Why do we need the docs for delivery?

WhatToDo · Feb 28, 2005

From a public health perspective, people doing research online about their health is great! While I'm sure docs and nurses get annoyed with answering a lot of questions, it really empowers a patient and allows them to have some control over their health. Plus it really tests a doc or nurse's knowledge on the subject. If docs or nurses can't answer their questions or don't feel they have to, it's time to get a different health care provider.

I also think that internet research helps mom's learn to ask the right questions to their OB prior to birth like "what is your episiotomy rate?" "what is your C-section rate?" etc. This helps ensure that mom's goals and docs goals can work together.

Mimi2RN, ASN, RN · Mar 1, 2005

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.

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.

I modified this. We do have nurse delivered babies. I'd rather have the baby delivered by a labor nurse than wait for the doc to get it out, when the baby isn't looking good. We have a ped hospitalist for the baby, an RT, and a nicu RN available, and the L&D nurses are very glad we are able to attend. Our peds have no desire to do deliveries....just get the baby OUT.

It must be nice to have the OB in house before the baby is crowning. Our CNM's usually are here much earlier.

directcare4me · Mar 1, 2005

When I was a much younger nurse I would get really frustrated with the docs and think to myself "I know more about this than they do". And perhaps I did. But I have learned that what the MD provides, in addition to medical care, is a "the buck stops here" person. And no matter if I do feel superior in my knowledge and skills, I do not want that responsibility; even if I can "do it better" I am not willing, as the docs are willing, to have the ultimate responsibility for all outcomes. As an NICU nurse, I've heard a good number of horror stories, most of them regarding what were supposed to be "normal" deliveries. The docs can have it.

kc2004 · Mar 15, 2005

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.

You are right about the lay person's lack

of education about thier own health. Especially

during pregnancy. Can't tell you how many times

a Doc has ordered a C-section on a perfectly

normal labor patient just becuase he/she didn't

feel like waiting or wanted to " get it over"

so they can go home. If people knew what was

normal and knew what to expect during labor, Docs

wouldn't be able to "take the baby" at will.

I think that it is such a shame for docs to do

that to a laboring woman. An unwarranted c-section

takes all the joy out of having a baby. Being able to

bring a baby into the world "naturally" is a real pleasure

for a new mom. After 9 long months of pregnancy, it

is what I always looked forward to.

novb33 · Apr 22, 2005

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?

In the UK the midwives do the"Normal" deliveries at hospitals, birthing units and at home. That is what we are trained to do, as well as look after abnormal pregnancies. It is very rewarding and very good experience/practice, you do enhance your skills(ie. suturing, water births etc)! The Drs would always be called if there are abnormalities in the pregnancy or labour. I think midwives from the UK would become very de-skilled working on a L&D unit in the US!!

hospitalstaph · Apr 22, 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.

My husband caught our last two (not to be confused with delivering them, I did that:). It was a wonderful experience but when he tells other men what he did, about 80% are completely grossed out. I certainly married the right guy because he just LOVED it!

Tracy

hikernurse · Apr 22, 2005

Aw, you guys might not love delivering the babies, but you do a good job when you have to! I have great memories of the L&D nurse who delivered my daughter a few years ago.

nursey_girl · Apr 26, 2005

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?

Being an L and D nurse for several years, I admit that RN deliveries can be an adrenalin rush... but I want a Doc there whenever and wherever I can have him... Perfect deliveries can go to Hell in one split sec... Shoulder dystocias, uncontrolled bleeding... Yadda Yadda...Give me a doc anyday!

novb33 · Apr 26, 2005

Being an L and D nurse for several years, I admit that RN deliveries can be an adrenalin rush... but I want a Doc there whenever and wherever I can have him... Perfect deliveries can go to Hell in one split sec... Shoulder dystocias, uncontrolled bleeding... Yadda Yadda...Give me a doc anyday!

Midwives in the UK are trained to deal with all eventualities and we can call a Dr in a split second too!!! but not for a "normal " delivery !!!!!

teeituptom, BSN, RN · Apr 28, 2005

Maybe in other areas midwives are regulated. But under the current laws in Texas. Anyone can claim to be a midwife. The quality of the midwives in Texas is suspect at least. Ive worked ER for long time and nothing we hate worse than call from the Medics they are bringing in patient or patients from either a delivery that went south or one that was botched by a midwife. I can relate a sadly large number of tragic midwife attended deliveries. Unfortunately.

BETSRN · Apr 29, 2005

Maybe in other areas midwives are regulated. But under the current laws in Texas. Anyone can claim to be a midwife. The quality of the midwives in Texas is suspect at least. Ive worked ER for long time and nothing we hate worse than call from the Medics they are bringing in patient or patients from either a delivery that went south or one that was botched by a midwife. I can relate a sadly large number of tragic midwife attended deliveries. Unfortunately.

More than likely, these "midwives" that you refer to above are NOT certified nurse midwives (CNM's). CNM's are highly regulated and have wonderful skills.

teeituptom, BSN, RN · Apr 29, 2005

More than likely, these "midwives" that you refer to above are NOT certified nurse midwives (CNM's). CNM's are highly regulated and have wonderful skills.

I didnt say that they were certified. In the Proud State of Texas, anyone can advertise that they are a midwife. Unfortunately only the ones who are certified can be censored by the state if some unfortunate event happens.