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#11
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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
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I was just wondering, is it standard procedure in a normal delivery...
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#13
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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 |
#14
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I was just wondering, is it standard procedure in a normal delivery...
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#15
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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
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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. |
#18
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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
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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
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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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