Nurse Midwives

[Noyac]

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I'm curious as to how some of you out there handle the call for an epidural from a midwife. Do you consider it a consult just like any other and see the pt.? Do you require a DR. to Dr. consult? Do you require that the OB on-call be notified (this is our policy)? What are your policies?

 

[militarymd]

No midwives where I am currently, but before....we required OB consultation and approval and immediate availability.

 

[Noyac]

Military Do you know of any ASA or ACOG guidelines with respect to midwives? I have looked on the 2 websites but nothing there that I can find with respect to guidelines. I know they have some.

 

[militarymd]

Military Do you know of any ASA or ACOG guidelines with respect to midwives? I have looked on the 2 websites but nothing there that I can find with respect to guidelines. I know they have some.

I only know of the ASA's guidelines for obstetric anesthesia, and it is relatively silent on advanced Nurse practitioners.

Where in CO are you?

 

[zippy2u]

Ah, just put the thing in and don't make waves. I've never had a doctor call me to put an epidural in a patient; it's always been the OB nurse taking care of the patient. If you're working in a small hospital, the cat's meow is getting the bylaws of the hospital to allow you to put the epidural in, throw it on a pump and let the OB nurses manage the pump while you go back home and do what you were doing before you were rudely interrupted. ---Zippy

 

[Noyac]

Point well taken Zippy. So I ask you are we the deep pockets if we are the only doctor on record? Whats our liability? If none then great but I doubt it.

Military, I'm in Durango. Have you ever been there?

 

[militarymd]

I haven't but, my associate is doing some consulting in Telluride? Is that close by?

And Z....you can go home...if your hospital bylaws allow it, and your malpractice carrier allows it....both of which is not true for me.

And we discussed the deep pockets before with my residents......our consensus was that as the only MD...you will be the deep pocket....however, I don't know if there are any cases closed based on that.

 

[Noyac]

I haven't but, my associate is doing some consulting in Telluride? Is that close by?

Telluride is about 30 mins away if your a raven, 2 1/2 hrs by car, or 1 1/2 hr by 4X4 over the pass (my prefered way). What is your companion consulting on? I don't think they have any anesthesia there, just some primary care and emergency med. By the way, this is some of the best motorcycle riding in the country if your interested. I tend to stick to the off-road trails, however.

 

[militarymd]

I haven't but, my associate is doing some consulting in Telluride? Is that close by?

Telluride is about 30 mins away if your a raven, 2 1/2 hrs by car, or 1 1/2 hr by 4X4 over the pass (my prefered way). What is your companion consulting on? I don't think they have any anesthesia there, just some primary care and emergency med. By the way, this is some of the best motorcycle riding in the country if your interested. I tend to stick to the off-road trails, however.

I'll see him this weekend...I'll ask him.

 

[militarymd]

There is some hospital there that has 2 anesthesiologists who hate each other and provide very poor service for everyone, and the hospital would like to figure out a way to get rid of the anesthesiologists.

 

[Noyac]

Really? I had no idea that there was even an OR there. That town is much to fine for those guys to be complaining. They must be seasoned veterans just to be able to live there. Unless they live in Rico or a surrounding town. Anyhow, tell you friend that the group in Durango may be able to help out. I know that our orthopods go there but it just for a clinic. No cases. We should continue this off the forum.

 

[militarymd]

Really? I had no idea that there was even an OR there. That town is much to fine for those guys to be complaining. They must be seasoned veterans just to be able to live there. Unless they live in Rico or a surrounding town. Anyhow, tell you friend that the group in Durango may be able to help out. I know that our orthopods go there but it just for a clinic. No cases. We should continue this off the forum.

ok

 

[jetproppilot]

I'm curious as to how some of you out there handle the call for an epidural from a midwife. Do you consider it a consult just like any other and see the pt.? Do you require a DR. to Dr. consult? Do you require that the OB on-call be notified (this is our policy)? What are your policies?

Never even knew epidural analgesia was available to what I consider inferior obstetrical care. Would never send my (pregnant) wife to a nurse midwife. Nothing personal. Just want a dude/dudette whos done a residency caring for my boss and our future child.

 

[Noyac]

Never even knew epidural analgesia was available to what I consider inferior obstetrical care. Would never send my (pregnant) wife to a nurse midwife. Nothing personal. Just want a dude/dudette whos done a residency caring for my boss and our future child.

You would be surprised at what goes on out there in the world of the uninformed know-it-alls. Not that you don't know, but its not as prevelent in the south.
I'm with you jet. But our OB's seem to think the midwives are great and don't necessarily want to know when there is a pt on the labor deck being cared for by a midwife. I insist when it is a VBAC or pre-eclamptic but its the straight forward ones that I'm in the air about. Do I push the issue for what I feel is safer medical care or do I let it go and hope that I am not involved in a bad situation? Ultimately, I want the OB's on board but the midlevel practitioners in this country are insecure about having any backup or MD assistance. They seem to be threatened by it. Or why else would they be so militant? What gets me is that they admit to less training and knowledge but refuse to admit to the possiblity of a MD making things safer for the mother and baby. This is all regarding hospital deliveries. I don't even have the time or space here to discuss the at home deliveries with midwives. Just last month and disaster happened in a town only 45 mins away. Can you say CP. Can you count the state and federal dollars spent to fly the baby to Denver emergently after being stabilized here and mother taken to the OR to control bleeding. I gotta believe we can do better than that. But this is were our country seems to want to go. Whats wrong with supervision? Whats wrong with consultation? Whats wrong with having the best trained and qualified individual involved with the case? Its the ones that think that they need no additional input that scare me.

 

[militarymd]

I personally would insist on some OB's name on the chart before I would place the epidural, but that's just chicken s h i t me.

 

[zippy2u]

Well if you're hesitant about puttin' in the epidural, pray that ya got one of those New Age, Kumbaya, Birthing Center midwifes who promotes all that Lamaze, hypnosis, warm water submersion crap for labor pain and who severely disdains all physician involvement. If ya got one of them in your town, you're golden because after 10 years in this gig who wants to put in an epidural at 3AM. Regards, ---Zippy

 

[Noyac]

How about some input from some of you doctor lawyer types. Do I assume any increased liability if there isn't an OB on the case?

 

[jwk]

Why can't you just refuse to put in an epidural for a midwife-only case? I'm not an MD, but I can certainly understand the concern for being the only MD name on the chart.

 

[DropkickMurphy]

I agree, why not just refuse? If the patient is refusing an OB attending her birth because they don't like the "medical" approach to delivery, then why should they put the anesthesiologist at risk by forcing him to partake in their little clusterf-ck.

If I sound a little harsh on nurse midwives, it's because my fiancee just had a baby and our insurance originally assigned us when she found out she was pregnant to a maternity clinic where we were forced (no warning) to see a nurse midwife. She started in on us about the "dangers" of an epidural, assuming that we were both stupid kids- neither of us look 24 y/o- all of this while Jen (my fiancee) was only 8 weeks into her pregnancy. So I hate midwives and think they are dangerous. Personally I would not go anywhere near a case where there was an OB in charge of it. But that's just my opinion from several years of practice as an allied health provider.