Midwife versus OBGYN

"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

Here (Long Island, New York) there are barely any midwives available for
prenatal care and labor and delivery. The ONLY one I was able to find that
would assist in a home birth is a few miles from here and is literally the
only one for about a hundred miles. What's even scarier is the C-section
rate over here. There was actually an article in Elle magazine not too long
ago about all of the elective C-sections and *all* of the hospitals and
doctors they mentioned are within 25 miles of my house.

I consider myself lucky to have managed thus far without a C-section and to
have had 2 relatively normal vaginal births. I birth in a hospital, and I
will again this time (because we decided as a family that a home birth was
not for us - mostly due to our other 2 kids).

Many offices here have midwives on staff, but they are not permitted to
deliver babies. My OB's office has one and it's the same situation. It
also has to do with malpractice insurance, which is sky high in New York.

HTH,

Jen

Many offices here have midwives on staff, but they are not permitted to
deliver babies. My OB's office has one and it's the same situation. It
also has to do with malpractice insurance, which is sky high in New York.

what exactly is a midwife who doesn't deliver babies, presumably they don't
have the same level of training as a midwife practising independently, so
what training do they have, are they really a specialist anti/post parturm
nurse?

I'm sure they do a helpful job, just that calling them midwives is rather
confusing, though of course if they really are midwives and just not able to
practise as such, that makes it even sadder, for them as well as the women
missing out on their care.

Cheers

Anne

"Anne Rogers" wrote in message
...
Many offices here have midwives on staff, but they are not permitted to
deliver babies. My OB's office has one and it's the same situation. It
also has to do with malpractice insurance, which is sky high in New York.

what exactly is a midwife who doesn't deliver babies, presumably they
don't have the same level of training as a midwife practising
independently, so what training do they have, are they really a specialist
anti/post parturm nurse?

I'm sure they do a helpful job, just that calling them midwives is rather
confusing, though of course if they really are midwives and just not able
to practise as such, that makes it even sadder, for them as well as the
women missing out on their care.

Cheers

Anne

In most cases, they *used to* deliver babies, but now just perform office
exams. Again, the insurance was making it impossible for them to practice.
They are CNMs (certified nurse midwives - same as any others here in the
US).

In most cases, they *used to* deliver babies, but now just perform office
exams. Again, the insurance was making it impossible for them to
practice. They are CNMs (certified nurse midwives - same as any others
here in the US).

aww, that's a shame, I guess most of them don't want to be practicing like
that, but are forced to as moving elsewhere for employment is not an option.

remember that there are both CNMs and direct entry midwives in the US. I
don't know how long the extra training is to jump from nurse to CNM, we have
similar in the UK, though the end title is the same, direct entry midwifery
is a full 3 year training course, for those already nurses it's around 18
months, but is gradually being extended to 2 yrs, which just shows how much
more there is to learn beyond nursing to become a midwife. It may even
become the case that even those already qualified as a nurse have to do the
full direct entry program.

Cheers

Anne

Anne Rogers wrote:

remember that there are both CNMs and direct entry midwives in the US. I
don't know how long the extra training is to jump from nurse to CNM, we have
similar in the UK, though the end title is the same, direct entry midwifery
is a full 3 year training course, for those already nurses it's around 18
months, but is gradually being extended to 2 yrs, which just shows how much
more there is to learn beyond nursing to become a midwife. It may even
become the case that even those already qualified as a nurse have to do the
full direct entry program.

I believe that it's typically two years from RN to
CNM in the US. Also keep in mind that DEMs do not all have
the same background or education in the US. A DEM can have
anything from no formal training to a great deal of formal
training. A DEM may be registered or certified or not. Of
the states that allow direct entry midwifery, most require
the CPM (Certified Professional Midwife) credential, which
requires some combination of in class education, an
apprenticeship, and passing an exam. There is no formal
curriculum that applies to all DEMs in the US.

Best wishes,
Ericka

I believe that it's typically two years from RN to
CNM in the US. Also keep in mind that DEMs do not all have
the same background or education in the US. A DEM can have
anything from no formal training to a great deal of formal
training. A DEM may be registered or certified or not. Of
the states that allow direct entry midwifery, most require
the CPM (Certified Professional Midwife) credential, which
requires some combination of in class education, an
apprenticeship, and passing an exam. There is no formal
curriculum that applies to all DEMs in the US.

it's actually fairly similar in the UK, that there is no formal curriculum,
but to use the word use the word midwife you have to be a member of the
royal college of midwifes and though there is still no set curriculum, that
does at least give a professional body and you know what you are getting,
obviously there is going to still be a range of knowledge and experience,
but the minimum is still pretty high and within the NHS they must undertake
ongoing training, only a tiny amount, but some nonetheless. There would be
room within the system for some midwifes who don't practice within the NHS
to be not undertaking/keeping uptodate, but the number of them is very small
and when you are paying to use their services rather than getting it free on
the NHS, they have to be practicing at a higher standard and actually be
much more competant as they almost always attend births at home, but will
attend things other than straight forward births, so are likely to more
experienced in breech, twins etc. In the end it means I can't really get
what I want in either the US, or the UK, because I don't think I'd want to
go for a homebirth anymore, because I feel I need the option of a c-section
right there and having had 2 precipitate labours, I don't have time to let
labour start, see how it goes then transport, but if I'm going for a vaginal
birth, I want an expert midwife there!

Cheers

Anne

Lady Penelope Creighton-Ward wrote:
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.

Yes...that's what I gathered from the programs. Whilst homebirths here
are rareish, its generally accepted that if that's what you want to do,
then it's up to the medical staff attending to support this. The Royal
College of Midwifry states that a community midwife cannot 'refuse' to
attend a labouring woman at home since this constitues dereliction of
duty. Many women are strongly advised against home births for a variety
of reasons, not least of which is lack of resources, but most ordinary
people would not particularly look askance at a woman if she said she
would have a home birth and the midwives would certainly attend.

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.

Huh? I'm sure I must have misunderstood... Are you saying that the
obstetrics consultant has NEVER seen a birth? How can this possibly be
and where the hell did he get his license, out of a cornflake packet!
I'm surprised he's allowed in the delivery room. What are they teaching
consultants! Frankly, I'd rather be delivered by my best friend then
someone who has never seen a live human birth, at least she's had a
couple of children and has a vague understanding of what is going to
happen. I'm astounded that this man has the temerity to call himself a
medical professional.


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


Heaven Forbid!

ChocolateChip_Wookie wrote:
Lady Penelope Creighton-Ward wrote:

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.

Huh? I'm sure I must have misunderstood... Are you saying that the
obstetrics consultant has NEVER seen a birth?

She said a *natural* birth--i.e., one without
interventions.

Best wishes,
Ericka

She said a *natural* birth--i.e., one without
interventions.

Best wishes,
Ericka

That's just appalling! That there are so few natural births that he has
never seen one. I guess that's the American medical professional all
over then. If no woman is allowed to have a *natural* birth because of
the risks then of course, none of the medical staff have ever seen a
natural birth and this just re-enforces their prejudice that you cannot
have a *natural* birth! That's just insane! Urgh!

Wookie

Lady Penelope Creighton-Ward wrote:
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.

I also had a homebirth, but I was attended by two certified nurse
midwives. I got LOTS of comments, also but both my husband and I used
it as an opportunity to tell people that statistically it's safer for
an uncomplicated labor and birth to happen at home, and that if
complications occured, we'd simply go to the hospital, that in over
3000 births, my midwives had never lost a mother or baby.

I would NOT take the irresponsibility comments lying down, especially
without knowing all the details, they are making assumptions based on
inadequate information.

I was aggressive enough that I didn't wait for people to make those
comments - I informed them of the stats BEFORE they could get around to
insulting me. Surprise, or incredulous looks or "you must be really
brave!" comments, I could take (after all, it is a fairly rare choice),
but insulting me for my choices wasn't something I would tolerate.

I also take most opportunities to talk about it - that it was a safe
and wonderful experience. Not so much because I am pushing my beliefs
on others, but because I want people to realize that it's a legitimate
choice, and to be accepting of it, not just for me, but for other
people as well.

A woman should be able to birth whereever she is most comfortable
(home, hospital, birthing center) without people getting all
judgemental on her, especially in ignorance.

rant off
Cathy Weeks