Midwife interview - "We're more caring"

[Dr Oops]

http://video.foxnews.com/v/4266741/pregnancy-birth-and-the-midwife

Interview with a midwife. They really got the propaganda machine rolling.

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[PharmaTope]

ya i just threw up in my mouth.

wtf was that ****. get the frig out of here. she just sounds so freakin arrogant to me. i will never ever have a midwife involved in delivering my children.


this is such a damn joke. Obama needs to get out of office. What i find really funny is all these med students that voted for Obama and support his agenda. They gonna be screwed in the long run.

 

[476515678234896]

when something goes wrong...

different my ass. I was waiting for that damn physician to chew her out.

 

[THP]

I would love to hear how she quantifies caring. It sounds like something a chiropractor would say.

 

[luxpara]

All right, I gotta bust in here -

When I was preggo the first time, hubby was a 4th year med student. I wanted a midwife and he was against it - at first. Then he did his OB/GYN rotation, for some reason that opened up his mind to it.

We decided on a waterbirth assisted by a midwife in a birthing center attached to a hospital. All my check ups were mostly done with midwives, but I also saw an OB/GYN 4 of those times. I have to say that the midwives were a lot better than the docs as far as taking their time and answering our questions, they also were nicer. Baby A was born, it was an awesome birth.

Because of insurance changes, couldn't have baby B at same place. When I found out I was preggo, I went to the women's center at the hospital that hubby was doing residency at. It was the opposite of great. I complained to another resident's wife, and she set me up with an OB/GYN that was in private practice but had ties to the hospital. He was a nice guy, but he really shined when it was apparent that I would need an emergency c-section. He saved the day!

the point of all this? Midwives rock and OB/GYN's rock. A good midwife knows that she can only help with a low-risk normal birth, they just don't have the ability to do what docs need to do in abnormal cases.

 

[476515678234896]

I love how you refer to them as "hubby," "baby A," and "baby B."

the point of all this? Midwives rock and OB/GYN's rock. A good midwife knows that she can only help with a low-risk normal birth, they just don't have the ability to do what docs need to do in abnormal cases.

Sure but on cases that both could handle, they are compensated equally with unequal qualifications.

 

[Geekchick921]

the point of all this? Midwives rock and OB/GYN's rock. A good midwife knows that she can only help with a low-risk normal birth, they just don't have the ability to do what docs need to do in abnormal cases.

Sure but on cases that both could handle, they are compensated equally with unequal qualifications.

For a normal vaginal delivery, why shouldn't they receive the same compensation for the same work? There's already a thread about this here; I think it's still on the first page.

 

[Dr Oops]

For a normal vaginal delivery, why shouldn't they receive the same compensation for the same work? There's already a thread about this here; I think it's still on the first page.

Because you dont pay for them to sit there and catch you pay for the the breadth of knowledge, so that in the event that something goes wrong you have the most learned person there.

However, if they do cost the same why would you not go for the practitioner with the longer and more rigorous training?

 

[Geekchick921]

Because you dont pay for them to sit there and catch you pay for the the breadth of knowledge, so that in the event that something goes wrong you have the most learned person there.

However, if they do cost the same why would you not go for the practitioner with the longer and more rigorous training?

Well technically, I don't really pay them so much as my insurance does, and I shell out the same copay and/or deductible either way. Regardless, any midwife worth their salt knows when a problem goes beyond their scope of care and refers to a physician, at which point the doctor will be compensated accordingly for the more specialized care, true? With that in mind, I don't see how the potential to handle a complication means they should be paid more for a situation in which none actually presents itself. But hey, we're each entitled to our opinions, and as I'm a pre-med and you're a medical student, neither one of us really has a dog in this fight yet.

Anyway, I can tell you right now this argument will go nowhere. People can scoff at things like what the midwife says in this video (which I can't view right now) til they're blue in the face, but the fact is that women do choose midwives over physicians and often cite the fact that they felt they got more personalized care and that the midwife cared about what they wanted more than a doctor did as reasons why. A nurse-midwife (I'm assuming a hospital-based CNM) is a perfectly safe choice of a caregiver for many mother. You don't really think low-risk pregnant women choose their caregivers based solely on their breadth of knowledge or length of training, do you? Assuming they have any opinion on the kind of birth they want, they will at least ask about their viewpoint and standard practices for their pregnant and laboring patients

FTR, I have always been, and continue to be, very interested in Ob/Gyn as a specialty, but I will be seeing a CNM when I am pregnant again. The reasons are personal and I'm not going to discuss my medical history on this forum.

In regards to the compensation debate, here's the last thread about it. http://forums.studentdoctor.net/showthread.php?t=728323

 

[Dr Oops]

Well technically, I don't really pay them so much as my insurance does, and I shell out the same copay and/or deductible either way. Regardless, any midwife worth their salt knows when a problem goes beyond their scope of care and refers to a physician, at which point the doctor will be compensated accordingly for the more specialized care, true? With that in mind, I don't see how the potential to handle a complication means they should be paid more for a situation in which none actually presents itself.

Well as of right now midwifes are required to have an agreement with a doc to be backup in case things go wrong. They are trying to get that law changed. So they can dump the patient at any hospital if things go wrong. We hear a lot in med school that you cant see what you dont know. So if complications do arise it may take time to for the midwife to even figure out and then additional time for the ob/gyn to actually get there.

The potential to handle other situations definitely commands more pay. Its like having a licensed contractor vs just some handy many build your house.

But hey, we're each entitled to our opinions, and as I'm a pre-med and you're a medical student, neither one of us really has a dog in this fight yet.

Your absolutely wrong here. I most certainly have skin in the game as do all med students, especially those with accumulating debt and rising tuition costs. The nurses know theres more money in expanding their scope with or without the education required. They use the shortage of primary care docs and other things to try and expand their scopes, but the ultimate plan is to infiltrate all aspects of medicine. If you think this alarmist, then you need to do some research into nursing "residencies" in fields such as derm, em, cards. They can say hey we can do this here in this field so we can do it in others.

Anyway, I can tell you right now this argument will go nowhere. People can scoff at things like what the midwife says in this video (which I can't view right now) til they're blue in the face, but the fact is that women do choose midwives over physicians and often cite the fact that they felt they got more personalized care and that the midwife cared about what they wanted more than a doctor did as reasons why. A nurse-midwife (I'm assuming a hospital-based CNM) is a perfectly safe choice of a caregiver for many mother. You don't really think low-risk pregnant women choose their caregivers based solely on their breadth of knowledge or length of training, do you? Assuming they have any opinion on the kind of birth they want, they will at least ask about their viewpoint and standard practices for their pregnant and laboring patients

FTR, I have always been, and continue to be, very interested in Ob/Gyn as a specialty, but I will be seeing a CNM when I am pregnant again. The reasons are personal and I'm not going to discuss my medical history on this forum.

In regards to the compensation debate, here's the last thread about it. http://forums.studentdoctor.net/showthread.php?t=728323

Well this nurse says that people can come to them for gynecological needs aswell. Im clearly no expert but that sounds out of the scope of midwives as well. They must be geniuses to cover most of the stuff physicians do in less than half the time.

 

[Geekchick921]

Well as of right now midwifes are required to have an agreement with a doc to be backup in case things go wrong. They are trying to get that law changed. So they can dump the patient at any hospital if things go wrong. We hear a lot in med school that you cant see what you dont know. So if complications do arise it may take time to for the midwife to even figure out and then additional time for the ob/gyn to actually get there.

Yeah, I don't like that either, at all, and it does nothing for the stigma against midwives some doctors have.

Okay, I just read about the bills in NY and NJ, and I am admittedly confused by the wording. It says they will still consult and refer, so what was the requirement before? Most midwives I have spoken to in PA (a few solo practices and groups) have their own practice, but do have a doctor or group they refer to if the patient becomes high-risk, but they also continue to see the patient and typically will still be the one to deliver them unless a c-section is necessary. They are two separate practices, however, and i don't know if they have a contractual agreement.

The potential to handle other situations definitely commands more pay. Its like having a licensed contractor vs just some handy many build your house.

I think we are going to just agree to disagree here. It doesn't say doctors will be paid less, though that can be inferred if the money is all coming from the same place, which it probably is, but they are still going to receive additional compensation for things that go beyond a midwife's scope. Also, I think this is a poor and somewhat disrespectful analogy. CNMs and CMs are all masters-prepared, are certified through ACNM, and licensed, I believe. Lay midwives are often not certified by anyone except possibly NARM or a similar group, and there are no specific training requirements, as far as i can tell (and I'm posting from my phone right now so I can't double check).

Your absolutely wrong here. I most certainly have skin in the game as do all med students, especially those with accumulating debt and rising tuition costs. The nurses know theres more money in expanding their scope with or without the education required. They use the shortage of primary care docs and other things to try and expand their scopes, but the ultimate plan is to infiltrate all aspects of medicine. If you think this alarmist, then you need to do some research into nursing "residencies" in fields such as derm, em, cards. They can say hey we can do this here in this field so we can do it in others.

I agree this is something to be concerned about, but I don't see anything that suggests that midwives are trying to expand their privileges, just that they are calling for a change that they believe will allow them to practice with less interference. Whether or not that's true is debatable as well, but that seems to be their argument.

Well this nurse says that people can come to them for gynecological needs aswell. Im clearly no expert but that sounds out of the scope of midwives as well. They must be geniuses to cover most of the stuff physicians do in less than half the time.

Midwives can handle things like routine well-women care such as a yearly pelvic exam and pap. I don't know if that's all she means but if it's not I have no clue what they can handle beyond that.

 

[DeigoT]

ya i just threw up in my mouth.

wtf was that ****. get the frig out of here. she just sounds so freakin arrogant to me. i will never ever have a midwife involved in delivering my children.


this is such a damn joke. Obama needs to get out of office. What i find really funny is all these med students that voted for Obama and support his agenda. They gonna be screwed in the long run.

This is not the first time I have seen this type of thing. ANA is a much better machine at getting its agenda pushed than AMA (I know this, I am a former advance practice nurse and now in residency). That nurse midwife came with the agenda of informing the public that they would get the same care (and she said it more than once) plus the extra of having someone who is more caring and is always by their side, vs the non-caring (greedy) doc who simply pops in a out. You can't be mad at her, she has her own agenda. It is up to the OBGYN to correct that information and she did a poor job. Nurses have figured out that the best way to push their agenda and garner support is to inform the public. Docs allow it to happen, shake our heads when inaccurate statements are made, and even bitch about it but don't correct it. In the end, the public walks away with one message...the one they heard from that nurse. As docs, we need to do a better job of getting our message across to the public and correcting inaccuracies.

 

[mslinzyann]

Pronounced mid-wiff-er-y (seriously if anything makes you sound pretentious, what does!)

Anyway, I have a huge interest in midwifery because I DON'T want to be the Chief. I do not want to do surgery (I would love to assist however) and I have no problems with stepping back when I need advice from an expert. I believe midwives and other midlevels are more than capable of handling medical situations that fall in the realm of normal/routine/uncomplicated. Its the overconfident midwives that scare me; know when to call in for backup.

Furthermore, I always thought the point of midlevels was to be physician extenders, to bring money into the practice and free up the doctors time so they can focus on the complicated stuff. I am not here to compete with them, its really that simple.

My biggest fear is that I will not know when to call for backup- I won't recognize something. That is a real concern of mine and I want to do whatever I can to learn the signs of potential complications. I guess beyond that (and I think that is the point of physician oversight?) I don't see what the big argument is about!

 

[Dr Oops]

Yeah, I don't like that either, at all, and it does nothing for the stigma against midwives some doctors have.

Okay, I just read about the bills in NY and NJ, and I am admittedly confused by the wording. It says they will still consult and refer, so what was the requirement before? Most midwives I have spoken to in PA (a few solo practices and groups) have their own practice, but do have a doctor or group they refer to if the patient becomes high-risk, but they also continue to see the patient and typically will still be the one to deliver them unless a c-section is necessary. They are two separate practices, however, and i don't know if they have a contractual agreement.

The agreement is that there is a doc who is linked up with that midwife, so when sh.t hits the fan that doc knows something about the patient before hand and has agreed to be there when the midwife cant handle. The midwifes want to get rid of this rule because it limits their practice (a common theme, damn safety rules). So with out this regulation there is no standby.

I think we are going to just agree to disagree here. It doesn't say doctors will be paid less, though that can be inferred if the money is all coming from the same place, which it probably is, but they are still going to receive additional compensation for things that go beyond a midwife's scope. Also, I think this is a poor and somewhat disrespectful analogy. CNMs and CMs are all masters-prepared, are certified through ACNM, and licensed, I believe. Lay midwives are often not certified by anyone except possibly NARM or a similar group, and there are no specific training requirements, as far as i can tell (and I'm posting from my phone right now so I can't double check).

Do you know whats disrespectful? When nurses pushing this expansion, claim how they are not only equal to drs (except for the pay) but are actually much better.
from various news sties some of them have been posted on the forum. Go look up the forbes article written by the creator of the DNP (mary mundinger). Or the article about 28 states expansion rights.

Its actually scary more than anything that these people think they know as much as physicians with less than half the training. I seriously fear for peoples lives. Instead of having nurses who want independent practice come up to the gold standard (physicians) of independence we lower the standards.

There are some members here on the forum who were in nursing and then went to med school. Their ideas on the subject are the best word there is after having gone through both systems. Their consensus is that there is a whole world of difference between the knowledge of physician and a nurse. And apparently you need to goto nursing school if you actually want to know how to care about your patients according to the nurses.

I agree this is something to be concerned about, but I don't see anything that suggests that midwives are trying to expand their privileges, just that they are calling for a change that they believe will allow them to practice with less interference. Whether or not that's true is debatable as well, but that seems to be their argument.

it is all about the $$$. they need more independence to get that money so they can charge more. Damn the risks to the patient.

The nursing motto is get what you want through legislation instead of education.

There are some amazing nurses and they are extremely important to healthcare, but they are important in nursing, not practicing medicine without the proper training and then claiming its nursing. Nobody ever talks about the nursing shortage and how these nurses expanding their scopes will affect that. Nurses arent stupid, they dont want to work where physicians dont want to either. Its just easier for them to gain latitude there due to peoples desperation. Once theyve gotten their way they shortages in those areas will go back into full swing.

 

[2Sexy4MedSchool]

Well as of right now midwifes are required to have an agreement with a doc to be backup in case things go wrong. They are trying to get that law changed. So they can dump the patient at any hospital if things go wrong. We hear a lot in med school that you cant see what you dont know. So if complications do arise it may take time to for the midwife to even figure out and then additional time for the ob/gyn to actually get there.

The potential to handle other situations definitely commands more pay. Its like having a licensed contractor vs just some handy many build your house.

This is the basic flaw in your logic. Most babies delivered in this world today, 100 year years ago and 1 zillion years ago were born without the assistance of doctors because most (young) women are healthy and most (normal) pregnancies do not require medical attention. Using your terms, it would be like hiring a licensed contractor to unclog your sink or put a nail in the wall to hang up a picture.

Does that mean OBs are redundant? Absolutely not. First of all, someone has to evaluate that (healthy) woman to confirm she is healthy and the pregnancy is normal. Secondly, someone has to manage the pregnant woman who had IVF, diabetes, gestational hypertension, sickle cell disease, etc. Third, poop happens, and when it does, it can happen very quickly. I have no problem whatsoever with a CNM managing labor in the hospital, so long as there is access to medical intervention ASAP in the case of an unanticipated 4.5kg baby, or distocia, or atonic uterus or whatever.

The point is, there are plenty of pregnant women to go around, so it doesn't have to be "us vs. them" between CNMs and OB/Gyns. The fact is that when I'm on call and have to cover triage and the laboring patients and the postpartum patients, yes, I'd love to spend a lot more time with each woman, especially the first-time laboring moms who are working their way to complete. However, I can't, because there just isn't enough time. I would love to do a better, gentler cervical exam, and I will, with more practice, but I will never have as much experience as the CNM who works with us who has been doing this for 30+ years. By the same token, that CNM knows that she will need me when those zebras do come clip-clopping their way down the hall.

That's my $0.02 worth. 2S4MS

 

[Emikosma]

All right, I gotta bust in here -

When I was preggo the first time, hubby was a 4th year med student. I wanted a midwife and he was against it - at first. Then he did his OB/GYN rotation, for some reason that opened up his mind to it.

We decided on a waterbirth assisted by a midwife in a birthing center attached to a hospital. All my check ups were mostly done with midwives, but I also saw an OB/GYN 4 of those times. I have to say that the midwives were a lot better than the docs as far as taking their time and answering our questions, they also were nicer. Baby A was born, it was an awesome birth.

Because of insurance changes, couldn't have baby B at same place. When I found out I was preggo, I went to the women's center at the hospital that hubby was doing residency at. It was the opposite of great. I complained to another resident's wife, and she set me up with an OB/GYN that was in private practice but had ties to the hospital. He was a nice guy, but he really shined when it was apparent that I would need an emergency c-section. He saved the day!

the point of all this? Midwives rock and OB/GYN's rock. A good midwife knows that she can only help with a low-risk normal birth, they just don't have the ability to do what docs need to do in abnormal cases.

 

[Dr Oops]

This is the basic flaw in your logic. Most babies delivered in this world today, 100 year years ago and 1 zillion years ago were born without the assistance of doctors because most (young) women are healthy and most (normal) pregnancies do not require medical attention. Using your terms, it would be like hiring a licensed contractor to unclog your sink or put a nail in the wall to hang up a picture.

Does that mean OBs are redundant? Absolutely not. First of all, someone has to evaluate that (healthy) woman to confirm she is healthy and the pregnancy is normal. Secondly, someone has to manage the pregnant woman who had IVF, diabetes, gestational hypertension, sickle cell disease, etc. Third, poop happens, and when it does, it can happen very quickly. I have no problem whatsoever with a CNM managing labor in the hospital, so long as there is access to medical intervention ASAP in the case of an unanticipated 4.5kg baby, or distocia, or atonic uterus or whatever.

The point is, there are plenty of pregnant women to go around, so it doesn't have to be "us vs. them" between CNMs and OB/Gyns. The fact is that when I'm on call and have to cover triage and the laboring patients and the postpartum patients, yes, I'd love to spend a lot more time with each woman, especially the first-time laboring moms who are working their way to complete. However, I can't, because there just isn't enough time. I would love to do a better, gentler cervical exam, and I will, with more practice, but I will never have as much experience as the CNM who works with us who has been doing this for 30+ years. By the same token, that CNM knows that she will need me when those zebras do come clip-clopping their way down the hall.

That's my $0.02 worth. 2S4MS

according to your logic then, the human race has survived before the existence of doctors so why bother with modern medicine at all?

 

[Doctor4Life1769]

This clip was hilarious. The midwife was the center of attention vs. an OBGYN.

On top of that, the OBGYN indirectly encourages mid-wife usage (pop-culture/wealthy/celebs using mid-wives) and even goes on to ask how one may even get in touch with a midwife. The issue of reimbursement never showed up. The issue of training never really was emphasized. Instead, the midwife states how they provide equal quality of care as per ACOG standards ...

Physicians need to start being better at articulating their thoughts to the mass media/general population. They need to start standing up for themselves, because nobody else will.

 

[DeigoT]

This clip was hilarious. The midwife was the center of attention vs. an OBGYN.

On top of that, the OBGYN indirectly encourages mid-wife usage (pop-culture/wealthy/celebs using mid-wives) and even goes on to ask how one may even get in touch with a midwife. The issue of reimbursement never showed up. The issue of training never really was emphasized. Instead, the midwife states how they provide equal quality of care as per ACOG standards ...

Physicians need to start being better at articulating their thoughts to the mass media/general population. They need to start standing up for themselves, because nobody else will.

Totally agree with this.