Midwives

Katherine - posted on 06/28/2011 ( 52 moms have responded )

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Oh, the irony! At a time when skyrocketing malpractice insurance premiums are making it more and more difficult for midwives to practice at all, the U.N. releases a report stating that more investment in midwifery worldwide could save the lives of millions of infants and hundreds of thousands of women who die each year from lack of access to adequate healthcare during labor and delivery. You don't say, U.N.?

Released on Monday, this report was actually the U.N.'s first study on midwives, so I'm sure they were somewhat startled to find that 358,000 women and 3.6 million babies die annually from mostly preventable childbirth complications (an additional 3 million infants per year are stillborn).

They were probably even more shocked to find that midwives are useful for more than just delivering babies -- they can provide contraceptive counseling and services, too. And you know what they say about an ounce of prevention! Of course, that's just common sense -- except it isn't, or hasn't been, to the powers that be in this country or any other, apparently.

So let me get this straight: When it profits governments/healthcare systems to deem the practice of midwifery prohibitively expensive, that's what they do. When, on the other hand, it profits the governments/healthcare systems to send midwives off to work their magic in places where doctors and nurses are in short supply, that's what they do. What a very consistent and humane way for world leaders to make life-or-death decisions! At least now midwives here in America can stop worrying about how they'll continue to do the life-saving work they've been trained to do. According to the U.N., a whopping 38 countries are in desperate need of more midwives. Clearly several third-world countries would welcome them with open arms!

I'm trying not to be cynical here (actually, that's a lie, I'm not bothering to try at all), but if there was ever proof that women and children, especially minority women and children, are considered expendable by the predominately male people in charge of our planet, well, this is it. As if you really needed more proof.

Do you think it should be easier for midwives to practice in this country?

http://thestir.cafemom.com/pregnancy/122...


I totally agree with the blogger. It's an interesting study. Do you think midwives are better than doctors?

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[deleted account]

I say this for every midwife debate....

The reason midwives are so successful in many countries like the UK is because they are closely affiliated with the entire health service. They are not paid by the patient, they get their pay check from the NHS. They get paid regardless as to whether or not they deliver the baby or whether they refer the mother to an OB. It is not in their interest therefore to take any unnecessary risks with the lives of mother and baby.

In the US, most midwives are independently practising. They follow the mother wishes rather than possibly the best course of action. The training is of a questionable level. Obviously there are a few well trained, professional midwives out there but you have to pick through to find them. There is additionally the issue of insurance which limits a woman's choices. And the lawsuit factor which leads to rushed decisions by OBs.

So what you have is a midwife willing to take too many risks and OBs so scared of taking any risks and jumping to the most extreme procedures. The system isn't balanced enough.

Mary - posted on 06/30/2011

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"I think there does need to be someone around during the birthing process in hospitals who actually cares"

Ah, but Nichole, who's to say that all midwives are necessarily the warm, fuzzy, caring practitioner that you are fantasizing about? I think many people have this romanticized concept of midwives as these totally compassionate, altruistic care-providers with saint-like quantities of patience and tolerance. Granted, there are some who actually are like that, but, as someone who spent years working OB, I can also attest to the fat that there are a good number who are no more touchy-feely or snuggly than a porcupine. As well, just because a doctor, nurse, or midwife is "nice" does not mean that they are necessarily skilled or competent. Some of the nicest, kindest care providers I know are downright scary when it comes to actual knowledge.

In a perfect world, ALL doctors, nurses and midwives would be both skilled and kind. However, since they too are human, not all of them are. Some of the most skilled practitioners I have worked with are not always the ones that patients "like" the best. As well, what appeals to you may not appeal to everyone. I personally, would have been annoyed beyond reason by someone fawning all over me, hanging out in my room during labor, or coming to my house every day for 10 days after delivery.(I think I would have refused to answer the door by day two!).

Charlie - posted on 07/01/2011

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The birth statistics are not favourable for all women with the US having the second highest infant mortality rate in the modern world.
"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report.

and according to the CDC it doesnt appear to be getting any better.
http://www.cdc.gov/nchs/data/databriefs/...

Adrienne - posted on 07/01/2011

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I don't know about the laws in the rest of the country, but here in the NW (Oregon/Washington) Midwives can either be trained to the Master's level - meaning that you have to earn your RN, then your BSN, then go through a Master's program in Midwifery to become a CNM (Certified Nurse Midwife). Then you have to pass a national board and licensing exam. They have two options, practice independently or affiliate with a hospital. Or they can be CPM's and go through a midwifery school. Licensing is voluntary for Direct Entry Midwives, but they can't bill insurance, affiliate with a hospital etc if they aren't licensed. Mostly you find CNM's around here. I got really lucky in that the women's clinic I found was staffed by primarily NP's and CNM's. They had two OB's on staff for high risk patients or if a mother really wanted an OB. The clinic was affiliated with the local hospital and the midwives from the clinic were the on call practitioners in the birthing center there.

All in all, I had 3 midwives. One who saw me for all of my prenatal care and two who were at the hospital when I gave birth (there was a shift change). All three were amazing. The midwife on duty when I went into labor talked to me when I called (I called before going in) and was so respectful and informative. Right up to telling me to stay home as long as I was comfortable for, eat what I want if I'm hungry (she also warned me to make it worth it because it would probably be coming back up). Then when I got there she was calm, informative and concerned to make sure that MY wishes were heard. She even made me feel better about having puked on her shoes (she did warn me, lol) by laughing it off and saying "well, that's a really good sign! it means your labor is progressing nicely.) Her replacement knew exactly what position to put me in immediately for the easiest birth the minute she felt my son's head. ("okay hun, on your side - you're about to meet your son. Dad hold her leg.")

There is also the fact that there are statistically fewer complications with a midwife attended birth than with births attended by an OB. I'll have to look up the study - I found the information when I was pregnant with my son.

Mary - posted on 06/30/2011

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Just like any other profession, there are some fantastic midwives, and there are some that are truly dangerous. Are they overall "better" than obstetricians? No, not necessarily; they are just different. It really varies from practitioner to practitioner, as well as the individual needs of each woman.

As to whether or not it should be easier for midwives to practice in this country...I don't think that's the right question to ask. I do think that the educational and training requirements need to be more standardized within the profession. Many people just hear the word "midwife" and assume that they are the same. They do not realize that there are several different types of midwives, whose level of preparation, certification, and credentialing are vastly varied. This is further confused by the different rules and regulations which vary from state to state. There isn't even a standardization of the requirements for completion of the educational programs within each classification. Some programs only require a student to have attended 20 births for qualification, and others 40 births. The average person does not realize that these distinctions even exist. All practitioners that call themselves "midwife" are not equally skilled or trained.

I think that is something the profession itself needs to address if they want to become a predominant provider of women's care within this country.

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[deleted account]

Jennifer from what I've seen on COM it seems that many women in the US do not have the option of having a midwife even when they are low risk.

Erin - posted on 07/01/2011

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I started off in the birth centre attached to the hospital. When I became 'high risk' for macro (which is stupid.. big baby should not equal high risk!) I was punted back to the OBs and had to give birth in the Delivery rooms. But even then, I still saw a combination of midwives and OBs for the rest of my pregnancy (this happened at 28 weeks). It was mostly midwives while in labour too, but they were working under the supervision of the OB (unlike in the birth centre where they operate autonomously unless there is a problem).

[deleted account]

Emma i was considered high risk and the midwives wouldn't even look at me for shared care. It was so stupid considering it was the midwives who delivered and stitched. Not once did i have the Dr come and look at me until i was asking to go home.

Stifler's - posted on 07/01/2011

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Here the midwives are there anyway. The midwife and her student came into the theatre with us and took the photos and told us what was going on and everything. They do shared care if you're high risk.

Katherine - posted on 07/01/2011

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I know plenty of people who had "high risk" pregnancies that went with a midwife and were glad they did. The midwife helped them through it and there were no complications in the end.
I think to some extent midwifes are more educated about the body than doctors are.

Erin - posted on 07/01/2011

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Exactly. So when you look at those stats, they seem to blast the 'midwives only see low-risk women' argument out of the water.

Erin - posted on 07/01/2011

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Jennifer, birth statistics for minority women in the US are far from impressive too.



Nationally, blacks have a four-times greater risk of pregnancy-related death than whites—a rate of 36.1 per 100,000 live births compared with 9.6 for whites and 8.5 for Hispanics, according to a 2008 report by the Centers for Disease Control and Prevention (CDC).



http://newamericamedia.org/2011/06/mater...



You might want to consider that before labelling another country 'backwards' and uncivilised. There is NO excuse for such a discrepancy in what is supposed to be the richest and most powerful country in the world. Your health care system has a lot to answer for.

Jennifer - posted on 07/01/2011

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Skyrockting malpractice insurance affects everyone who needs it to practice, not just midwives. In the US, doctors are still preferred to midwives and that's fine that we have both and people can choose. I wouldn't say that for sure midwives having fewer complications means that they are safer overall. Women who are high risk are not treated by midwives, so of course they should have fewer complications. I totally don't agree that here in the US men do not value women and children. No where in the civilized world are women and children thought of as expendable. However, the places the blogger is referring to are not civilized. The cultures are backwards and unhealthy and women and children face conditions that are appalling to western sensibilities. Having midwives who are trained to help in other countries is part of what some ministries and health organizations are doing in order to educate people and make them safer. ChildFund International supports such a program. I don't think we should try to replace midwives with doctors, I support having both and letting us choose.

Erin - posted on 07/01/2011

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It's a bit of a Catch 22. If midwifery was accepted in the US (and Aus if we're talking homebirth), as it is in Europe and the UK, there would be no need for lay midwives. With appropriate training and regulation, and collaboration with OBs and hospitals, all women could have access to qualified midwifes if they so chose. But midwifery is going to struggle to gain that acceptance and normality while ever it has these underground elements.

I am lucky enough to live in one of only six Australian cities that has a publicly-funded homebirth service. It operates out of a birth centre, and has full backing of the public health system. But in mosts parts of Australia, it is extremely difficult to find an IM for a homebirth. And yes, it has led to a rise in UC.

Cyndel - posted on 06/30/2011

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I think most midwives are better then most OB's with normal uncomplicated pregnancies, births, a basic women's care.
OB's should be the back up for complicated and problematic cases...not the main care provider for the perfectly normal and healthy women and babies.
I do believe we need a lot more midwives. But also a bit more stricter watch over lay midwives, most of the problems I've heard about come from under trained lay midwives, who don't have the training and expertise to recognize many early symptoms of danger in mom or baby, and give a bad name to the whole profession. Not all lay midwives are bad...not at all...I've known a truly wonderful lay midwife for nearly as long as I can remember, and she truly has the knowledge necessary to do her job and prevent dangerous situations from getting out of hand.

Frances - posted on 06/30/2011

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I think what really matters is whether the medical professional practices midwifery obstetrics or managed obstetrics. I went to a great doctor for three of my births who practiced midwifery obstetrics. He listened to me more than the midwife who delivered my last baby. She wanted me to leave and go and eat out 45 minutes before my baby was born.

Erin - posted on 06/30/2011

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There's always going to be bad midwives. Just like there's bad teachers or bad cops. But in general, the way a midwife is trained is more woman-centred. That doesn't mean they are all touchy-feely, rainbows and unicorns. But rather they are better at communicating and sensing what is the best approach for each individual woman. Midwifery does not operate on the same 'cookie-cutter' plan for pregnancy and birth as the medical model. That is what appeals to so many women.

I absolutely agree with Mary too, about the lack of standardised training and regulation among DEMs and CPMs in the US. I understand why there is such backlash to that. And until that is rectified, midwife-led care is never going to succeed in the US.

Lady Heather - posted on 06/30/2011

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My sister had a sub for her regular midwife because she was already at another birth and apparently the sub was a major cow. My sister actually told her to fuck off because she was trying to force her into these positions she didn't want to do. hahaha. I guess some people are just bitches.

Sometimes it's just a personality thing. I know some of my friends said they didn't care for my midwife. But these friends are the kind who wanted that overly huggy, fuzzy, everything is beautiful types. I never wanted that. I just wanted someone who was knowledgeable and honest because as a worry wart, that's what I need. We have three midwives in town and they are all really different. All skilled, but they have different styles.

√v^√v^√♥ - posted on 06/30/2011

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Geez :( I was just hoping that this midwife thing would be better than nurses. It's really sad. There really needs to be more support :(

[deleted account]

Nichole trust me not all midwives are nice. There was one when my daughter was born who when i was having trouble breastfeeding her came in squeezed and twisted my boobs to unimaginable shapes to try and get it in my daughters mouth and when she still wouldn't latch on this midwife took my daughter wrapped her put her in the cot thingy and pushed her to the other side of the room and said "Don't touch her until she is hungry" Now i would have gotten up and got her right in front of that midwife but i had a broken ankle so there was no way i could physically get my daughter. Lucky for me it had just gone visiting hours and all my visitors came to meet my daughter and had just seen what happened.

[deleted account]

I have found all the midwives (and I had many as I was in hospital for 17 days prior to having Ethan and was in and out for 3 weeks prior to Poppy) I have had to deal with except one to be great - mostly nice and very competant however, they don't always have the time to hold your hand as they are run ragged - I'm lucky to have the hospital with a very successful maternity unit right on my doorstep so people from out of the catchment area want to birth there - so it is very very busy, but I don't particularly want my hand held, if I had a question I asked it but generally I knew what was happening and why with both pregnancies - so others may have found my midwives to be unfriendly and uncaring.

Maybe like Heather's midwife mine just realised I didn't require the continual care as I made sure I made all the appointments I needed (GP apt 2 wks post natel to check BP and reduce meds etc) and I'm very independant,so I wonder if that's why I was signed off fairly quickly with very few home visits - I know my friends ho had twins got a lot more visits from the midwife and health visitor.

I have to say that the doctors I saw (again there were several) were all very friendly and competant too - even though they were also run ragged.

Lady Heather - posted on 06/30/2011

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Fortunately I think my midwife is smart enough to know when her service are not needed. If you were annoyed by someone coming every day, she wouldn't come every day. But because I needed her, she came. That's how it should be I think. This second time round my appointments are shorter too because we don't need to discuss as many things. I think finding someone who is skilled, flexible to a degree and has a personality that meshes with yours is pretty important and I feel sad that not every woman can find that in a midwife or an obstetrician. I've found it in both. Maybe I just won the pregnancy and childbirth lotto.

[deleted account]

I would like to say at this point ... I was not a big fan of my hospitals midwives. They were no different to the nurses going in and out .... I call my local hospital maternity ward the conveyor belt because all they care about is getting you in and out as quickly as possible. Little more than glorified nurses probably with less skills. And the one who delivered my son was a right bitch!

My community care midwives who dealt with pre and postnatal care, along with homebirths, on the other hand were fantastic. Kind, helpful, encouraging...
First child they came every couple of days because I wasn't coping particularly well. Second child they came back the first day, 2 days later then the 10th day I went to them to get checked out. So it does depend on your individual circumstances.

√v^√v^√♥ - posted on 06/30/2011

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I think there does need to be someone around during the birthing process in hospitals who actually cares. I had doctors in and out of my room left and right. Nurses too. But anyone for moral support? To care about my questions? To ask me how I was really feeling? Meh, not really. My nuse was new and broke a vein and also hit a nerve on her 2 attempts to stick me. Wasn't happy with her after that. She was too ditzy. Where is the heart? And afterwards too, there should be post partum help. Nope. Here, you just shoved out a kid, breastfeed it while you cramp. Oh, you don't know how? Let me tell you everything is fine and I don't know whats wrong while you cry and then send in the lactation consultant who will yell commands out you don't understand right after they told you they don't have enough time to stay with you and teach you to breastfeed. This, all from one of Americas best hospitals. If that is best, our entire system and go in the trash if you ask me. My experiances were horrible so I can't help but think the UK and other countries are onto something with midwives.

Lady Heather - posted on 06/30/2011

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I have no idea what happens with obstetricians in this country, but my midwife came every day the first week and then every couple of days the second week and then once a week for another weeks. At 6 weeks we did an office visit with her. My midwife will also provide this care for women who were not able to acquire a midwife for prenatal and birth, but who desire postnatal care. And that is why she is awesome. Ha. She freaking came over at 4am one day and hung out on the couch with the baby because I was really ill and refusing to sleep.

I think this time around her checkups will be much briefer because we actually know what we're doing this time, but I still expect to see her with great frequency.

Lissa - posted on 06/30/2011

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Really? When I had mine it was every day, maybe it was down to the area, who knows.

[deleted account]

I had two high risk pregnancies so for both I had dual care - I saw a midwife for day to day stuff but had to attend special clinics run at my local hospital to see a OB, who ultimately decided what would happen with my pregnancies. For me even though I was high risk and delivered early with both my children I still only had a midwife with me to deliver - the doctors come round to me a few hours after delivery (to discuss my after care and what would be happening). So although I live in the UK where midwife led care is predominant I feel there is 100% a need for both midwives and OB's even in normal low risk pregnancies as things can and do go wrong, although the doctors should take a backseat on low risk pregnances.

I don't know if midwives would be the best move for the US though because the healthcare system is drastically different to ours and is so much more restricted with the care given due to the lability clauses and the insurance restrictions. I do feel it would be great though if more fully trained midwives could work with the OB's to provide care for low risk women. Normalising birth is the first step though.

Lissa my midwife didn't come to me everyday first time she came every 3 days until 10 days, this time she visited me twice and both times she only came out to me that much because she had to check my BP - otherwise she wouldn't have - that would really pee me off everyday for 10 days lol

Lissa - posted on 06/30/2011

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Something I have been wondering about how things work in other countries. In the UK midwives come out to your house every day for 10 days after the baby is born to check on you both and help out with any issues. What happens where you are?

Erin - posted on 06/30/2011

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Vicki, I heard about that case and joined the FB group (Save HBAC in Australia). Unbelievable. I'm going to go back to uni to do Midwifery in 3 years, but I will admit the constraints of the current legislation almost turned me off. As a single mother, I will not be able to work as a independent in this political environment. So instead I will be working for change from the inside and going the hospital/BC route.

Vicki - posted on 06/29/2011

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I would choose a midwife any day. If I had complications I would consult an ob, but still have the primary care of a midwife.

There is currently a witchhunt happening here in Australia. A homebirth midwife has been reported for attending a VBAC at home even though she worked within all the guidelines, birth went fine, baby and Mum are healthy. Midwives are having to fight for the right just to exist and practice independently. They are told to 'collaborate' with obs or lose registration but no obs want to collaborate on a homebirth. Lose lose.

I considered studying midwifery but decided against it. The choice of having to work in the hospital system or fight for your very livelihood as an independent is not very enticing.

Becky - posted on 06/29/2011

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I haven't had a midwife in the past, but I'm really wanting to with this pregnancy. From what friends have said and what I've read on the midwifery clinic websites, the care is just so much more personal. They say each visit is 1/2 an hour to an hour. My OB visits were 5-10 minutes, and I didn't even feel like my OB took my concerns seriously with my first. With my second, I didn't go to an OB, I went to a maternity clinic staffed by family practioners who specialized in maternity and neonatal care. They were awesome, but still not as personal as I think midwife care would be. One of my friends had a midwife-assisted home birth and said that when her midwife came to do a post-partum check-up, she did her dishes for her! I was sold! :) Never heard of an OB doing that!
Unfortunately, midwives are in short supply and high demand here. I called all the midwives in the city the day I found out I was pregnant and I'm still on the waiting list. :( They are fully funded here now, which is awesome. And one of our universities just announced they will be offering a midwife certification program, so hopefully in a few years, there will be a lot more midwives here. Unfortunately, that's too late for me to have one. :(

Kate CP - posted on 06/29/2011

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Wish I could have found your OB, JuLeah...mine was doing weekly ultrasounds on me in my last month because I had GD. I didn't measure large or anything...I really shouldn't have consented to them but I was scared and facing something new. If I ever have a baby again (NOT HAPPENING) I'll find a midwife. I liked my doctor but after this last pregnancy he didn't really impress me. :(

JuLeah - posted on 06/29/2011

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Better then .... Our doctor and mid wife worked closely with one another, great respect all around. The doctor felt birth ought to happen at home with a mid wife BUT if anything went wrong, he was there and ready.

Doc trusted the mid wife to make the call about when to transport if that was needed, trusted her judgment totally from what I could see and she trusted him.

This doc took most all the mid wife cases in the city and STILL had the lowest c-section rate of any doc in the state .... He didn't believe in c-sections, and believed that if things were dealt with correctly, a women would not tear or need to be cut - he said that was barbaric ....

He didn’t believe in tests for the sake of tests, so we didn’t have any of them done.
He didn’t believe in preventive antibiotics, or really any of that crap.

Did I mention, he was not raised or educated in America???

Tara - posted on 06/29/2011

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I think midwives are better than doctors when it comes to healthy low risk pregnancies.
I also think having a midwife for a high risk pregnancy and delivery is far better than having no care at all.
I do think midwives in the US are getting the raw end of the deal, however I also think there are too many midwives in the US who act like doctors and on the flip side there are far too many midwives in the US who think their way is the only way and put women in danger because they are too extreme in their position.
Midwives are and have been delivering babies for a lot longer than doctors. Today's midwives (in Canada anyways) are very thoroughly trained and schooled.

I would love too see midwives take over all low risk pregnancies. This would be a step in the right direction for infant and maternal health, both at home and abroad.

Lissa - posted on 06/29/2011

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I'm in the UK too and I have to agree with Lucy, midwives treat labour and birth as the normal process it is. In my experience of midwives they don't need monitors etc to tell how things are progressing. Midwives watch how you are moving, talking, tone of your voice, facial expressions etc, they can tell a lot from all of that. You don't just get hooked up to monitors, if they want to check the heartbeat they use a handheld monitor so they can do it in whatever position you are in. When it comes to pain relief it is clearly explained long before labour what the pros and cons are. Women here know the risks of an epidural for instance and generally don't use them. Midwives discuss how a labour progresses and ways to help yourself and the baby while you are pregnant. You go in to hospital (if you choose that option) knowing that being relaxed, walking around and rolling your hips will all help ease the pressure and keep the labour going.

The only people I know who have had much input from a Doctor were 2 c-sections, one (non c-section) epidural. A friend (who I was with) her water had broken with no labour after 24hrs so she was induced putting her at higher risk even then the Doctor took all her cues from the midwives.

I can only say if complications occur then of course you may need a doctor but in my experience most people have no need for a doctor.

[deleted account]

2 of my pregnancies were what the ob's said were high risk. One was born at home in the bath 3 weeks early extreemly fast and unexpected. The other was born in hospital by induction 3 days early during the hospital birth the ob did not look at me once. I was so friggin annoyed because they made out that i was so high risk i couldn't go to my due date and the baby was measuring big etc etc and yet he didn't or any other ob didn't do a damn thing during delivery or the labour itself. Midwives did everything with all 3 of the kids.

Lucy - posted on 06/29/2011

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Here in the UK, unless you are a high risk pregnancy or there are complications during the birth, midwives are the norm. In fact, midwife assisted home births are increasingly common.



Many women here will only see a doctor once or twice during their whole pregnancy and birth experience, and the UK has (for the western world) a relatively low rate of c-sections, epidurals and post birth complications, so it is a system that makes sense to me.



From my limited experience talking to friends and watching One Born Every Minute USA, it seems to me pregnancy and birth can be some what over medicalised in the US, almost as if being pregnant were an illness! I am always shocked when I watch the show mentioned that women are encouraged to have epidurals straight away and seem to be instantly hooked up to a foetal monitor, even when the labour seems to be progressing normally and there is no evidence of the baby being in distress. I am all for women having the choice of any pain relief they want, but they should be aware of risks and problems associated (especially with epidurals) so they can make informed choices as their labour progresses.



IMO the people around women during pregnancy and birth should ensure that the woman feels empowered to take control of her own body and birth experience, and midwives are trained to do this.



If there are complications, then yes, of course the involvement of a doctor my be necessary, but it should be the exception not the rule.

Stifler's - posted on 06/28/2011

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I think they do different jobs. If you're right to give birth naturally and have no complications then you don't need an obstetrician. The midwives are there to give you drugs and support you and catch the baby. I had pretty much only midwives with Logan and saw the ob twice for routine checkups because I was extremely low risk and I saw the OB during the birth with Renae because he heartbeat was low and all this other stuff went wrong. The ob was there to cut me open and pull her out.

Amber - posted on 06/28/2011

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I don't think either group is better than the other. Some midwifes will be better, some doctors will be better. In the end, it probably evens out somewhere in the middle.
I personally am all for both as long as they have proper medical training.

I chose an OB because midwives are not available in my area. But from all the descriptions I've heard of midwives...I think I had an OB who acted just like a midwife would.
I actually had an OB and an NP, that way it was almost guaranteed that one of them would be there with me when I delivered. Because I ended up high risk with complications, it was the OB.

The hospital I delivered at was very much for natural births and very hands on. I actually ended up seeing all 4 of their OBs at one point or another because my OB wanted me checked up on when she was in surgery or went home for some sleep. All 4 were respectful, thoughtful, and helped me make informed decisions. One actually went and got research for me since I was on bed rest and unable to get up.

Nikki - posted on 06/28/2011

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I am biased because I loved my midwives, I had 2. Where I lived there was a hospital program for low risk patients. I was able to have my pre natal care with 2 midwives so the chances of them delivering my baby was high. Thankfully they were both on that morning! I only saw a doctor once, they were busy and seemed uninterested.

Lady Heather - posted on 06/28/2011

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We have a midwife degree in BC too. It's pretty rigorous training. A friend of mine just became a registered midwife after a four year degree, a year of practicum experience and a qualifying exam. She even spent a few months in Nepal delivering babies at this crazy rural clinic. She can deliver my baby any day.

Erin - posted on 06/28/2011

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Sara, you're absolutely right! Insurance and hospital policies play a huge role in the treatment women receive from OBs. My daughter's birth ended up in a forceps delivery because 'the hospital doesn't let you push for more than 2hrs'. Grrrr

Katherine - posted on 06/28/2011

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When I went for my first daughter I was given the option of having a midwife. I declined only because I wasn't informed enough. I wish I would have gone through with it in retrospect.
But oh well. With my second, I just don't know WHAT I was thinking.

[deleted account]

I don't know if midwives are better than doctors. I've never experienced a midwife, and I haven't done enough research to make up my mind. A midwife was out of the question for me because the birth center where they are is almost an hour away, which is why I haven't done any research. I DO know that some insurance companies don't cover midwives. A few of my friends ran into this problem in their pregnancies. I also know that my insurance company required an ENTIRE surgical team to be AT the hospital during my ENTIRE labor at the hospital...because I was having a VBAC. I have an amazing doctor, but I'm sure there are doctors out there that wouldn't have even given me the option of VBAC for this very reason. I don't know where I'm going with this...except to say insurance restrictions cause doctors to not necessarily make the best decision. And women SHOULD be the one in control of their birthing decisions...not insurance companies.

Erin - posted on 06/28/2011

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Midwives are 'better' than doctors at dealing with a normal, low-risk pregnancy and birth. By 'better' I mean more suited. OBs are surgeons. They are trained to diagnose and treat complications in birth and pregnancy, not to guide and observe a normal, natural pregnancy and birth. There are some doctors who have never even seen a normal, physiological birth. Some have never caught a baby with the mother in any position other than lithotomy. Many aren't trained in breech vaginal births at all. That is insane. And that is why midwives are the 'experts' on normal pregnancy and birth.



Now if I developed some pregnancy-related issue, you can bet your ass I will be glad for the assistance provided by an OB. Sometimes specialist medical advice is required, and that is what OBs were intended for.



Many European countries already use this system. In those places, most mothers will never lay eyes on an OB. The only reason they do is if the midwife identifies a potential complication and refers them on. The idea of needing a specialist surgeon for what is, for the vast majority of women, a normal physiological function, is outrageous.



Now obviously for this system to work, the midwives need to be adequately trained. In Australia, midwives are university qualified. They either have an RN with a Graduate Diploma in Midwifery, or a straight Midwifery degree (this changed fairly recently). I think the reason midwifery comes under attack so much more in the US is due to the lack of regulation. There are DEMs (Direct Entry Midwives) who do no official training, and learn on the job (as an 'apprentice') and CPMs (Certified Professional Midwives) who may have only done a short online course and attended a handful of births. It's not surprising that there is backlash against these groups, especially when there is a homebirth loss.



The situation for homebirth midwifery in Australia is a joke (as of July last year). They can only keep their licence if they are affiliated with an OB, which we all know is unlikely to happen. But our public maternity health care is midwife-led, so we do have access (albeit in a hospital setting).

Kate CP - posted on 06/28/2011

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I wish I could have found a better midwife than the first lady I found. She was a total bitch to me and didn't believe me when I told her I was barfing all day, every day, no matter what I ate or did. I was hormonal and a first time mom and scared so I ran to an OBGYN instead of finding another midwife. It turned out pretty good in the end, but I think I would have really enjoyed birthing in a birthing center or at home more. :/

Lady Heather - posted on 06/28/2011

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I don't think all midwives are better than all doctors. I think in many low-risk situations it would make more sense to make use of a midwife than an obstetrician because at least where I live, it is hard to get an appointment with an obstetrician. They are really busy and more midwives would lighten the load. I think midwifery should be standardized everywhere as it is in the province where I live. I think midwives should be able to practice in hospitals like they do where I live, so women who seek the care of a midwife do not feel like they HAVE to have a home birth (not that there's anything wrong with home births, but you know what I mean).

I think my midwife is better than pretty much any doctor. I see an obstetrician for consultations because I'm high risk and he's cool (not all evil, pushing the medical interventions and crap like that some people say doctors always do), but my midwife takes so much more time with me and the postnatal care is freaking amazing. So I rave about her and I think it would be awesome if everyone could have the care I have. I do know some women who have had poor experiences with midwives though. As with any other group of people, there are always going to be bad apples.

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