alath wrote:
Midwives have fewer patients (and since they usually
only handle childbirth they DON'T also have patients with gyn-related
concerns), and are able to plan their schedule so that they won't have
more than a few women due any single week.

According to the last survey by the ACNM, approximately 90% of visits
to nurse-midwives were for primary preventive care including
gynecologic care. The 90% figure is somewhat inflated due to midwives
who work in clinic-only jobs, but still for most midwives, basic
gynecologic care, annual exams, birth control, etc., is a large part of
the practice.


Actually I was thinking primarily of DEM's and homebirth midwives in
general having fewer clients and so being able to spend more time with
them. CNMs and hospital based midwives, in general, I would assume
work pretty much like OB's do, for the reasons you mention; they have
other patients, both in the office and in the hospital, and so CAN'T
spend 18 hours sitting there holding a laboring woman's hand. They
will have a little less do do because they don't have surgeries and ER
emergencies to deal with, but neither are they likely to be in the room
the whole time.

Naomi


In a hospital or birth center setting, having 2 or 3 patients in labor
at the same time is really not a problem. Think about it - if your
birth attendant is in your labor room for 20 or 30 minutes out of every
hour, and is there for the actual delivery, and that is in addition to
having a one-on-one primary nurse, that really should be plenty of care
and attention for most laboring patients.

The problem OB-GYNs have is scheduling GYN surgery. You can't just tell
your surgery patients to go home because someone is in labor.

The model most private midwife practices are using is to have a very
small number of midwives - usually 2 to 4. No patient really has a
"primary" midwife, but instead, sees each of the midwives throughout
pregnancy. That way, you still have someone you know fairly well
attending your birth. At the same time, the midwives are not on call
24-7.

24-7 primary models only work with very small, very low-volume
practices. With any kind of volume, it creates an unliveable situation
for the midwife and is potentially dangerous. If the midwive has three
patients deliver in a week (which is not really very high volume at
all), and labor-sits each patient all throughout their labor, you are
talking about a midwife who didn't get any sleep that week. The dangers
of health care providers going two and three days in a row without
sleep are well documented - this is unsafe for patients.

Even home birth midwives have to have some kind of back up on-call
arrangement in case they have more than one patient in labor at the
same time. It is easy to flip back and forth between rooms in the
hospital or birth center, but not so easy to go back and forth across
town for two patients laboring at home.