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I was just wondering, is it standard procedure in a normal delivery...



 
 
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  #11  
Old October 10th 06, 08:55 PM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I was just wondering, is it standard procedure in a normal delivery...

That's not true.
I am able to somehow schedule office hours as well as stay at my
client's homes from the time that labor is established until after the
birth.

Not only that,...but OBs don't see you after the birth until 6 weeks
postpartum. I come back 1 day after the birth, 3 days aftrer the
birth, 1 week, 3 weeks, and then 6 weeks after the birth.
and still manage to do all my prenatals and birth care.


presumably though you occasionally have to cancel an office hours time, or
have someone else attend for a short time?

My midwife had her clinic 2-4pm on a Tuesday, and it's certainly not going
to be the case that no one ever has a baby at that time! She kindly did all
my prenatals at my home and a couple of times they got moved to later the
same day because other things happened.

Cheers

Anne


  #12  
Old October 10th 06, 10:11 PM posted to misc.kids.pregnancy
Bryna
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Posts: 25
Default I was just wondering, is it standard procedure in a normal delivery...


wrote:
Bryna wrote:

I agree that it's not uncommon (I used an OB for my first birth --
never again!) but it can't simply be because of office hour concerns.
Many midwives run practices that are identical to OBs, but are
nonetheless able to "wait it out" with the woman in labor, often by
having group practices where one midwife is "on call" for office
visits, while the others attend laboring women. OBs, in my experience,
just have a different standard of care. If you want someone to be with
you during labor, use a midwife.


As noted in my post, many (most?) OB's have group practices too, to
allow some docs to be in the office while others are at the hospital
for labors and deliveries.

I'd guess that a bigger difference (allowing the typical midwife to
spend more time with the laboring woman) is simply the size and scope
of the practice. 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. I'm sure that when OB's are
hanging out in the hospital anyway, they aren't just sitting in the
doctor's lounge watching Oprah while waiting for Mrs. Jones to crown.
They are tending to the other 5 women who are in labor at the same
time, being called down to the ER to check on OB/GYN-related cases,
doing emergency c-sections, and much more.

Naomi


I guess I see that as a standard of care issue -- they schedule more
patients (therefore making more money) because they intend to spend
only a minimal amount of time with a laboring woman, which is SOP as
taught in medical school. For women with a separate support system, or
who don't need or want that type of "hand-holding," it can be a fine
set up. If, however, one wants more personalized attention during
labor, I would still recommend a midwife.

Bryna

  #13  
Old October 11th 06, 12:48 AM posted to misc.kids.pregnancy
Elle
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Posts: 95
Default I was just wondering, is it standard procedure in a normal delivery...

don_tspamme wrote:
...for the doctor who is delivering your baby to only show up when you
are at the pushing stage? I guess it doesn't really bother me, as my
doctor was in contact with the nurses at the hospital and everything,
and I did see him earlier in the day when I first went into labor - I
just was surprised that this was so. Now I am due with a second, and my
first doctor has retired, so I am wondering if this is normal procedure
or if basically the doula/midwives are the ones who spend time with you
during the labor process and the doctor only shows up at the end? I
have to find a new doctor, and I don't know if what I'm looking for
(more handholding I guess???) is more of a doula thing than a doctor
thing...


Was true for me. We have one-on-one L&D nurses though -- not sure what
I would have wanted my doctor around for. If something was going awry
he would have been there but since it was all normal he checked in on
me a couple of times and left me to it. My OB was there for my birth,
he attends about 60% of his patients' births. This figure will vary
from doctor to doctor though. If you want/need handholding from your
care provider you might want to go the midwife or doula route.

Elle

  #15  
Old October 11th 06, 03:10 AM posted to misc.kids.pregnancy
Ericka Kammerer
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Posts: 2,293
Default I was just wondering, is it standard procedure in a normal delivery...

Bryna wrote:
wrote:
Bryna wrote:
I agree that it's not uncommon (I used an OB for my first birth --
never again!) but it can't simply be because of office hour concerns.
Many midwives run practices that are identical to OBs, but are
nonetheless able to "wait it out" with the woman in labor, often by
having group practices where one midwife is "on call" for office
visits, while the others attend laboring women. OBs, in my experience,
just have a different standard of care. If you want someone to be with
you during labor, use a midwife.

As noted in my post, many (most?) OB's have group practices too, to
allow some docs to be in the office while others are at the hospital
for labors and deliveries.

I'd guess that a bigger difference (allowing the typical midwife to
spend more time with the laboring woman) is simply the size and scope
of the practice. 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. I'm sure that when OB's are
hanging out in the hospital anyway, they aren't just sitting in the
doctor's lounge watching Oprah while waiting for Mrs. Jones to crown.
They are tending to the other 5 women who are in labor at the same
time, being called down to the ER to check on OB/GYN-related cases,
doing emergency c-sections, and much more.


I guess I see that as a standard of care issue -- they schedule more
patients (therefore making more money) because they intend to spend
only a minimal amount of time with a laboring woman, which is SOP as
taught in medical school. For women with a separate support system, or
who don't need or want that type of "hand-holding," it can be a fine
set up. If, however, one wants more personalized attention during
labor, I would still recommend a midwife.


Actually, I think it's more than that. I think
continuity of care is a very real issue. A lot of the art
of medicine is instincts. When you limit continuity of
care, you limit the ability of the caregiver's instincts
to function at peak effectiveness. Most of the time, this
isn't a big issue, but when it's important, it's *really*
important. I truly believe that ideal care is for one
skilled caregiver to participate in all prenatals, much
of labor, delivery, and postnatal care. That gives you
the very best opportunity for your caregiver to be able
to bring every possible resource to bear on detecting
problems, especially those subtle ones that are easily
missed. Better yet, it allows the caregiver to know you
better and know what is normal *for you* rather than
relying on textbook descriptions of what should be.
So, if one believes that to be the gold standard,
there is value in getting as close to that situation as
possible, or at least realizing that as one moves away
from that situation, one gives something up.
I've had three homebirths. Two were with a very
small direct entry midwifery practice where the two midwives
were at virtually all the prenatals and virtually the entire
labor and delivery (well, except the second labor was so
fast that the second midwife didn't make it until after the
fact ;-) ). The third was with a CNM practice where
there were five midwives, you rotated through the midwives
for prenatals and were attended by the midwife on call for
your labor (along with a birth assistant of your choosing).
I definitely perceived a significant difference between
the two models. I adored all the midwives at both practices,
and I think they are all wonderful caregivers, but there were
many more ways for details to fall through the cracks in the
group practice and I didn't have the level of communication
with the midwives in the group practice that I did with the
smaller practice. I would recommend both practices, but
if I had my 'druthers, I'd go with the smaller practice.
Now, it's *really* hard to get continuity of
care. Many women don't even have access to a situation
where they could have a reasonable chance of counting
on a single caregiver for prenatal/birth/postnatal care.
Many wouldn't be willing to consider a homebirth
practitioner, which is where one is most likely to
find that level of continuity of care if, in fact, it
is available at all. Sometimes one has to trade off
other desirable qualities against continuity of care.
Nothing is perfect, so I don't criticize any individual's
choice. We all have to make the best decision we can for
our individual situations. That said, I think people in
general greatly underestimate the value of continuity of
care. What I think is absolutely amazing is that this
is one aspect of quality care that is often *cheaper*
than the alternative (though not necessarily in terms
of out of pocket costs, if insurance doesn't cover
midwifery care).

Best wishes,
Ericka
  #16  
Old October 11th 06, 03:31 AM posted to misc.kids.pregnancy
cjra
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Posts: 1,015
Default I was just wondering, is it standard procedure in a normal delivery...


Ericka Kammerer wrote:
Bryna wrote:

I guess I see that as a standard of care issue -- they schedule more
patients (therefore making more money) because they intend to spend
only a minimal amount of time with a laboring woman, which is SOP as
taught in medical school. For women with a separate support system, or
who don't need or want that type of "hand-holding," it can be a fine
set up. If, however, one wants more personalized attention during
labor, I would still recommend a midwife.


Actually, I think it's more than that. I think
continuity of care is a very real issue. A lot of the art
of medicine is instincts. When you limit continuity of
care, you limit the ability of the caregiver's instincts
to function at peak effectiveness. Most of the time, this
isn't a big issue, but when it's important, it's *really*
important. I truly believe that ideal care is for one
skilled caregiver to participate in all prenatals, much
of labor, delivery, and postnatal care. That gives you
the very best opportunity for your caregiver to be able
to bring every possible resource to bear on detecting
problems, especially those subtle ones that are easily
missed. Better yet, it allows the caregiver to know you
better and know what is normal *for you* rather than
relying on textbook descriptions of what should be.


For example, during labor DH was the one I wanted holding my hand, tho
having my midwife there was important for both of us, to reassure us
all was normal and well. But very importantly, when we transferred to
the hospital and saw the OB on call whom I'd never met - tho she was
fabulous, having never had interaction with her could have made a
difficult situation more difficult. Being very wise, she turned to my
midwife who knew me well, knew the circumstances and had been with me
through labor to help guide her in her decisions with me. And I turned
to my midwife then for the same reasons. When it was most important
having that continuity of care was critical.

  #17  
Old October 11th 06, 04:00 AM posted to misc.kids.pregnancy
[email protected]
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Posts: 215
Default I was just wondering, is it standard procedure in a normal delivery...


birth junkie wrote:
wrote:

I'd guess that a bigger difference (allowing the typical midwife to
spend more time with the laboring woman) is simply the size and scope
of the practice. 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. I'm sure that when OB's are
hanging out in the hospital anyway, they aren't just sitting in the
doctor's lounge watching Oprah while waiting for Mrs. Jones to crown.
They are tending to the other 5 women who are in labor at the same
time, being called down to the ER to check on OB/GYN-related cases,
doing emergency c-sections, and much more.

Naomi


All the more reason to hire a midwife OBs can have their
emergencies and women can get better one-on-one care. Everyone's happy.


Though (just being practical here) until there are more midwives
available, everyone CAN'T hire a midwife. If a midwife finds herself
with 20 patients all due in the same week, she won't be able to sit
with them for hours on end either! (Another post commented about
doctors taking on lots of patients so they can make lots of money.
Unfortunately, that really isn't the case. Doctors take on lots of
patients because lots of women need doctors. I'm sure most OB/GYNs
would be thrilled to have smaller patient loads.)

So here's hoping that the number of midwives WILL increase, so everyone
WILL be happy!

Naomi

  #18  
Old October 11th 06, 04:58 AM posted to misc.kids.pregnancy
Anne Rogers
external usenet poster
 
Posts: 1,497
Default I was just wondering, is it standard procedure in a normal delivery...

For example, during labor DH was the one I wanted holding my hand, tho
having my midwife there was important for both of us, to reassure us
all was normal and well. But very importantly, when we transferred to
the hospital and saw the OB on call whom I'd never met - tho she was
fabulous, having never had interaction with her could have made a
difficult situation more difficult. Being very wise, she turned to my
midwife who knew me well, knew the circumstances and had been with me
through labor to help guide her in her decisions with me. And I turned
to my midwife then for the same reasons. When it was most important
having that continuity of care was critical.


the wierd thing for me about all this is, that though in the UK you should
get the same person through your labour and delivery unless there is a shift
change, or something untoward, most of the time it's going to be someone you
don't know because most hospitals operate a system of having a set of
midwives on a given unit and a team of community midwifes, so you see the
community midwife antenatally and postnatally, but unless you have a
homebirth, someone else handles the birth and if you are admitted to
hospital, they are out of things, which can make for a bad situation. I
think had my midwife been involved in the late pregnancy discussions about
mode of delivery, a different result may have occurred, because she knew me,
knew that I was in tune with my body and that if I was requesting a
c-section then that meant I needed one, when the hospital midwives just
assessed me as someone who was fearful of labour. But given all that, at
least during labour a doctor didn't just waltz in at the last minute,
thinking there prescence was all important and necessary, when in actual
fact I just delivered the baby onto my tummy and absolutely zero
intervention was given, which we'd probably have had to fight had there been
a doctor there.

Cheers

Anne


  #19  
Old October 11th 06, 01:43 PM posted to misc.kids.pregnancy
New York Jen
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Posts: 28
Default I was just wondering, is it standard procedure in a normal delivery...


"don_tspamme" wrote in message
ups.com...
...for the doctor who is delivering your baby to only show up when you
are at the pushing stage? I guess it doesn't really bother me, as my
doctor was in contact with the nurses at the hospital and everything,
and I did see him earlier in the day when I first went into labor - I
just was surprised that this was so. Now I am due with a second, and my
first doctor has retired, so I am wondering if this is normal procedure
or if basically the doula/midwives are the ones who spend time with you
during the labor process and the doctor only shows up at the end? I
have to find a new doctor, and I don't know if what I'm looking for
(more handholding I guess???) is more of a doula thing than a doctor
thing...


It's been my experience that the doctor comes by periodically to check, or
they have a resident check you to see your progress...but the nurses at the
hospital I deliver at are the ones doing all the pre-delivery work. The
doctor's role is pretty short, just for active pushing and just after
delivery.



  #20  
Old October 11th 06, 01:50 PM posted to misc.kids.pregnancy
alath
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Posts: 89
Default I was just wondering, is it standard procedure in a normal delivery...


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.

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.

 




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