Why all the rag on technology in L&D??

CEG · Mar 28, 2007

Well, I am only a midwifery student, so take what I say with a grain of salt. I have never met a CNM who turned up her nose at someone who was informed of the risks and benefits of procedures and interventions and chose to have one. It's a shame the midwives in your area are like that.

Why would someone turn up their nose at the epidural? There are many risks with the epidural that few women are informed of, either through their own research or by the OB/ anesthesia. Epidurals introduce a whole new set of risks to the process with the only benefit being pain relief for mom.

As for the "naturalness" of labor, so many interventions in L & D snowball into bigger issues. I am not sure what you mean by someone going into labor on their own "within reason" but elective inductions are the cause of many problems. The US has one of the worst maternal and neonatal death rates among all developed countries- despite spending more per capita on maternity care than any other country. We obviously are doing something wrong.

I don't think it's quite fair to blame people who judge you for not breastfeeding long on La Leche League. Unless they showed you their membership card I don't think theres any way of knowing whether they are members. People are going to judge people all the time much the way you are judging the people who practice extended breastfeeding.

Also, if you are worried about being flamed I probably wouldn't inflammatory comments about CNMs on a CNM message board. It sounds like you still have some issues with your birth, I hope you resolve them soon.

deann52 · Mar 28, 2007

The US has one of the worst maternal and neonatal death rates among all developed countries- despite spending more per capita on maternity care than any other country. We obviously are doing something wrong.

The United States has a high rate of infant mortality because of the technology we have regaurding NICU care. The US routinly delivers babies 25 weeks and up whereas many countries do not deliver that early nor do they have the technology to do so.

If a 26 week preemie dies of complications 2 days after delivery it is termed an infant death. However if the docter let the baby go like many countries who don't have the technology or believe in a fairly high level of infant intervention it is keyed as miscarraige, not infant death. The US RARELY loses full term healthy babies. That is what the statistic does not take into account and people go "oh there must be something wrong with the US maternity system because of all these babies dying"...

I posted my first comment on a CNM page because I didn't know if midwives realized how much they push some people away who may have chosen a mid wife to a doctor...

CEG · Mar 28, 2007

Point taken about the NICU, but it is incorrect to say that babies in other countries born at early gestations count as miscarriages- there is a precise definition of neonatal, perinatal, maternal, etc. So in fact, given that our technology allows us to save many more babies than other countries, our neonatal death rates should be better, not worse.

Our maternal death rate is also higher than all but two developed nations.

I do think you have a good point about people being turned off by the idea that midwives are natural childbirth freaks. Many people say to me that they wouldn't have a midwife as they want an epidural. Over and over again I tell people they can have epidurals with midwives.

I wish there were more positive mainstream images of midwives, maybe Grey's Anatomy or ER could have midwives come in and start doing deliveries. I'll have to suggest it to ACNM :)

imenid37 · Mar 28, 2007

I am not a CNM,j ust an OB nurse for 16 years, an RN for 20. I have met nurses and CNM's who love epidurals, technology, etc. and some who are quite earthy, love birthplans, and are very pro-naturale. Most of the CNM's I have met will listen to the patients more than the docs do. I find many times they are less pushy re. opinions to encourage epidurals. A pt. who delivers in a hospital should be able to have one if she wants, but she shouldn't be ridiculued for being "silly" and not wanting one.(Yes, I have heard it said.."why wouldn't you want an epidural, dear?) As nurses first, many CNM's I have met are advocates for the patient. I do not work w/ any CNM's now, but still get the opportunity to talk w/ some in our general area from time to time. They are people who are, like the rest of us, subject to having their own opinion about things. That is why it is so nice to be able to choose who suits you.

BAtoCNM · Mar 29, 2007

I'm so sorry you've dealt with judgmental jerks Deanna! I guess those come in every profession. I am a soon-to-be midwifery student, but one reason I chose that route rather than OB was the emphasis in midwifery education on patient advocacy, and giving the patient all the information she needs to make the best choice for her. For some women (I'm sure for me!) that will include an epidural. For others, it may not. The history of OB in this country, which many awesome OBs have been working hard to change, has been to perform interventions for the convenience of the practitioner and/or the hospital rather than for the benefit of the mom/baby. For example, episiotomies were standard operating procedure for decades, and now research shows that they are associated with a slew of negative outcomes for mom and do not improve outcomes for baby unless s/he is truly in distress during delivery. Also, there is peer-reviewed data that one intervention often leads to a cascade of others. I've read that an epidural often predicts a C-section, even when controlling for other factors that could require one. Likewise, constant electronic fetal monitoring is associated with epidurals and C Sections. And C sections do carry the risk of death, disability, infection, and complications in your next pregnancy. It really sucks that one helpful intervention can trigger a whole slew of others, and that's why CNMs are trained to be conservative on that count, at least according to the midwives I interviewed.

I've met a few people who think CNMs will only perform "natural" births, or that working with one means you can't get a C Section if you need one. However, most of the time, CNMs are medical professionals working within a hospital system that allows them access to all kinds of pain relief, including epidurals, and the surgical skills of OBs should a section be neccessary. Several midwives I've interviewed in the area (all CNMs - perhaps CPMs are different) said that although they did not have epidurals during their own labors, nearly all of their patients choose to have one.

Like any practitioner, a midwife should not judge the choices you make for your own health! I have had this experience with MDs in the past and the result has been I never return to their practice. I guess when you know a lot about health you can get to thinking you know better than the person whose body you're treating, and yours is a cautionary tale for clinicians and other health professionals (ie breast-feeding folks) to remember their place as advocate for, not overlord of, a patient.

BAtoCNM · Apr 3, 2007

Deann, you might want to take a look at this book:

Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First

by Marsden Wagner

The information provided is current and backed up by research, plus it's written in a very conversational style.

CEG · Apr 4, 2007

Deann, you might want to take a look at this book:
Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
by Marsden Wagner
The information provided is current and backed up by research, plus it's written in a very conversational style.

:yeahthat: I had the chance to meet Marsden Wagner and hear him speak at a conference recently- very interesting issues he raises, particularly with his background as an MD and working for the government.

Sarah LnDHopes · Apr 6, 2007

I'd just like to add that it works the other way too...it also happens that women are made to feel silly or marginalized for wanting to go natural. Not just from doctors or nurses, but family and friends. And I got many "oh, um okay" type-comments regarding my decision to breastfeed. I didn't go around preaching why "everyone" should bf, but people often think negatively of it, and also my declaration that my next birth would be med free (or at least attempted.)

So it goes does go both ways...

crissrn27, RN · Apr 6, 2007

I only work with one CNM and she would not "rag" a person for wanting an epidural or for anything else. She does do more teaching from what I've seen than the OB's, on the risk and benefits of epis and everything else. Seems to spend more time with the patients. As far as breastfeeding, I agree its not for everyone, but patients deserve to know the risks of not breastfeeding, and I don't think most OB's (in my area) go into that. Breastfeeding is not the all of motherhood, but it does have importance, and patients should be educated as part of their PNC. That being said, after education is done, its up to the person to make their choices and no one should "rag" on anothers choice.

BAtoCNM · Apr 6, 2007

Yes, I've heard this from several woman that, when they choose the CNM route or a low-tech birth in general, people accuse them of everything from being a naive hippy to being a child abuser. Some women who want to give birth at home or with no epidural pain relief are chided for being silly or denied choice once they're in labor and can't really argue.

crissrn27, RN · Apr 6, 2007

I'd just like to add that it works the other way too...it also happens that women are made to feel silly or marginilized for wanting to go natural. Not just from doctors or nurses, but family and friends. And I got many "oh, um okay" type-comments regarding my decision to breastfeed. I didn't go around preaching why "everyone" should bf, but people often think negatively of it, and also my declaration that my next birth would be pain free (or at least attempted.
So it goes does go both ways...

I got this too. My MIL would say you are still BF?, but she is 13 months old, give her cows milk:lol2: and just got really mad when I said but she is a baby human not a baby cow! Even my own mom said more times than I could count, "boy am I glad I never did that (breast feeding)" it does work both ways............I certainly didn't tell my SIL I thought she was a bad mother for bottlefeeding.