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Midwives & Home birth vs. an OB & hospital ?



 
 
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  #1  
Old September 10th 03, 02:47 AM
LSU Grad of '89
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Default Midwives & Home birth vs. an OB & hospital ?

OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way. A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely relying
on a midwife. She will have a natural birth at home with the midwife and
husband in attendance.

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?

Hope this isn't a flame starter, I just cannot identify with the natural at
home no doctors thing. Give me an epidural, no problem...Mother hood is
demanding enough without being a hero when you don't need to. Vicki is
right - no one hands you a medal after labor and says "you get a gold medal
for having the most pain !"

However, I completely understand that each person has a right to their own
method, and just because I cannot identify with this, it doesn't mean it's
wrong. I just have this nagging feeling that if it were me, I'd be concerned
that I wasn't doing the best I could do for my baby. I can't help worrying
for her but I don't know why...I guess I can't imagine going through an
entire pregnancy without ever seeing a doctor when one has insurance and
access (can mid wives write prescriptions for prenatal tablets ?) My friend
works where I do and has excellent insurance...

L.
DS, 5-25-01 & EDD 4-28-04


  #2  
Old September 10th 03, 03:30 AM
Larry McMahan
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Default Midwives & Home birth vs. an OB & hospital ?

LSU Grad of '89 writes:

: OK, this really bothered me so I will share it in hopes that I am just too
: used to the "modern" way. A woman at work is having hr first child, she's
: ~5months and has had no visits to an OB or Doctor. She is completely relying
: on a midwife. She will have a natural birth at home with the midwife and
: husband in attendance.

And just what is wrong with this. In most states midwives are professionals
with just as strong licensing requirements as doctors.

: I just can't identify with it. I LIKE knowing I've done tests and
: ultrasounds and stuff to make sure - with modern technology - that my baby
: is progressing fine. I just don't believe that a midwife can catch
: everything - right ?

Wrong? Your "from line" lists you as a graduate of a major university, but
it certainly seems you have not done your homework on the safety issues of
this one. Let me offer just a few stats to start with.

1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.

2. Did you know that NO major medical study in the last 20 years have
shown OB/hospital birth to be any safer than home/midwife birth for a
matched population? In fact, most studies have shown them to be almost
equal. A few studies have shown homebirth to be safer. What does come
out of the studies VERY STRONGLY is that the rate of complicaitons for
planned hospital births is much higher than for planned home births.

I have two very specific suggestions for you to increase your level of
objective knowledge in this area:

A. Do a search on MEDLINE. It is a national database of peer reviewed
journal articles in the medical area. You can looks for studies in almost
any specialty. Learn to use it. Look up the studies on birth. Find out
what the stats really are.

B. Read one of Henci Goer's books: "The Thinking Woman's Guide to a Better
Birth" is aimed primarily at birthing women who want to know what the best
and safest way to birth is, but it also contains plenty of references to
the medical studies that back up its conclusions. "Obstetric Myths versus
Research Realities" is aimed more at the medical professional, and contains
strong evidence based on the medical research why certian common procedures
should or should not be done.

I think either of these routes would give you the objective information to
be able to speak soundly on this subject.

: Hope this isn't a flame starter, I just cannot identify with the natural at
: home no doctors thing. Give me an epidural, no problem...Mother hood is
: demanding enough without being a hero when you don't need to. Vicki is
: right - no one hands you a medal after labor and says "you get a gold medal
: for having the most pain !"

Excuse me for saying it, but here is another statement based on total ignorance.
Again I will offer you two reasons your statement is off track.

1. This issue has been discussed on this newsgroup many times. If you take
a women who has experience both a medicated birth with an epidural, and an
unmedicated birth, which do you think that woman will say that she preferred.
At least 95% of the mothers on mkp who have done both say they would go
natural in an instant. I am sure you will get not a few replies to this
post from those women! :-) There is a good reason for this. The comfort
measures available to a woman who is allowed to labor naturally are far more
effective than the medications are to a woman who must labor passively while
hooked up to IVs and other mobility limiting devices.

2. Numerous studies have shown that the epidural anesthesia passes from the
mother to the babies bloodstream, and that babies who are born to moms with
epidurals have lower apgar scores, are more morbid, have more difficulty
breastfeeding, and in general do not respond as quickly or well.

: However, I completely understand that each person has a right to their own
: method, and just because I cannot identify with this, it doesn't mean it's
: wrong. I just have this nagging feeling that if it were me, I'd be concerned
: that I wasn't doing the best I could do for my baby. I can't help worrying
: for her but I don't know why...I guess I can't imagine going through an
: entire pregnancy without ever seeing a doctor when one has insurance and
: access (can mid wives write prescriptions for prenatal tablets ?) My friend
: works where I do and has excellent insurance...

Unfortunately you have a view of midwives that is straight out of the middle
ages. What you do not know is how modern and professional they are, and
how much the obstetric process has actually increased risks by the inappropriate
overuse of technology. I suggest that you do some objective reading on the
subject before becoming subject to such unfounded fears.

: L.
: DS, 5-25-01 & EDD 4-28-04

Larry
  #3  
Old September 10th 03, 05:00 AM
hierophant
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Default Midwives & Home birth vs. an OB & hospital ?



LSU Grad of '89 wrote:

OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way. A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely relying
on a midwife. She will have a natural birth at home with the midwife and
husband in attendance.


GASP!

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?


Wrong. Midwives are trained experts in normal (and variations thereof)
of pregnancy and birth. For the most part, considering where midwifery
is regulated, midwives have access to everything doctors do-- labs to
send their clients to for blood work, radiologists or techs for
ultrasounds, and on. Midwife doesn't equal sub-par practitioner or dark
ages medicine.

Hope this isn't a flame starter, I just cannot identify with the natural at
home no doctors thing. Give me an epidural, no problem...Mother hood is
demanding enough without being a hero when you don't need to. Vicki is
right - no one hands you a medal after labor and says "you get a gold medal
for having the most pain !"


Well, the only one I know who deserves a gold medal is my husband who
competed in the Olympics But seriously, your friend cannot identify
with you and your desire for a medically and technologically managed
pregnancy and birth. That's why she's chosen to give birth at home.

However, I completely understand that each person has a right to their own
method, and just because I cannot identify with this, it doesn't mean it's
wrong. I just have this nagging feeling that if it were me, I'd be concerned
that I wasn't doing the best I could do for my baby. I can't help worrying
for her but I don't know why...


Well don't be because she doesn't need your negative or doubtful energy
surrounding her (really, I'm not being rude). It's doubtful you're the
first person who has expressed this about her or to her. Thanks for
your concern (I accept on her behalf G). She may be equally as
worried for you to be walking into a hospital where intervention lurks
behind every procedure. Besides, having a baby at home is not a simple
feat. She has likely accepted more personal responsibility for her
choice to birth at home than many women do for their choice to hand over
care to doctors and hospitals for their births.

I guess I can't imagine going through an
entire pregnancy without ever seeing a doctor when one has insurance and
access (can mid wives write prescriptions for prenatal tablets ?) My friend
works where I do and has excellent insurance...


You must be channeling my dad! He was the first one in his family to
be born at a hospital, so he equates it with "making it" in the world.
Midwives can get insurance reimbursement, usually as out of network
providers. Certified Nurse-Midwives (many of whom practice out of
hospitals) have prescriptive authority. Aside from that, there is no
reason a prescription has to be written for a prenatal vitamin-- there
are 800 brands for sale in any given Whole Foods Market or other health
food store.

Anyway, you're right, it's all about choice

Kris, mother to 4 children, all born with midwives attending; three at
home and also a student midwife who attended the home water birth of a
9lb 2oz baby girl yesterday morning

  #4  
Old September 10th 03, 05:30 AM
aps
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Posts: n/a
Default Midwives & Home birth vs. an OB & hospital ?

In article , Larry McMahan
wrote:

LSU Grad of '89 writes:

: I just can't identify with it. I LIKE knowing I've done tests and
: ultrasounds and stuff to make sure - with modern technology - that my baby
: is progressing fine. I just don't believe that a midwife can catch
: everything - right ?


1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.


No argument with that, but for those of us who haven't cultivated a
distrust in medical science, it can be reassuring. And it's not clear
what you mean by "specific indications." Our ultrasound involved a
bunch of specific measurements, which we enthusiastically asked a lot
of questions about.

out of the studies VERY STRONGLY is that the rate of complicaitons for
planned hospital births is much higher than for planned home births.


Mainly because pregnancies with identified risks for complications are
planned for hospital birth.

B. Read one of Henci Goer's books: "The Thinking Woman's Guide to a Better
Birth" is aimed primarily at birthing women who want to know what the best
and safest way to birth is, but it also contains plenty of references to
the medical studies that back up its conclusions. "Obstetric Myths versus
Research Realities" is aimed more at the medical professional, and contains
strong evidence based on the medical research why certian common procedures
should or should not be done.


I don't think lsugo89 said that nobody should do natural birth. We did
a planned hospital birth (with a midwife), but we read a lot about the
stuff you refer to--and we discussed them rationally with our midwives.
Some things we changed, some things we were reassured about.

I think either of these routes would give you the objective information to
be able to speak soundly on this subject.


See, it just sounds like she'd have to voice your opinion on order to
"speak soundly."

1. This issue has been discussed on this newsgroup many times. If you take
a women who has experience both a medicated birth with an epidural, and an
unmedicated birth, which do you think that woman will say that she preferred.
At least 95% of the mothers on mkp who have done both say they would go
natural in an instant. I am sure you will get not a few replies to this


Actually, our labor nurse said exactly the opposite--she had 2
unmedicated and 1 with an epidural, and she said the epidural was the
better experience.

2. Numerous studies have shown that the epidural anesthesia passes from the
mother to the babies bloodstream, and that babies who are born to moms with
epidurals have lower apgar scores, are more morbid, have more difficulty
breastfeeding, and in general do not respond as quickly or well.


My wife had an early epidural and the did a couple bolus' during labor.
Our daughter scored 9.9 apgar and breastfed like a champ. I don't
disagree that statistically epidurals are more likely to produce those
problems, but that's not the same as what you're stating.

Unfortunately you have a view of midwives that is straight out of the middle
ages. What you do not know is how modern and professional they are, and
how much the obstetric process has actually increased risks by the
inappropriate
overuse of technology. I suggest that you do some objective reading on the
subject before becoming subject to such unfounded fears.


I agree that many fears about home natural midwife birth are unfounded
and irrational, but there's plenty of axe grinding on both side of the
issue. And I doubt that a woman who has faith mainly in one side would
do very well in the opposite. Knowing a lot about both approaches is
probably the best strategy

APS
also an LSU grad of 1989 :-)
  #5  
Old September 10th 03, 06:19 AM
Irrational Number
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Default Midwives & Home birth vs. an OB & hospital ?

mountainspring wrote:

However, once I switched to the midwives, I can honestly say, I will
never switch back. [...] With all the doctors I've ever
dealt with, I usually feel lucky to keep them in the room long enough to
answer whatever questions I may have before they're running out the door
to see another patient. [...]


Just piping in to say that not all doctors are
always in a hurry. I have a fabulous ob/gyn
who has never, ever made me feel rushed. The
one time he did have a few emergency c-sections,
they told me up front that I'd only have 15
minutes with him. Otherwise, I've always been
able to ask all the questions I want and he's
been a rock of support during the easy part
of my pregnancy, during the horrible premature
contractions / u/s misdiagnosis by the
perinatologists / possible hydrocephalus /
fibroid problems, and during the c-section,
and afterwards. Plus, he has a fantastic
front office who will fight for you and make
calls and send faxes until you get the result
you want (a squeezed appointment into a
completely booked pediatric neurologist, for
example).

-- Anita --
--
SUCCESS FOUR FLIGHTS THURSDAY MORNING ALL AGAINST
TWENTY ONE MILE WIND STARTED FROM LEVEL WITH ENGINE
POWER ALONE AVERAGE SPEED THROUGH AIR THIRTY ONE
MILES LONGEST 57 SECONDS INFORM PRESS HOME CHRISTMAS.

  #6  
Old September 10th 03, 08:08 AM
Dagny
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Default Midwives & Home birth vs. an OB & hospital ?


"LSU Grad of '89" wrote in message
...
OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way. A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely

relying
on a midwife. She will have a natural birth at home with the midwife and
husband in attendance.

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?
[snip]


I obviously agree with a lot of what has already been posted (or I wouldn't
be planning a homebirth) and add as follows:

(1) I went into this pregnancy assuming that the medical model of care is
best for the baby (I live in the US) and set out to research what tests and
prenatal and labor protocols were best for my baby and secondarily, myself.
I was fortunate to have some free time on my hands to do this, something
most employed women don't have. I was self-employed and made it a priority.
I was shocked when my very competent, intelligent and generally non-asshole
obstetrician had very little interest in my well-researched and reasoned
judgments about what treatment I will request and what treatment I will
refuse. I think this is why it is sometimes said derogatorily that
obstetrics is "myth based" not "outcome based." A colorful example is the
giving of a 40-week "due date." Some guy made that up a long time ago based
on *moon cycles* not research. And it's still stuck around.

My midwife *wants* to do what research and common sense indicate are best
for babies and mothers AND for me as a mother of a particular child in a
family with particular values. Big difference. If she is not up on a
particular issue or doesn't come down strongly either way, she admits it.
She is always reading and learning after decades of practice. She has a lot
fewer patients than my OBs and has time to do that, plus she only needs to
know a small subset of obstetrics since her job is healthy mothers and minor
complications. Both my OBs, probably in an attempt to instill confidence,
simply start talking out of their asses when they fall out of their range of
knowledge. I forgive them, these guys have jobs. Very demanding jobs. I
don't expect them to have exactly the same knowledge base I have. And they
would be able to do their jobs a lot better if they didn't have to know how
to do EVERYTHING, e.g., they delegated healthy normal births to midwives.

(2) I did go see an obstetrician regularly during the time I have had
co-care with a (non-nurse, homebirth) Certified Professional Midwife. The
OB is very handy for things like prescriptions and lab slips within the HMO
type system. They also are pretty easy to reach in my experience compared
to primary care doctors. But bottom line, what I need the OB for prenatally
my family practitioner could have done for me, and most of the tests that I
needed done were due to my particular medical history and my Rh- status, so
may not apply to your friend. It was good to get to know the OB in case I
have to transport to the hospital during labor (or risk out prior to labor)
and that was important to me, but must not be to your friend.

(3) Finally, while the obstetricians will tell you (against the evidence)
that homebirths are not safe, you are risking X, Y, and Z, here's what the
*other* doctors in my life had to say.

My family doctor (female, late 40s, MD, two children): I think your
interest in homebirth is well-reasoned. I wanted to have my children at
home but my husband wouldn't agree. I will come give the baby a checkup at
your house in the first 24 hours if you want.

The pediatrician I interviewed (female, early 30s, MD, one child): Oh,
homebirth is no problem. You can call for an appointment to bring the baby
in the next day. We might have a problem since we don't keep Vitamin K
here. Wait, no, we can write you a prescription.

My dermatologist (female, early 30s, MD, one child): You are brave to not
get an epidural. Me: You're a doctor, you know how the hospital is, would
you really check yourself into a hospital if it wasn't medically necessary?
Dermatologist: (Pause) maybe not.

-- Dagny
EDD 10/6/03






  #7  
Old September 10th 03, 10:06 AM
Kereru
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Posts: n/a
Default Midwives & Home birth vs. an OB & hospital ?


"LSU Grad of '89" wrote in message
...
OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way.


Maybe where you are! Here in New Zealand most Mums I know have a midwife or
shred care with a midwife and a GP.

A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely

relying
on a midwife.


Same here, I am 35 weeks pregnant and haven't seen a doctor once.

She will have a natural birth at home with the midwife and
husband in attendance.

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?


With a midwife I have had blood tests at 12, 28 and 36 weeks. I have been
tested for GD, I have the option of a nuchal fold ultrasound, amnio, etc...
I had a morphology scan by choice at twenty weeks. I see my midwife four
weekly (then two weekly and from 36 weeks, weekly) for urine test, BP,
doppler and a really good chat all in my home. Any time ANYTHING is a
problem my midwife will refer me to an OB who I would see within a day or
two (sooner if urgent). When I had problems with baby's movements I went
staright to hospital for monitoring, done by my midwife.

She has had three years university training and several supervised years on
the job and works with two back up midwives. So yes I think a midwife does
has as much or more chance of catching any problems.

Hope this isn't a flame starter, I just cannot identify with the natural

at
home no doctors thing. Give me an epidural, no problem...Mother hood is
demanding enough without being a hero when you don't need to. Vicki is
right - no one hands you a medal after labor and says "you get a gold

medal
for having the most pain !"


It's about recovery and how you feel afterwards. I would rather put up with
hours of pain witha purpose than weeks of recovery.

However, I completely understand that each person has a right to their own
method, and just because I cannot identify with this, it doesn't mean it's
wrong. I just have this nagging feeling that if it were me, I'd be

concerned
that I wasn't doing the best I could do for my baby.


That's because you beleive what you have been told is "the best" for your
baby. The lady at work obviously disagrees.


I can't help worrying
for her but I don't know why...I guess I can't imagine going through an
entire pregnancy without ever seeing a doctor when one has insurance and
access (can mid wives write prescriptions for prenatal tablets ?)


Here they can, and they can write prescriptions for a lot more as well. I
have that choice, I could see an OB if I wanted to from day one but there's
nothing wrong with me so I don't.

Judy


  #8  
Old September 10th 03, 12:10 PM
Fia
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Posts: n/a
Default Midwives & Home birth vs. an OB & hospital ?

On Wed, 10 Sep 2003 10:50:35 +0800, "JoFromOz"
wrote:

For millions of years women have been giving birth without the help of
doctors.


I don't feel strongly one way or the other, but must comment on this
statement which is routinely trotted out by the natural folks.

Women may have been giving birth (millions of years is a stretch --
homo sapiens first appeared about 300-450,000 years ago) without
modern medical care, but that doesn't mean that it was safer then.

If you want to quote studies, great. If you want to point to
anecdoctal evidence, go for it. Please stop saying that since it has
been done in the past that it was done safely.

--
Help the women of Afganistan
http://www.rawa.org/

"You despise me, don't you?"
"If I gave you any thought, I probably would."
  #9  
Old September 10th 03, 01:35 PM
Sarajoyo
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Posts: n/a
Default Midwives & Home birth vs. an OB & hospital ?

LSU Grad of '89 writes:

: OK, this really bothered me so I will share it in hopes that I am just too
: used to the "modern" way. A woman at work is having hr first child, she's
: ~5months and has had no visits to an OB or Doctor. She is completely relying
: on a midwife. She will have a natural birth at home with the midwife and
: husband in attendance.

Sounds like a nice plan to me. I never saw a doctor during my
pregnancy, and I don't plan to with any future ones either. I loved
my completely natural, drug-free non-hospital birth attended by a
midwife and wouldn't trade it for all the ultrasounds in the world. I
liked not having tons of routine-but-unnecessary-for-me tests and
ultrasounds. My midwives checked my urine and blood pressure and the
baby's growth and everything at each appointment, and had anything
arisen that seemed wrong (or if I had wanted to have an u/s to see the
baby's sex), they would have referred us to a doctor right away. (In
fact, when a minor concern about me arose after the delivery, they had
an OB come right over to give his opinion, and he deemed all to be
fine.) Most of all, I loved that I was cared for by women who cared
about all aspects of my pregnancy, physical and emotional, and that my
baby was born in a quiet, low-tech setting where the emphasis was on
new-family-bonding and snuggling our baby, and I loved that she was
born calm and alert and very ready to nurse and gaze into our eyes.
It was completely wonderful, everything I could have hoped for and
more. But that's just my opinion; I know it isn't the right choice
for everyone, but for a low-risk woman with an uncomplicated
pregnancy, it's perfectly safe, maybe even safer (as Larry pointed
out).

And Larry wrote:
Unfortunately you have a view of midwives that is straight out of the middle
ages.


Nah, in the middle ages, they had a better view of midwives.

-Sara (Middle Ages student) and
Mommy to a perfectly-healthy, still-happily-nursing 18-month-old
"What's a hospital?" baby girl
  #10  
Old September 10th 03, 01:41 PM
Stephanie
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Posts: n/a
Default Midwives & Home birth vs. an OB & hospital ?

"LSU Grad of '89" wrote in message .. .
OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way. A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely relying
on a midwife. She will have a natural birth at home with the midwife and
husband in attendance.

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?

Hope this isn't a flame starter, I just cannot identify with the natural at
home no doctors thing. Give me an epidural, no problem...Mother hood is
demanding enough without being a hero when you don't need to. Vicki is
right - no one hands you a medal after labor and says "you get a gold medal
for having the most pain !"

However, I completely understand that each person has a right to their own
method, and just because I cannot identify with this, it doesn't mean it's
wrong. I just have this nagging feeling that if it were me, I'd be concerned
that I wasn't doing the best I could do for my baby.



Then research would be your friend. The outcomes for natural,
midwifery based prenatal care and child birth are statistically quite
superior to the intervention based medical attitude for low risk
pregnancies. Best for baby means best outcome. People do not have
natural child birth because they want others to give them a round of
applause. They do it because they have done the research and see the
advantages to mother and baby.

I can't help worrying
for her but I don't know why...



Don't. Midwives are trained at identifying risk and referring to a doc
when risk increases.


I guess I can't imagine going through an
entire pregnancy without ever seeing a doctor when one has insurance and
access (can mid wives write prescriptions for prenatal tablets ?) My friend
works where I do and has excellent insurance...



I cannot imagine why you would want to pay extra money for
prescription prenatal vitamins when they are available as generic over
the counters for about 3/4 the price.

L.
DS, 5-25-01 & EDD 4-28-04

 




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