Midwife versus OBGYN

Hi All,

One of the defining features I have noticed when watching 'birth'
programs from both here and across the pond is the completely different
aproaches to medical care in pregnancy. Here, almost all children are
delivered exclusively by midwives, so much so that I did not even see a
doctor during the course of my last pregnancy and labour. However,
watching a program from America, I was struck by the fact that midwives
are generally considered to be little better than quacks/witches and
charlatans and there rarely appears to be a midwife in attendance. Any
comments? How did this disparity come to pass? Where are all the
midwives in America?

Wookie

ChocolateChip_Wookie wrote:
Hi All,

One of the defining features I have noticed when watching 'birth'
programs from both here and across the pond is the completely different
aproaches to medical care in pregnancy. Here, almost all children are
delivered exclusively by midwives, so much so that I did not even see a
doctor during the course of my last pregnancy and labour. However,
watching a program from America, I was struck by the fact that midwives
are generally considered to be little better than quacks/witches and
charlatans and there rarely appears to be a midwife in attendance. Any
comments? How did this disparity come to pass? Where are all the
midwives in America?

I think your impression is a bit extreme compared to
the reality. Midwives have been gaining in popularity somewhat
in the US, and at least Certified Nurse Midwives are less
likely to be thought of negatively. Still, they are a minority.
Only about 1 percent of US births take place at home, and
probably only around that number are attended by direct
entry midwives (pretty much any midwife other than a CNM
in the US). CNMs mostly deliver in hospitals and deliver
about 7 percent of babies (that was the 2003 figure, anyway--
97 percent of those were in hospitals).
For a detailed analysis of what happened,
I think Arney's book _Power and the Profession of Obstetrics_
is one of the better descriptions. Basically, unlike in the
UK and many other places, midwives pretty much completely
lost their presence and power in childbirth in the US.
There is not an uninterrupted stream of midwifery care.
So, midwives have had to work their way back into the
system inch by inch with lots of obstacles (legal, professional,
economic, social).
Most areas now have *some* midwives available,
though not all by a long shot. Direct entry midwives
are still illegal in many states (de jure, or at least
de facto). It is still the case that many still perceive
midwives to be "less than" OBs, though it seems like most
have come to realize that they aren't the granny midwife
caricatures of old either.
By the by, don't put too much stock in many of
the tv programs from the US. Their portrayal is often
fairly unrealistic.

Best wishes,
Ericka

One of the defining features I have noticed when watching 'birth' programs
from both here and across the pond is the completely different aproaches
to medical care in pregnancy. Here, almost all children are delivered
exclusively by midwives, so much so that I did not even see a doctor
during the course of my last pregnancy and labour. However, watching a
program from America, I was struck by the fact that midwives are generally
considered to be little better than quacks/witches and charlatans and
there rarely appears to be a midwife in attendance. Any comments? How did
this disparity come to pass? Where are all the midwives in America?

I don't really know how things ended up the way they are in the US, but a
comment on "here", which I think you are talking about the UK, it isn't the
case that almost all children are delivered exclusively my midwives, it's
just that for the vast majority of women antenatal care is provided by
midwives and most spontaneous labours start out under the care of a midwife,
but I think you are actually fairly rare to not see a doctor, I don't know
what proportion to manage it that way, but when thinking amongst my friends,
though many started out just under midwives, I can't actually think of one
offhand where the whole pregnancy and birth ended up midwifery led, though
some had only minor intervention/monitoring by doctors. I still think it's a
better way round than the US though, assume normality and only add in
doctors as necessary and overall the stats do give us marginally better
results, though most of western europe does better than both the UK and the
US, I'm not familiar with models of care in each country.

Cheers

Anne

I am one of those rare 1% to give birth at home here in the Boston
area, attended by two direct-entry midwives. I faced a lot of
incredulous looks and comments about my irresponsibility when I would
tell people about my homebirth plans. Eventually I learned to just not
talk about it.

Anyway, I just spoke with a colleague who tells me a friend of hers is
planning to have a natural hospital birth, also attended by a midwife,
and her father who is an OBGYN is very distrustful, partially because
in his entire career he has never witnessed a natural birth.

Imagine entrusting the birth of your child to a doctor who has never
actually seen a real birth!

ChocolateChip_Wookie wrote:
Hi All,

One of the defining features I have noticed when watching 'birth'
programs from both here and across the pond is the completely different
aproaches to medical care in pregnancy. Here, almost all children are
delivered exclusively by midwives, so much so that I did not even see a
doctor during the course of my last pregnancy and labour. However,
watching a program from America, I was struck by the fact that midwives
are generally considered to be little better than quacks/witches and
charlatans and there rarely appears to be a midwife in attendance. Any
comments? How did this disparity come to pass? Where are all the
midwives in America?

Wookie

I am one of those rare 1% to give birth at home here in the Boston
area, attended by two direct-entry midwives. I faced a lot of
incredulous looks and comments about my irresponsibility when I would
tell people about my homebirth plans. Eventually I learned to just not
talk about it.

there can still be that against homebirth in the UK, though it's not a case
of disapproving of the choice of attendent, more about the location, because
that a birth is in the main primarily attended by midwives is the accepted
norm. Which means even if you deliver under consultant led care in a
consultant led unit, your primary carer will be a midwife, rather than a
nurse who just happens to be working in that area, so they should have much
wider experience as even if they usually work on such a unit, they are
required to do time elsewhere, so they should have full knowledge about
natural birth as well as medicalised birth, however there is a trend which
some radical midwifes are concerned about for hospital midwives to be much
more like "obstetric nurses" rather than professionals in their own right
and to then take all instructions from doctors, follow all their rules etc.
rather than make there own decisions about what is appropriate in the care
of any individual women. I definitely noticed this at my own two deliveries,
which were consultant led, but midwife attended, first time around the
midwife made her own decisions, she decided when it was appropriate to stop
syntocinon, she decided that it was not relevant to do a VE on schedule, 2nd
time around the midwife did not seem to make any decisions of her own accord
and paniced if I refused anything she was planning to do as standard.

Cheers

Anne

"ChocolateChip_Wookie" "wookie[at]bluelotusblossom[dot]com" wrote in
message ...
Hi All,

One of the defining features I have noticed when watching 'birth' programs
from both here and across the pond is the completely different aproaches
to medical care in pregnancy. Here, almost all children are delivered
exclusively by midwives, so much so that I did not even see a doctor
during the course of my last pregnancy and labour. However, watching a
program from America, I was struck by the fact that midwives are generally
considered to be little better than quacks/witches and charlatans and
there rarely appears to be a midwife in attendance. Any comments? How did
this disparity come to pass? Where are all the midwives in America?

Wookie

I'm in neither of those places, and I had actually considered looking for a
midwife over here. The closest one available was in a city that's a 3 hour
drive away. FWIW, it sure doesn't seem there's any midwives around here,
and across Canada, I've been able to locate only a small handful of them -
and that's from doing a bit of research from coast to coast, mostly out of
my own curiosity...

"Lady Penelope Creighton-Ward" wrote in message
ups.com...
I am one of those rare 1% to give birth at home here in the Boston
area, attended by two direct-entry midwives. I faced a lot of
incredulous looks and comments about my irresponsibility when I would
tell people about my homebirth plans. Eventually I learned to just not
talk about it.

Anyway, I just spoke with a colleague who tells me a friend of hers is
planning to have a natural hospital birth, also attended by a midwife,
and her father who is an OBGYN is very distrustful, partially because
in his entire career he has never witnessed a natural birth.

Imagine entrusting the birth of your child to a doctor who has never
actually seen a real birth!

Indeed! That describes a lot of the docs at Brigham and Women's/ Obstetrics
is really just emerging from a dark age where we have the obsetetrician at
one end of the spectrum and the direct entry midwife at the other. Gradually
the two are coming closer and though there is stilll a lot of ignorance
regarding midwifery and particularly home-birth, we are seeing advances.

I know what you mean comments about your "irrresponsibility" It just makes
the home birth seem a mistake when it is in reality hospitalbirth that i
sbizarre and strange.

Hugs,

Carl

"Anne Rogers" wrote in message
...
One of the defining features I have noticed when watching 'birth'
programs from both here and across the pond is the completely different
aproaches to medical care in pregnancy. Here, almost all children are
delivered exclusively by midwives, so much so that I did not even see a
doctor during the course of my last pregnancy and labour. However,
watching a program from America, I was struck by the fact that midwives
are generally considered to be little better than quacks/witches and
charlatans and there rarely appears to be a midwife in attendance. Any
comments? How did this disparity come to pass? Where are all the midwives
in America?

I know a GP here who went on a course where there were quite a few US
people. They got into a conversation about smear tests (as you do) and the
US people were quite horrified to find that the GPs did smear test despite
not specialising in obs/gyn. They were even more horrified when the GPs said
that actually they didn't do most smears-that was left to the nurses...

I don't really know how things ended up the way they are in the US, but a
comment on "here", which I think you are talking about the UK, it isn't
the case that almost all children are delivered exclusively my midwives,
it's just that for the vast majority of women antenatal care is provided
by midwives and most spontaneous labours start out under the care of a
midwife, but I think you are actually fairly rare to not see a doctor, I
don't know what proportion to manage it that way, but when thinking
amongst my friends, though many started out just under midwives, I can't
actually think of one offhand where the whole pregnancy and birth ended up
midwifery led, though some had only minor intervention/monitoring by
doctors. I still think it's a better way round than the US though, assume
normality and only add in doctors as necessary and overall the stats do
give us marginally better results, though most of western europe does
better than both the UK and the US, I'm not familiar with models of care
in each country.

I didn't see a doctor for #1 except for when my midwife was on holiday and
for the well-baby check before leaving hospital.
For #2 (in a different area), I only saw a doctor at the scans, after a
problem had been shown up, and for the well-baby check, despite being put on
high risk status due to the problem.
For the labour both times I didn't see a doctor from beginning to end, and I
believe in this area that that's usual.
Debbie

One of the defining features I have noticed when watching 'birth'
programs from both here and across the pond is the completely different
aproaches to medical care in pregnancy. Here, almost all children are
delivered exclusively by midwives, so much so that I did not even see a
doctor during the course of my last pregnancy and labour. However,
watching a program from America, I was struck by the fact that midwives
are generally considered to be little better than quacks/witches and
charlatans and there rarely appears to be a midwife in attendance. Any
comments? How did this disparity come to pass? Where are all the
midwives in America?

There's too much polarization -- the way views get presented, one might
conclude that all midwives are convinced that all births are natural
and none need intervention because we evolved to give birth (never mind
that birth is where the major selection pressure for our species is
these days, given that it's where 90% of the deaths prior to
reproduction in our species occurs) *and* that all OBs are convinced
that no one ever presents in a situation conducive to natural birth and
that everyone needs a section to guarantee a "good outcome" (never mind
that the majority of births are low-risk and can end in a spontaneous
vaginal delivery with a healthy baby and a healthy mother.)

The reality is quite a bit muddier. Midwives aren't generally crazy
enough to deliver known accreta or previa or known preeclamptics;
doctors don't generally insist on intensive management of every multip
with a history of two hour labors... and while there *are* some in each
camp who are insane, it's turned into a power struggle with bad
generalizations of the other side (whichever one that is) in most media
portrayals.

--
C, mama to three year old nursling

The reality is quite a bit muddier. Midwives aren't generally crazy
enough to deliver known accreta or previa or known preeclamptics;
doctors don't generally insist on intensive management of every multip
with a history of two hour labors... and while there *are* some in each
camp who are insane, it's turned into a power struggle with bad
generalizations of the other side (whichever one that is) in most media
portrayals.

so it seems to be, on that assessment that you want to start out with a
midwife, not one who refers to a doctor at any sign of doubt, but one that
you trust to know when that really is necessary.

My history is complex, but essentially my problems don't cause a risk to the
baby and don't cause a life threatening risk to me, because of that,
consulting a midwife extensively is on my list of things to do before
ttc/deciding to ttc. The reason being, that if I do get to the end of the
pregnancy and am in good shape and want to go for a vaginal delivery, I need
a midwife who is really on my side to get the best possible delivery.

Cheers

Anne