anything but comply " for their own good". ESPECIALLY in WOMEN, this can be true.

I can't tell you how many patients I have had to explain EVERYTHING to because their doctors have not the time or patience to do so in the office. So many have come to the hospital for inductions or NSTs or other procedures that have NO clue why they are doing these and what the plan is. They just show up as told to do. Some even have NO idea WHY they are being induced, just told "it was time". That, to me, represents a HUGE lack of education out there. Contrast that situation to that of midwife patients, who can tell ME a thing or two about their bodies, pregnancies, and plan of care. They seem so much better-prepared and educated as to the whole process.

Perhaps if women as a whole were taught to take more charge of their health care and choose more carefully or discerningly their providers--- we might see some things change a bit in how and whom women choose to provide for their heathcare and in what setting. I sure plan to educate my own daughter better than I was.

ShannonC · Feb 25, 2005

Wow... interesting thread. For me (have been an L&D nurse in Southern California for 7 years), I see the doctor as part of the patients' team. I am an important part, and so is the OB. I have caught some babies, but I always prefer it when the doctor is there. What if something goes wrong that I am not qualified to handle? What if she bleeds and I can't stop it? What if there is some unforeseen complication that only presents itself at delivery? Rare, I know, but if it happens, I want someone with an M and a D after their name present.

That said, I totally agree that there are many patients don't take the responsibility to get themselves educated. They blindly follow their doctor and don't understand what is happening to them. Some don't care. Last weekend we had 4 (or was it 5?) inductions scheduled in a 12 hour period for the same doctor. I asked my patient why she was being induced and she said "Oh, Dr. D has a conference to go to and she wants me delivered before she goes". This was perfectly okay with my patient. I think for some people, from what I see in my fairly affulent patient population, there is this idea of the doctor as the person they have "hired" to "take care" of the delivery, much like you'd hire a caterer for a party. They just want to turn all the decision making over to the doctor and leave it at that. And if that is what they want, so be it. It sits funny with me on some level, but another way to look at it is that it is the other extreme of letting someone have the kind of birth she wants. If a patient wants to not think about anything, not have to decide, wants to leave all the choices to someone else and have a completely medical birth, that is her choice here in 2005. Like I said, it's not the way I would do it, but I gotta respect her wish.

What a great topic. I wonder how the OBs would feel if they knew we dicussed their relative usefulness. LOL! :)

-Shannon

SmilingBluEyes · Feb 25, 2005

OBs are useful. But they are not our only choice. I don't think most of us mean to say OBs are "useless", here at all.

I have studied some on the history of dhildbirth in America, particularly that of the "grannie midwives" and their role in birthing in the Early American South. To me, it's sad how traditional midwives effectively got squeezed out--------by special interests such as the AMA, by sue-happy people, by insurance companies, hospitals, and by the public at large that has come to believe only doctors can deliver competent care in healthy pregnancy and birth in the "controlled" environment of a hospital. That is all I am trying to say here. It's interesting to me how we women as a group have been so willing to relinquish our choices and the power to make them in our medical situations.