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



 
 
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  #21  
Old October 11th 06, 02:18 PM posted to misc.kids.pregnancy
cjra
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Default I was just wondering, is it standard procedure in a normal delivery...


wrote:
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! (


This may not hold true for hospital/medical practice based midwives,but
the midwives around here who do homebirths all have a limit to how many
they schedule. Mine did no more than 5/month, and generally only 4 with
one per week. Sometimes there is overlap, but she says she's only been
stuck with two deliveries in one day once.

  #22  
Old October 11th 06, 04:50 PM posted to misc.kids.pregnancy
[email protected]
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Default I was just wondering, is it standard procedure in a normal delivery...


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.


  #23  
Old October 11th 06, 05:33 PM posted to misc.kids.pregnancy
alath
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Default I was just wondering, is it standard procedure in a normal delivery...


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.


Not the whole time, no, but we do tend to be there a lot more than OB's
are.

  #24  
Old October 11th 06, 09:23 PM posted to misc.kids.pregnancy
Lady Penelope Creighton-Ward
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Posts: 190
Default I was just wondering, is it standard procedure in a normal delivery...


Ericka Kammerer wrote:
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


Ericka,

For my first pregnancy I had a homebirth and was attended by a small
midwifery practice just like your first two. However, most of the
prenatal care was carried out by a large hospital as I only discovered
the midwives in my seventh month. Whether because I had the good
fortune to meet very lovely midwives or because prenatal care with them
from the seventh month onwards sufficed, I felt very much cared for and
trusted the midwives.

Now for my second pregnancy, I would like to follow the same model -
first seven months with the hospital, and the rest with the midwives.
The midwives were okay with it since we already know each other.

For me, this works better because I know my insurance will cover the
hospital portion, and the rest only at 75% after a pretty high
deductible.

My question is - am I losing out in some way by not conducting the
entire pregnancy through the midwives?

For my second pregnan

  #25  
Old October 12th 06, 01:02 AM posted to misc.kids.pregnancy
Ericka Kammerer
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Default I was just wondering, is it standard procedure in a normal delivery...

Lady Penelope Creighton-Ward wrote:

For my first pregnancy I had a homebirth and was attended by a small
midwifery practice just like your first two. However, most of the
prenatal care was carried out by a large hospital as I only discovered
the midwives in my seventh month. Whether because I had the good
fortune to meet very lovely midwives or because prenatal care with them
from the seventh month onwards sufficed, I felt very much cared for and
trusted the midwives.

Now for my second pregnancy, I would like to follow the same model -
first seven months with the hospital, and the rest with the midwives.
The midwives were okay with it since we already know each other.

For me, this works better because I know my insurance will cover the
hospital portion, and the rest only at 75% after a pretty high
deductible.

My question is - am I losing out in some way by not conducting the
entire pregnancy through the midwives?


I think so, but the question is whether it's worth
it to you in your situation. I think what you miss is the
opportunity for the midwives to see first hand how your
pregnancy develops. I think that gives greater opportunity
for them to develop an understanding of how *you* work and
for their intuition to kick in. How necessary is that?
Well, most of the time it probably doesn't make any
difference at all because everything is straightforward.

As far as the insurance goes, does it really matter
much in the end? Do you save much money? For instance,
with my homebirths, most of the cost was in the birth itself.
When they itemized the package price, I wouldn't have saved
much by doing the prenatal care elsewhere. I actually had
a slightly different situation with pregnancy #3--my insurance
would pay at the out of network rate for the prenatal care
but wouldn't cover for the birth (although when I submitted
the claim for the birth for giggles, they actually paid it).
And, if you are going to pay out the deductible anyway for
just the cost of the birth, then you won't pay any *more*
deductible for throwing in the prenatal care as well.

So, you might want to work the math and see how
things come out. If I recall correctly, when they unpacked
the package fee of about $3500, the prenatals were only about
$75/visit with my midwives. If you have prenatals at 10, 14,
16, 20, 24, 28, 32, 34, 36, 37, 38, 39, 40 weeks, then you'd
still end up doing almost half the prenatals with the midwives
anyway. That would be only about $450 in charges from the
midwives, and if you're already meeting the deductible with
the birth, then you're talking about a difference in out of
pocket costs of only just over $100 (if your costs worked
out similar to what mine were). Personally, I wouldn't
trade missing out on that continuity of care for $100, but
maybe it works out to more money in your situation.

Best wishes,
Ericka
  #26  
Old October 12th 06, 03:17 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...


Lady Penelope Creighton-Ward wrote:

Ericka,

For my first pregnancy I had a homebirth and was attended by a small
midwifery practice just like your first two. However, most of the
prenatal care was carried out by a large hospital as I only discovered
the midwives in my seventh month. Whether because I had the good
fortune to meet very lovely midwives or because prenatal care with them
from the seventh month onwards sufficed, I felt very much cared for and
trusted the midwives.

Now for my second pregnancy, I would like to follow the same model -
first seven months with the hospital, and the rest with the midwives.
The midwives were okay with it since we already know each other.

For me, this works better because I know my insurance will cover the
hospital portion, and the rest only at 75% after a pretty high
deductible.

My question is - am I losing out in some way by not conducting the
entire pregnancy through the midwives?


FWIW - I saw an OB for the first 20 weeks, however I had already seen
my midwife in my first pg which miscarried, so I knew her. (just one,
she had assistants but she wasn't part of a practice) I had assorted
testing and early u/s done since I m/c'd the first time. It was
reassuring to have that since I didn't know I m/c'd til 6 weeks after
the fetus had stopped developing and I'd have been a wreck until we had
a heartbeat. Also, given my age it was nice to see things developing
normally. However, now we've had a successful pg I'm less worried about
that.

In any case, I didn't officially see my midwife until ~ wk 24, tho I
talked to her each month. That was ok, but in some ways less than ideal
since she hadn't seen the whole progression of the pg. I kept her
updated, but that's not the same. Unfortunately it took til about week
36 to get my medical records to her. Next pg I will see my midwife only
from the start.

  #27  
Old October 13th 06, 03:50 PM posted to misc.kids.pregnancy
[email protected]
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Default I was just wondering, is it standard procedure in a normal delivery...

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



Actually, sometimes they do just hang out in the lounge and wait. Even
if they are in your room, they don't DO anything but sit in a corner
and watch.
I've had 7 babies, all in the hospital. #1,2,3 and 7 were OB attended,
#4,5&6 were CNM's.
My midwives labor sat, once I was active they were there with me from
that point until the baby was born and settled in nursing. My OB's
appeared briefly here and there to see what was going on and left until
it was time to catch.
With #7 he saw me in the office in the morning, sent me up to the floor
for induction, showed up again around lunchtime to check progress,
showed up around 4 to break my water, reappeared a couple times between
5 and 6:30 because it looked like she might be coming and his parting
words to the nurse the last time he examined me were "Let her push,
I'll be in exam 2 doing charts".
The final moments of the birth went like this:

Me- "She's COMING!!!"
baby now visible on perineum and me pushing like mad
Nurse "DR. M!!!!!"
Dr M literally comes running and skidding into the room and quickly
gowns and gloves while I push and the nurses take the bottom off the
bed. He sits down and I push for about 2 minutes and my baby is born.
Placenta comes on it's own within 10 minutes. He catches that, examines
me for any tears, congratulates me and leaves. He was a very nice guy,
respectful of my wishes (how many OB's out there would induce a grandp
multip VBAC with pre-eclampsia ?) but he was a surgeon/doctor not a
midwife.
I'd say all in all that OB spent less than 30 minutes with me during my
whole labor and birth. Now I did have 2 doulas and my husband and at
least 1 nurse with me most of the time. I was pre-eclamptic and a VBAC,
someone needed to be attentive to me and the baby.

He had nothing else to do. He was not the OB on-call for his practice.
He was there just to catch my baby, another doc was covering the other
births.

I don't expect OB's to labor-sit although there are few here and there
that do when they can.
You definitely need to use a midwife or hire a doula (or 2) if you want
hands on labor support.

  #28  
Old October 18th 06, 10:02 PM posted to misc.kids.pregnancy
blue
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Posts: 13
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?


It's how it's done here in my area of the US. I switched to a midwife before
my 8th month along because I discovered my area *had* one, and my last few
remaining checkups were 45 minutes to an hour instead of the 5 minutes the
OB spent with me. That was nice, to be able to talk about all my concerns
and issues. When I went into labor with the midwife (who was backed up by a
partnered OB group, a different group from my original OB BTW) she spent
lots of time on the phone with me helping me decide when to come in and she
met me at the hospital (the on-call OB and midwife sleep at the hospital
when they are on duty), and my labor was way over 12 hours long....she spent
a lot of time with me when we were just waiting for dilation (I had to be
induced), the nurses were checking on me a lot, and I was basically just
trying to catch some sleep. When it was time to push the midwife was right
there with the nurse and spent a ton of time with me..I had a problem (baby
was stuck) but the midwife spent a lot of time with me trying different
positions of pushing. Finally we did end up having to let her call the OB in
and the baby was delivered by forceps very quickly. The OB spent all of
about 15 minutes with me.

I decided that since I now don't feel I "need" as much time spent during the
office visits since I have experienced pregnancy, and since the OB ended up
delivering anyway I am just going to use the OB who ended up delivering my
baby's group next time. To be honest, the NURSES at the hospital are the
ones you see the most while you are just in labor, and then the OB comes in
for pushing. The nurses really do a lot of work (under the supervision of
the OB of course). Nurses are underrated--they deserve more credit. I
wouldn't have been as worried about having a midwife to "hold my hand" if I
had realized that just because the OB only comes in for pushing, that
doesn't mean NO ONE is there! Nurses constantly come in and check on you,
and help you push as well.

As it turns out the midwife group I used lost their contract with the
hospital and are out of business- the midwives still practice but had to
split up and go to other areas that still use their services. It's a shame
but I can't help but wonder if they had a high rate of having to have OB
intervention? There is some reason the hospital didn't allow them to remain.
They were good--they deserve more credit too. But I think the hospital must
have had some reason for letting them go. Insurance wasn't the reason
because they were able to bill through the partner OBs office so they took
most insurances. I think the hospital was just cutting costs when the same
work was being done by the delivery room nurses and OBs anyway, I guess...

But yeah, OBs just showing up for the pushing is normal, and it doesn't have
to be worrisome. A good OB will still give you good care and some will go a
little extra...I just thought I would respond to this post because the
OB-not-coming-until-pushing was one of the things that really worried me
during my first pregnancy. It seemed like abandonment, LOL. But things will
be fine assuming the hospital staff is good.


  #29  
Old October 18th 06, 10:13 PM posted to misc.kids.pregnancy
blue
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Default I was just wondering, is it standard procedure in a normal delivery...


"Elfanie" wrote
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.

True that the doctors won't be able to take a gazillian clients at
once like they do....


This is my biggest problem with OBs, they take a gazillion clients all at
once. SOME OB offices actually have the on-call OB take appointments on the
same day that they are on call for labors and I ran into that and was forced
to see the nurse instead of any doctor when I showed up for my appointments,
because the doctor was "doing a delivery". Also, I showed up some when the
OB was just running out of the office to go to a delivery and the staff said
they should be back in about 30 minutes! That's robo service. It's
wrong...at least some OB offices rotate the doctors to where the one on call
does not have to also take regular appointments all day! This should be a
standard IMO. (BTW my OB office was located right at the hospital in a
medical office section so they literally could run out and if the lady was
able to push the baby out in 15 minutes, they really could be back in 30!
Whew.

I liked that the midwives at least had the one on call NOT taking
appointments too. It's a shame that now I don't even have the *chouce* to
use them again. Well if I want to use a hospital an hour away from home
instead of 10 minutes I could see one of them again...but from experience I
know at 8 months pregnant with swelled up feet I don't want to drive into
huge city traffic for an hour each way for weekly appointments etc...

It is also true that the OBs schedule your checkup for 6 weeks after birth-
they check you before you leave the hospital last thing then unless you had
a C section they'll see you in 6 weeks. The midwives actually did this too
though--except I complained of pain so they had me come in at 4 weeks, and
they told me my stitches had all dissolved already, and that very night, I
decided to feel up where it was hurting and pulled out- you guessed it- a
suture.

Still, the midwives were great, they really were...they deserve credit...at
the time their contract was cancelled with the hospital they had a pretty
busy patient load as more women found them and liked their treatment. Their
office visits were lengthy, relaxed, and sort of informal...they had a great
nurse. It was very convenient too. I did say I decided to just see the OB
group next time though, before I even found out they were closing, but it
was NOT to their discredit. I have some OB problems that are going to
require surgery so I figured I may as well get in with an OB group anyway,
and I had discovered that the one the midwives partnered with that ended up
actually delivering my daughter is extremely excellent. So I figurd I may as
well get established as their patient to make the treatment I am going to
need (that nurse midwives can't do) easier...


 




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