Option of Midwives for Deliveries 
Author Message
 Option of Midwives for Deliveries

The local health care provider offers a service through its HMO where a couple
can choose a midwife.  The choice has been brought in response to my wife's
problem where her OB/GYN no longer delivers babies.  My wife has been given a
reference list of several GP's and a Nurse-Midwife.  Her doctor had no opinion
for/against the midwife.  In fact the Midwife is a recent addition to the
hospital staff.  We've been told that the delivery is performed in a hospital
room with both me and the Midwife present during delivery.  A "doctor" (no
specialty specified) would be available should there be any complications at
the time of birth.

What is medical professions' opinion of Nurse-Midwives.  What are the positive
and negative points in this matter?

Many thanks in advance.

--  
Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!233!13!Daryl.Perrero



Wed, 14 Apr 1993 09:43:47 GMT
 Option of Midwives for Deliveries
In a message of <24 Oct 90 14:54:36>, Daryl Perrero (1:233/13) writes:

 DP>The local health care provider offers a service through its HMO where a
 DP>couple can choose a midwife.  The choice has been brought in response
 DP>to my wife's problem where her OB/GYN no longer delivers babies.  My
 DP>wife has been given a reference list of several GP's and a
 DP>Nurse-Midwife.  Her doctor had no opinion for/against the midwife.  In
 DP>fact the Midwife is a recent addition to the hospital staff.  We've
 DP>been told that the delivery is performed in a hospital room with both
 DP>me and the Midwife present during delivery.  A "doctor" (no specialty
 DP>specified) would be available should there be any complications at the
 DP>time of birth.
 DP>
 DP>What is medical professions' opinion of Nurse-Midwives.  What are the
 DP>positive and negative points in this matter?

I have a couple of comments.  I am a nursing student and I just finished my
Maternity rotation.

Nursing is the study of human responses.  Responses to stressors, to illness,
to wellness.  Our professional focus is on responses.

Pregnancy is not an illness.  It is not a medical problem.  You only need a
medical professional (read: Physician) if you have a medical problem, a
complication, to your pregnancy.

Now, I can't advise you whether the individual Certified Nurse-Midwife (CNM)
you have at your disposal is better qualified to deliver your wife's baby than
the Medical Doctors you have at your disposal.  Many things go into making a
good baby birther (for lack of a better term).  CNM's and MD's have equivalent
educations about the birth process per se, their educations differ beyond that
knowledge.  MD's are trained to treat diseases, RN's are trained to help
people cope with their health situation(s).

The things beyond education that make a good baby birther are empathy,
sensitivity, good decision-making ability, confidence, patience, an ability to
work well on little sleep, and that proverbial ability to keep your head when
all about you are losing theirs.  Neither Nursing nor Medicine has a monopoly
on these qualities.

In general, I tend to believe that nursing is a more natural profession to
take baby birthers from because the main concern in an uncomplicated delivery
is helping the mother and child cope with a rapidly changing and stressful
transition.   Nurses do this kind of monitoring and intervention in ALL areas
of practice, therefore, it is an integral part of our education in EVERY area
in which we practice.  Doctor's are more geared towards planning and
implementing interventions to treat a disease.  Pregnancy is not a disease.

I know some highly gifted MD's, don't get me worng.  Really it will have to be
a personal decision based on your rapport with that particular CNM.  Good
Luck.

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

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



Wed, 14 Apr 1993 21:16:07 GMT
 Option of Midwives for Deliveries
As a pediatrician, I an say that I have had mostly positive experiences with
NURSE-midwives (emphasis placed emphatically on NURSE...)  they have a license
and a certification process and are fairly well trained.
If you are in a situation where a STAT OB consult can be had, and a
pediatrician or neonatologist can be had STAT, a Nurse-midwife would probably
do fine for you.  DO NOT use a LAY-midwife.  No or little certifiable
training, no basic medical/nursing training, and creators of some of the most
depressing obstetric disasters that I had the occasion to see.  They mad
mistakes that even someone outside of medicine would have known not to do.  
They are highly infiltrated by the granola set who don't believe in medical
technology (things like Oxygen, warmers,
suction for the baby.)  A lot do home deliveries which are frightfully risky.

--  
Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!3601!14.0!Jim.Harper



Tue, 20 Apr 1993 21:42:56 GMT
 Option of Midwives for Deliveries
In a message of <29 Oct 90 06:56:00>, Daniel Hagan (1:381/61) writes:

 DH>I'd sure hate to be in the delivery room when a teratoma or cystic
 DH>hygroma decides to show up with a mid-wife around.  Hope she's fast at
 DH>neonatal intubation...

Despite my repeated qualification of "uncomplicated" delivery, I assumed
someone would make a comment like this.  I am prepared to respond.  I will try
to shed some light here.

First of all, let's define your terms.  A teratoma is a tumor.  It does not
have an airway.  However, I surmise that what you were really referring to was
an infant that was subjected to some form of teratogen while it was gestating.  
A teratogen is an agent that is capable of interfering with the normal
development of the fetus.

There are chemical teratogens: {*filter*}, antibiotics of some types (e.g.
tetracycline), some cancer {*filter*}, and everyone has heard of thalidomide.  
There are certain microbes that are teratogens (Rubella, CMV , Toxoplasma
gondii, for example), radiation is also a teratogen.

Generally, the greatest influence that these subtances might have is between
the 3rd and 12th week of pregnancy.  If we are so concerned with
teratogenesis, we would give greater attention to the provision of prenatal
health care in this country.  Many more lives could be saved and much more
suffering eased (not to mention millions of dollars saved) by providing
prenatal care to all pregnant mothers than by providing people skilled in
emergency intubation of neonates, though that is an important resource as
well.

Some argue that much of this care is better done by nurses, it is certainly
cheaper that way.

The cystic hygroma you describe is a new one on me, but then I am not a
medical encyclopedia.  There is a con{*filter*} anomaly known as cystic
hydronephrosis, but I don't think that's what you meant.  This is a conditon
characterized by ureteral agenesis and atresia that results in renal cystic
degeneration.  Intubation (at least not endotracheal intubation) would not
exactly be indicated by the presence of this anomaly alone.

Surely you meant to imply that a few deliveries may require acute medical
intervention, neonatal intubation is the particular skill you mentioned.  This
is essentially a motor skill, learned as any other motor skill is
learned--through practice. Doctors, particularly pediatric anesthesiologists,
would no doubt be the best choice for intubating a neonate.  They get the most
practice.  No argument on that point.

We have fetal monitoring techniques and safe prenatal imaging techniques that
allow us to somewhat predict what level of care a mother and a fetus will need
at delivery.  If we utilize and continue to develop these, I am comfortable
with our skill at predicting which Moms need only nursing care for their
delivery.  We are have limited health care resources.  The most efficient use
of them is in everyone's interest.  Thanks for your interest in midwifery.

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

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



Tue, 20 Apr 1993 21:43:17 GMT
 
 [ 4 post ] 

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