From your link, this is their philosophy of care:
"We believe that pregnancy is a natural state, and that medical intervention is only necessary when that condition changes. We use intervention (e.g. continuous fetal monitoring, IVs, episiotomies, induction) during labor and delivery only when indicated, and not routinely.
We are with our patients starting from the time that they are in active labor, whether at the birth center or the hospital. Particularly in the hospital setting, we believe that it is important to provide advocacy and support for our patients throughout labor."
Hopefully some folks more familiar with admissions can address whether allying oneself with NPs and DNPs (especially via work in an all-nurse family practice office) is a turn-off or is just good clinical experience.
I see nothing wrong with that philosophy. Truly, I wish some physicians would take some of it to heart. I had a pretty unpleasant induction/C-section experience with my daughter that I am pretty sure was unnecessary from the get-go, and like mcrechio, a wonderful VBAC with the hospital-based CNM I saw for my son. If I do ultimately decide on Ob/Gyn (which is quite likely) and do not subspecialize, I intend to having CNMs in my office or, at the very least, serve as referring physician to those in their own practice.
One of my OB attendings told me there are a few things OBs do that have been shown to improve outcomes.
1) Treating GBS with penicillin (probably the biggest)
2) Rhogam for Rh- mothers.
3) recognition and treatment of preeclampsia/eclampsia.
4) treatment and diagnosis of gestational diabetes.
5) c/s in some circumstances.
Babies want to come out, they're not that hard to deliver.
They don't use fetal monitoring in Europe because it hasn't shown to improve outcomes.
Maybe I missed who/what you were responding to in this post, but 1-4 were all covered by my CNM during my prenatal care. There was an OB in-house throughout my entire labor to C-section me if necessary, but it wasn't. The only doctor I saw the whole time was the anesthesiologist (AKA saint) that did my epidural and I didn't see an OB until the day after when she was rounding through the maternity rooms. To be clear, there is a world of difference between an uncertified lay midwife and a CNM with a license.
And personally, I would agree with the European docs. I'm pretty sure there's been a fair amount of research that shows it doesn't do much to improve outcomes, just raise the amount and severity of interventions. I feel this way about my own experience with my daughter (I was continuously monitored because I was being induced), as well, and I know many other women that felt the same. I had to be on CFM with my son as well because he was a VBAC (fetal bradycardia or prolonged decels are the most reliable indication of rupture), but I didn't mind it at all. The staff at that hospital encouraged me to be out of bed, standing or on a ball, whatever was most comfortable for me to labor. Where I had my daughter, they acted annoyed if shifted in bed and they had to adjust the leads on me at all, and I was never asked if I wanted to get up except to use the bathroom. No bueno.
Anyway, OP, I think this would be a fine clinical experience, and something I would really enjoy personally. Good luck with whatever you decide.
🙂
