What about midwives?

[epsilonprodigy]

I'm still an undifferentiated MS-2, but I seem to really enjoy obstetrics. A few things are holding me back, however. For one thing, the c-section rate in the US and the cavalier way some physicians seem to view secitions is pretty unsettling. This leads me to the question: are MD's being displaced by midwives? What do patients show a preference for? (It seems that any time you hear the word "midwife," it comes alongside plenty of smack-talk about OB/GYN's.) What about the outcomes? Are we headed toward OB/GYN's being reserved for high-risk patients only? (FWIW, I think I would enjoy taking care of high-risk patients too, and would probably subspecialize.)

OB/GYN's, please don't take this as an insult, it's just that if the field is on the downhill slump, there are other specialties I can see myself being equally happy in.

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[anonperson]

I'm still an undifferentiated MS-2, but I seem to really enjoy obstetrics. A few things are holding me back, however. For one thing, the c-section rate in the US and the cavalier way some physicians seem to view secitions is pretty unsettling. This leads me to the question: are MD's being displaced by midwives? What do patients show a preference for? (It seems that any time you hear the word "midwife," it comes alongside plenty of smack-talk about OB/GYN's.) What about the outcomes? Are we headed toward OB/GYN's being reserved for high-risk patients only? (FWIW, I think I would enjoy taking care of high-risk patients too, and would probably subspecialize.)

OB/GYN's, please don't take this as an insult, it's just that if the field is on the downhill slump, there are other specialties I can see myself being equally happy in.

I'm not sure how you can really enjoy OB as an MS2, but whatever.

The cearean delivery rate in this country is multi factorial and is not as simple as physicians being cavalier. That viewpoint is touted by ignorant media outlets. Are some physicians more aggressive with cesarean deliveries? Yes, that is without a doubt true but again different surgical practices are common among any type of surgeons.

Most midwives work in a collaborative environment with attending physicians. At my residency, the private groups have employed midwives who are essentially first call for routine deliveries and the more routine things. The physicians take care of operative deliveries, complex perineal repairs, C/Ds, and urgent GYN cases from the ED and D+Cs for miscarriages. This is what is typically seen.

There are some more renegade midwife groups that are essentially practicing out on their own with little to no physician oversight. This is less common but you do see that from time to time. Their knowledge base is usually pretty piss poor and they're usually promoting home births etc.

Some patients prefer midwives while others prefer an obstetrician. As far as outcomes, unless you are talking about the same exact patient population you can't really compare outcomes.

 

[epsilonprodigy]

I'm not sure how you can really enjoy OB as an MS2, but whatever.

.

Okay, fair enough. What I meant was that we just completed a unit on OB/GYN, which I found really fascinating. In fact, when I got home after exams, all I wanted to do was "relax" with a glass of wine and... crack open Williams?! Paired with the fact that I was an RN before med school and really enjoyed my L&D rotation, I can confidently say it's something I can see myself doing. The thing that ultimately deterred me from it at that time wasn't the work. I was a bit more timid as a twenty- something fresh from undergrad, and didn't think I'd play well with the OB nurses I'd met, who frankly scared the daylights out of me ;-) I've gotten sassier with age, however, and would no longer allow something like this to play into the decision.

I've had very little exposure to midwives, but it seems logical that an MD would be far more prepared to handle complications. From what I have read, most midwives are appropriately quick to direct any potentially complicated patient to an MD, so comparing populations as a whole would be like comparing apples to oranges. I more meant that I was curious about the outcomes of the low-risk women in each population- for example, do the textbook births that just happen to come to an OB/GYN have equivalent outcomes to those that go to a midwife?

 

[deleted480308]

http://www.skepticalob.com/2014/01/...announce-that-it-shows-homebirth-is-safe.html

http://www.sciencebasedmedicine.org/the-tragic-death-toll-of-homebirth/#respond

some interesting studies on the topic

 

[THP]

Paired with the fact that me was an RN before med school and really enjoyed my L&D rotation

Hmmmmm. . . . .

 

[epsilonprodigy]

Hmmmmm. . . . .

????

 

[Geekchick921]

There are some more renegade midwife groups that are essentially practicing out on their own with little to no physician oversight. This is less common but you do see that from time to time. Their knowledge base is usually pretty piss poor and they're usually promoting home births etc.

Are you talking about nurse-midwives (who can be great), certified professional midwives (the validity of whom I still often question), or lay midwives (which often scare the hell out of me)? You sound like you're talking about the lay midwives who have little to no actual medical training and are the kind you hear news stories about where they hide in a closet while the EMTs and police show up to a home-birth gone terribly wrong. If that's what you're referring to, I don't disagree and I frequently question their knowledge and skills.

CNM's do not always have to be part of an Ob/Gyn practice. States vary in their laws regarding this. Many states allow at least CNM's to have their own separate practice as long as they have a professional agreement with an Ob/Gyn practice to refer patients to if they become high risk, require an operative vaginal delivery or a C-section, etc. I hope you're not referring to them. They are far from renegade and practicing by state regulations. They don't necessarily do home births and can deliver at a hospital or birth center (sometimes one attached to very close to/affiliated with a hospital). The CNM that caught my son (my VBAC baby) had her own offices and I delivered at a hospital. I had all the standard prenatal care (labs, ultrasounds, GD testing at 28 weeks, etc.); she was perfectly capable of taking care of me. I know she has an arrangement with an Ob/Gyn practice but I never needed to see them during my pregnancy. My son's birth was one of the best experiences of my life. I have nothing but love and respect for that woman.

I hope to do my residency at a program that has nurse-midwives involved in residency training in taking care of uncomplicated labor patients and SVDs. I spent a year after I had finished my prereqs strongly considering applying to a second degree BSN and subsquent midwfery program instead of medical school (obviously I changed my mind). I'd like to be in the kind of practice you describe above down the line, or have arrangements with CNM's with their own practice. Midwife does not necessarily equal home-birth or squatting in a thicket in the woods around burning incense. A licensed, certified nurse midwife is very different from a lay midwife with no license and questionable/possibly nonexistent legitimate training and it is unfair to compare them.

 

[anonperson]

The knowledge base of all midwives is lacking. Lay midwives and professional midwives being the worst. Nurse midwives are good at following routine/patterns which is fine. But it still doesn't negate my comment on their knowledge base lacking.

I'm not bashing nurse midwives. They play a role in the current health care system. As far as your midwife doing the standard prenatal labs. I'm not sure what that specifically means other than nurse midwives can follow routine/patterns very well.