Option of Midwives for Delive 
Author Message
 Option of Midwives for Delive

In a message of <31 Oct 90 14:45:52>, Terry Sadowsky (3:712/744) writes:

 TS>I basically do not disagree with your posting PROVIDED the midwife is
 TS>adequately trained as to when to call for medical intervention when
 TS>or if something is not going to plan.

Agreed.  No one is more concerned about nursing education than myself, I can
assure you of that.

 TS>The only reason i bring this up is because i do not particularly enjoy
 TS>being called to a 'Baby not breathing - post delivery' discovering that
 TS>the baby has been cyanosed/apnoeic for an unacceptable time since its
 TS>delivery.

This brings up an issue that should not be ignored. Often, at least in this
part of the country, midwives have not been allowed to practice the same
environment that the obstetricians did.  I know a few midwives who quit doing
independent births and went back to work for hospitals for this same reason.

Let's take your above hypothetical.  If that midwife had been practicing in an
environment that allowed for external fetal montioring, being surprised by a
severely compromised cyanotic infant at birth might be malpractice.  She would
not have to rely on frequent auscultation only to assess the fetus.  There
would be a record of fetal heart rate and an estimation of contraction
patterns.  

MD's don't like to do delivery's without such equipment because they believe
the benefits of a (modern) non-traditional birth environment, the home, do not
outweigh the risks.  Generally, if someone wanted to have anyone in a
medically responsible postion attend a home birth, it had to be a nurse
midwife.

Put time and human beings together and you will get mistakes.  These lead to
these apocryphal tales of gross negligence.

I would argue that all other things (resources, environments) being equal,
midwives are just as safe as obstetricians.  My belief that they might be
better could be attributed to professional cheerleading because of my
position.  But, my assertion that they are as safe is supported by empirical
evidence.  The numbers show that they might be a little better at prenatal
care, which is understandable given our prfoessional focus on human response.

Richard DeWald, BSN Student
Univ. of TX - Austin.

--  
Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!382!70!Richard.DeWald



Sat, 24 Apr 1993 12:33:18 GMT
 Option of Midwives for Delive

Quote:
>Let's take your above hypothetical.  If that midwife had been practicing in an
>environment that allowed for external fetal montioring, being surprised by a
>severely compromised cyanotic infant at birth might be malpractice.  She would
>not have to rely on frequent auscultation only to assess the fetus.  There
>would be a record of fetal heart rate and an estimation of contraction
>patterns.  

But, according to a study published in the New England Journal
of Medicine within the last two months, babies born with external
fetal monitors actually have statistically *worse* outcomes than
those monitored through stethoscopes.  (Apologies for the very
inexact citation; like most laymen, I found out about the study
from reading the writeups in newspapers, in my case the
*Boston Globe* and *New York Times*.)  

Quote:

>MD's don't like to do delivery's without such equipment because they believe
>the benefits of a (modern) non-traditional birth environment, the home, do not
>outweigh the risks.  Generally, if someone wanted to have anyone in a
>medically responsible postion attend a home birth, it had to be a nurse
>midwife.

And part of the reason the "natural-birth" movement has gained such
strength is the belief that there are also risks associated with
standard modern medicine.  Expectant mothers are thus caught
between two bad outcomes:  *over*-intervention in the hospital,
and *under*-intervention at home.  Either can be dangerous;
at the end of the line, you just have to trust your practitioner.

Me, I gave birth in a hospital, and was glad of it; my daughter
was healthy and beautiful, but I was glad to know that expert assistance
was available if needed.

Apollo Division, Hewlett-Packard, Inc.
(her opinion doesn't matter, matter, matter, matter...)



Fri, 30 Apr 1993 23:18:00 GMT
 Option of Midwives for Delive

Quote:

>But, according to a study published in the New England Journal
>of Medicine within the last two months, babies born with external
>fetal monitors actually have statistically *worse* outcomes than
>those monitored through stethoscopes.  (Apologies for the very
>inexact citation; like most laymen, I found out about the study
>from reading the writeups in newspapers, in my case the
>*Boston Globe* and *New York Times*.)  

This statistic is meaningless. Did you know that people treated with
anti-cancer chemotherapy have a much higher mortality rate than the general
population? Gasp! (Of course, the cancer rate among such people is a heck of
a lot higher than in the general populace. It's not surprising that more of
them are dying.)

I suspect that babies born with external fetal monitors are precisely those
who are expected to have the worst deliveries. Fetal monitors are a result of
this, not a cause.



Sat, 01 May 1993 22:24:26 GMT
 Option of Midwives for Delive

Quote:

>>But, according to a study published in the New England Journal
>>of Medicine within the last two months, babies born with external
>>fetal monitors actually have statistically *worse* outcomes than
>>those monitored through stethoscopes.

>This statistic is meaningless. Did you know that people treated with
>anti-cancer chemotherapy have a much higher mortality rate than the general
>population? Gasp! (Of course, the cancer rate among such people is a heck of
>a lot higher than in the general populace. It's not surprising that more of
>them are dying.)
>I suspect that babies born with external fetal monitors are precisely those
>who are expected to have the worst deliveries. Fetal monitors are a result of
>this, not a cause.

I believe the study being discussed is the one in the March 1, 1990
New England Journal.
It dealt with a fairly small sample and only examined the use of fetal
monitoring for premature infants, but it _was_ a randomized trial.
Unless there was a problem with the randomization such as    
obstetricians pulling patients out of the study whom they felt
were at high risk if they were randomized to the no fetal monitoring
group (a common way that randomization can break down) then the
explanation can't be the one given above.
There are lots of technologies that turn out to be pretty much useless
once subjected to a randomized trial.  I don't know if this was the
definitive study for fetal monitoring, but those who think it's useful
now must bear some burden for proving it.

For those who care, the reference is:    
NEJoM 1990 Mar 1;322(9):588-93 "Effects of electronic fetal-heart-rate
monitoring, as compared with periodic auscaltation, on the neurologic
development of premature infants."




Sun, 02 May 1993 03:14:50 GMT
 
 [ 4 post ] 

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