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Anybody choose to use a midwife?

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8 years 1 month ago #81097 by Baby Einstein

tr_ wrote: But again, I wonder whether the surprising degree of safety of homebirth might be related to this kind of issue. 90% of women in hospitals get analgesia for labor; most homebirths don't. It seems obvious that there would be a small percentage of babies like the ones clee03 mentions, who would have much better chances of survival in the hospital than when born at home. So why don't those kids show up on the homebirth statistics? As I said up above I suspect it may be that the hospital environment (which may or may not include epidural use - could also be issues like nosocomial infection, etc.) contributes to neonatal M&M in other cases, which end up approximately canceling out with the ones that benefit from the hospital.


Fascinating discussion. I think you're exactly right. There are risks and poor outcomes to routine instrumentation that we recognize much less readily than the positive or life-saving interventions (which are probably not as common as we think). I really admire your dedication to EBM and your ability to take away the sensational anecdotes and focus on the data. The thing is, it's much more memorable to hear the story of the baby/mom who would have *certainly* died without immediate, highly specialized intervention, than the story of the mom who *maybe possibly who knows* could have avoided C-section which probably led to multi-organ failure. Also, personally (and I suspect for many of us), it's easier on the conscience to anticipate bad outcomes despite "doing everything" than bad outcomes after choosing the route of least intervention. In simpler words, I would personally feel intolerable guilt if something happened to my baby after a home birth (ie my choice) for example, than after a hospital birth (even if the epidural/forceps/vacuum/etc, ie the OB's choice, was the root of the problem). Even knowing the statistics. Even if the birth setting is an active choice too, and apparently the safer one. It's not rational, but purely emotional for me. Again, I'm so impressed with your logical reasoning!

PS - this is why I love deliveries. I'm handed a blue, floppy, low heart-rate baby and 5 minuts later? Apgar 9! Love it!!! I feel like the superhero pediatrician who saved the day! Granted, in the vast majority of cases, it's just basic resuscitation that a trained midwife could have done as well as or better than me, in any setting, with just a bag-mask and some O2. But you know what the parents think? That the pediatrician/hospital setting saved the baby. Not that the pitocin or epidural was the problem in the first place. And oh the relief when it goes beyond basic resuscitation and my NICU attending takes over!

PPS - sorry I'm rambling. Soooooo post-call with zero sleep, a good 15 overnight deliveries, including a cord prolapse!

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8 years 1 month ago #81103 by southernmd
Awww...you pediatricians are awesome. You save our babies AND take our crazy mommy call. Superheros for sure!

I love my pedi so much. I sat in her office after my Friday night delivery on Monday morning and just cried. I was exhausted, was still hurting from tearing, my back had just stopped hurting and I could finally stand, and I had to start studying that day for my test less than two weeks later in Pulm.

She just patted my head and told me it was going to be ok and told me how beautiful my baby was. It was so simple, but pretty awesome. I left feeling like I could do this.

Anyway - rambling on a tangent, but God bless the pediatricians!

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8 years 1 month ago #81331 by Emily2651
Stumbled across this the other day:

Wright JD, Pawar N, Gonzalez JS, Lewin SN, Burke WM, Simpson LL, Charles AS, Dʼalton ME, Herzog TJ. Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins. Obstet Gynecol. 2011 Aug 5.

OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College). METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations. RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232(32.4%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049). CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

PS. OBs, take heart. There's a 2009 JAMA paper that says the situation in cardiology is even worse!

The cure for anything is salt water: sweat, tears, or the sea. -- Isak Dinesen

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8 years 1 month ago #81337 by asunshine
E-love it love it love it!

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8 years 1 month ago - 8 years 1 month ago #81343 by mommd2b
Interesting topic!

I had my first three pregnancies monitored by a mixture of OBs and midwives. With my third child, the clinic that I attended sent healthy, low-risk patients to the midwives. The higher risk patients were seen by the OBs. I was assigned to a midwife. As an interesting twist, during my delivery there were some concerns, so the OB resident immediately took over my care. The peds resident didn't clamp my son's cord properly and he bled out and had to spend 3 days in the NICU as a consequence. The OB left my bedside right after he was born and it was the midwife who noticed that I was passing large clots. She had me move back from the wheel chair into the bed and I passed a grapefruit-sized clot. She is the one who was on my bed trying to stop the bleeding while the OB was being paged overhead. Her lingering might have saved my life ... at a minimum, it saved my ability to continue to have children. I did require emergency surgery, but I was already in the OR being prepped by the time the doc got there.

That being said, my present gyn who delivered my daughter when I had cancer rocks. He was incredible and I couldn't imagine being cared for by anyone else.

I think it's important to look at who is publishing these articles to evaluate whether there is a conflict of interest. I have received care from both OB/GYNs and midwives ... my experiences are anecdotal. That being said, I have felt comfortable with the knowledge base and skills of my care providers regardless of whether they were midwives or ob's. Each had something a little different to offer. I found that the docs pretty much came in at the very end and then left pretty quickly. Midwives have a tendency to linger, talk, provide comfort and listen. They seem more willing than many physicians to allow women to shift positions etc.

In terms of quality, I think it's unfair to paint all midwives as being incompetent or incapable of providing adequate or even exceptional care.

There are many studies available and I imagine there is a tendency to select articles that support our own opinions.

So here you go:

www.springerlink.com/content/n54v0033ux4w8624/

:)

Like I said though, my OB/GYN is fabulous.

In the midst of winter, I found there was, within me, an invincible summer.
Last Edit: 8 years 1 month ago by .

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7 years 10 months ago #82801 by Sarahdoc
Sorry to resurrect this thread but was just wondering if anyone has delivered with a FP-OB? I'm currently doing my OB/GYN rotation and am somewhat horrified from what I've seen on the L&D floor. I come from a "hippie" background where I was born at home and was present for both my younger sisters home births. I've been present for a number of other home births as well. This rotation was the first time I'd ever witnessed a hospital birth...and so far I am less than impressed with the entire process. I do have to say, there are no mid-wives present at this facility, and I am sure there are hospitals that cater to more "alternative" practices.

Since I'm a 3rd year medical student I'm currently trying to figure out what I want to focus on. I love the idea of doing OB, but have become a little disillusioned with the practices that I'm seeing.

Anyone have any experience with a FP doc delivering their baby in the hospital or birthing center? Is this still a viable practice?

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