There weren’t any.
That’s right. The 20th Century saw one of the greatest public health advances of all time, the steep drop in both perinatal and maternal mortality. Childbirth went from being an occasion for women to write their wills to a “birth experience.” Childbirth is not inherently safe; it is inherently dangerous. It only looks safe because the myriad innovations of modern obstetrics and neonatology have made it safe. Discoveries included antibiotics, blood banking, epidurals, incubators, respirators, surfactant, and Rhogam among others. Not a single one was invented or discovered by a midwife.
Could we do better? I suspect that every obstetrician and neonatologist believes that we can save even more lives and is assiduously working toward that end. What are midwives doing to improve perinatal and maternal mortality rates? Not a blessed thing.
Is it any wonder then that midwives downplay or deny the inherent dangers of childbirth? Well educated, well trained midwives can provide excellent care for women, but only so long as they respect the fact that childbirth is fraught with risk for both baby and mother and it is only the liberal use of the innovations of obstetrics and neonatology that leads to safe outcomes.
I beg to differ Amy.
http://www.takepart.com/article/2015/12/02/lifewrap?cmpid=tp-ptnr-upworthy&utm_source=upworthy&utm_medium=partner&utm_campaign=tp-traffic
Read it carefully. She copied it from a doctor.
Thank you all for your congratulations and well wishe, I really appreciate it! We are home now, were discharged yesterday 10/3. I am doing fine and so is little Robert. He eats very well and is a good sleeper. He does spit up a lot but we are still trying to figure out the best/ proper way to burp him. He is so little and delicate, I don’t want to hurt him.
So glad you got a good sleeper! He is a cutie! Congrats again! Looks like your dog is a good helper. 🙂
Thank you, my dogs are in awe of him =)
He is adorable! Absolutely adorable! Congratulations!
Also, newborns are tougher than you think. 😉 Don’t worry; you’re doing fine!
My mom keeps telling me the same thing, that I am worrying too much. I appreciate the help!
Congratulations! They don’t break *that* easily. In a year he’ll be able to do things that give you a metaphorical heart attack on a regular basis.
My boy was a serious spit-upper for ages. Nothing seemed to ease the spit up, but since he didn’t seem to care, we just bought extra cloths to clean up.
My little guy is a happy spitter too. I was worried for a while (typical doctor thing, kept feeling his stomach thinking he had pyloric stenosis), but then I realised that he was clearly happy and thriving so there couldn’t be anything seriously wrong. Once I accepted that he was just going to spit up for a while and resigned myself to the idea of just cleaning up after him, it got easier.
YesYesNoNo, your little one is beautiful!
Thank you so much! ♡♥
This is my plan, he has a fast suck. He is always so hungry. He was just at the pediatrician’s office today and all is good.
Also, take comfort in the idea that your baby has no idea if you don’t know what you’re doing, so he can’t criticise you later. 😛
Baby who sleeps well is worth a million! Congratulations with coming home!
Burping techniques which worked with our baby – first one from this video https://www.youtube.com/watch?v=b_UosOPIc8Q, also one which I haven’t found in Youtube but which is basically propping baby upright with back to your chin and holding with your lap his chest tightly (his legs are dangling and it’s looking a bit rough but it was only way how we got him to burp in first week or so).
Thanks, he is eating againg, I am going to try these.
Congratulations!! He’s so cute. There are days when I miss when my son was that tiny. He spit up a lot in the beginning as well. I found that feeding him half his bottle, burping him and then letting him finish the bottle before burping again helped a lot. Same thing with breastfeeding; let him nurse, burp, then either switch sides or top off with formula and then burp again. I also remember having to pat him VERY firmly to get a burp. None of this circular rubbing business. Good, firm, rhythmic pats in the low middle back.
They are tougher than they look. *Almost* makes me want another baby.:-)
Thanks!!
He had hardly any spit up so far today…. knock on wood…
I have been trying to burp him in the middle of feedings. I just need to be comfortable handling him.
He also despises having his diaper changed. He cries bloody murder.
I know – they say keep the baby fed, clean, and warm – but my child hated having her diaper changed those first weeks. Evidently she had not read enough baby books.
He screams and turns bright red as soon as the diaper is off. He makes the cutest cry. I guess he didn’t read or join a blog either.
I found that a little pressure on DD’s tummy helped, too. I’d have her sit on my lap, and lean over my hand, which was on her stomach, and then pat her back good and firmly. The combination of tummy pressure (nothing heavy, just her weight on my hand) and back pats seemed to work.
I have never been around new borns before, now I am mom to one. I am always scared of hurting his head. Today was a good day, hardly any spit up. My husband has also been great, very hands-on daddy. My mom is also a NICU nurse so I call her constantly. She’s been over the last two days to help and advise.
Guessing in time, like anything else, I’ll get the hang of it.
It’s scary!
Be kind to yourself, each other and the baby and you won’t go far wrong.
Yep. 🙂 And honestly, as long as his tummy’s full and his diaper’s dry and he’s been snuggled recently, he is FINE, even if he doesn’t think so. Really. 🙂 It took me a while to figure that out. DD wanted to be held all. the. time., and considered it a personal offense if I set her down. I remember once after she pooped all over me getting her cleaned up, then putting her in her crib, stripping off my clothes, throwing them in the washer, and then taking a 2-minute shower to get the mess off. She howled the whole time, and I honestly thought I was doing something wrong, but couldn’t figure out what I could do differently…I mean, walking around covered in poo wasn’t an option. :p
Answer: I was doing nothing wrong, and I’m pretty sure she doesn’t hold it against me that she had to lie in her crib for five minutes by herself at two weeks old.
FWIW, I hadn’t been around newborns much, either, and it’s a particularly nasty learning curve when it’s your own kid. You’ll be fine, though. Keep it up!
Yes tell me about it, I have to ease up on myself. I want to cry when he screams, like I am doing something wrong to him. I keep tellin myself it has not yet been a week. I am lucky my family is very helpful and my mom an RN.
beautiful!!!
Thank you ♥
Looks like Robert has made a new friend. <3
Yes, I have two Boxers.
I don’t think I’ve ever seen a Boxer that has white fur. What’s a Boxer’s general temperament like? Anything different once they’re neutered or spayed?
White Boxers aren’t recognized by the AKC, I have had Boxers since I was 18, all females, and all spayed by 6 months. They are very playful and full
of energy. They like to be the center of attention. I love mine, can’t imagine life without them. Yes, they love to lick!
They love to lick becase they want you to smell like family. 😀 I have a cat who thinks he’s a dog, because, before we adopted him, he’d grown up in a home with 2 Rotties and a Labrador. Washing is how he expresses his affection (and also makes me smell like family again after I’ve showered, because to him, I smell weird.)
*dog(s) thinking about new baby*
“He smells like milk, but he doesn’t smell quite right. Yet.”
*proceeds to wash new baby everywhere*
“There. NOW you smell like family!”
(I had a dog once, who, every time I got out of the shower, wanted to lick the water off me. She couldn’t fathom why humans want to douse themselves in water every day, and hated going out to pee in the rain.)
You stated that midwifes aren’t doing anything to improve birth… since when ob gyn invented antibiotics, blood banking, epidurals, incubators, respirators, surfactant, and Rhogam???? I guess biologists should deliver babies since a biologist discovered antibiotics….
Did you miss where she said “innovations of modern obstetrics and neonatology” – she wasn’t claiming that OBs have made all those innovations themselves. And the overall point still stands, regardless:
“[…]that childbirth is fraught with risk for both baby and mother and it is only the liberal use of the innovations of obstetrics and neonatology that leads to safe outcomes.”
The incubator was invented by a French obstetrician, Dr. Tarnier. The idea to treat premature infants with surfactant was a pediatrician’s. I’m going to go out on a limb and say that none of the other stuff was invented by midwives…
On a related note, here’s a news story on some research that may turn out to have a major impact on neonatal mortality in preemies: http://www.cbc.ca/news/health/preemie-light-1.3254813?cmp=rss
To summarize, it appears that neonatal mortality may be cut in half when parenteral nutrition is fully shielded from light. There’s a link to the study from the article page. The authors are all MDs or PhDs. Nary a midwife among them!
If the reduction in neonatal mortality turns out to actually be 50%, what a breakthrough! Even if only half that, it’s still a significant reduction and worthy of implementation.
That’s amazing. Here’s hoping it turns out to be that simple! Wow!
But-but-but Gaskin Maneuver!!!!
It seems like life in the 20th century in Western countries has become too safe and comfortable, and some people are bored… They want danger, adventure and romance like in the Dark Ages. They want to make a will before birth and say good-bye to relatives… They want to make guesses if their baby will survive or not, then pray and then visit a small grave and weep over it. They want to stay bedridden for 40 days after delivery. Safe sterile hospital? Healthy mom and baby? Noooooo, this is sooooo trivial!
I can see that as a component of what’s going on. It also explains extreme sports and the popularity of post-apocalyptic scenarios in entertainment (movies, TV, video games.) But I do wish that people would stick to bungee jumping* or even motorcycle riding rather than risking a non-consenting person in the process.
There’s another component as well, though: People are convincing themselves that it’s not really dangerous. The whole “birth is as safe as life gets” component. Not to mention the claim that birth is not really painful. We want to climb mountains and conquer the world, but we want to be safe as well. Because, really, while it may be fun to make your will and go off to have the baby alone in the desert like the ancestors may or may not have, no one really wants to be the person who rolls a botch and dies in the process. We all want to be the person who comes back in triumph, having conquered birth or whatever. It has to be both dangerous and safe–dangerous, but somehow we never really get caught by the danger. Hence the confusing propaganda about birth being safe and yet women who give birth at home being “mommy warriors.”
*Which is actually pretty safe. Shh…don’t tell anyone!
Exactly! Why not do some parachute jumping or scuba diving if fascinated by danger and all? Instead of freebirth.
“It has to be both dangerous and safe”
It has to be dangerous for everyone else but them. They convince themselves it isn’t dangerous for them because they’ve got that special thing (kale, determination, knowledge, mommy instinct) that all those it was dangerous for lacked. It’s the hero walking into the danger with the magic talisman, and emerging victorious.
No. This is due to the cultural advancement and the higher information and empowerment that women currently have, which allows you to avoid abuse and indiscriminate use of cesarean interventions when they are not necessary (promoted by the vision of childbirth as always risky, for the wrong vision to see other professionals such as competition, and for the ambition to continue making as much money as possible)
Which c-sections were unnecessary? How do you determine that?
most risky deliveries can be predetermined with current technological advances, and those that occur unexpectedly may be referred to an obstetrician (are the exceptions, not the rule)
.But given the safety and success of c-sections these days, why wait until an emergency arises?
“…the safety and success of c-sections…”??? Do you know all the risks and future complications from unnecessary interventions ? Do you know how unbelievably higher costs result from these interventions? It is not efficient when no necessary.
I know the risks and future complications of both c-sections and vaginally birth. But why don’t you tell us all about it.
And again, which c-sections were unnecessary?
Are you a medical doctor? How do you know if interventions and/or cesareans are necessary or not? Sorry if I sound rude but this stuff just freaks me out. These “empowered and educated” women run to the “evil docs” in the last minute when things get hot and it takes plenty of effort to save them and/or babies. And all this UNNECESSARY risk is dealt with by hospitals. And if the doctors don’t succeed in a complicated situation like that they are the ones to blame not the irresponsible woman. Everyone has become SO educated with the advancement of Internet, social media, forums. I guess we will not be needing doctors anymore, anyone could just take care of themselves having done some “research”.
same answer, most risky deliveries can be predetermined with current technological advances, and those that occur unexpectedly may be referred to an obstetrician (are the exceptions, not the rule)
Current technological advantages that homebirth midwives can’t use, and consequently demonize.
Those that occur unexpectedly can be teleported to hospital instantaneously, I assume, where OBs, without the patient’s medical history, can Sherlock the problem and House the solution.
Now that *would* be an expensive system.
Isn’t this what we do? We don’t do c-sections willy-nilly, we do them for indications. We pre-schedule c-sections for situations where the risk of an adverse event is high, like breach, or where the risk of an adverse event may be low but the consequences of that adverse event are disastrous, like for VBACS (and even there, we will do them provided the hospital has sufficient resources to handle the emergency).
We also do c-sections include when monitoring indicates some sort of distress during labor, or if labor stalls, creating higher risk.
That accounts for the vast majority of c-sections that I know about, and sounds like exactly what you are suggesting in your comment.
So what’s the problem?
Again, the complications that occur unexpectedly happen so quickly, and injure or kill so quickly, that there isn’t time to “refer to an obstetrician.” For example: cord prolapse; placental abruption; uterine rupture; postpartum hemorrhage; etc. etc.
If you’re not already with an obstetrician, or at least at a hospital with an OR and an obstetrician available in minutes, you and/or your baby are doomed.
So you’re saying giving birth is not risky? That, say, a low risk woman going into labor will always come out of it safely?
same answer, look down
Okay, so if I understand correctly, you ARE saying that a woman who goes into labor low risk shouldn’t worry, nothing bad could possibly happen to her. Because apparently you can simply wish away fetal malpresentation, amniotic fluid embolism, post partum hemorrhage, uterine rupture, and cord prolapse. Uh-huh. Sure.
no, it’s clear… and those that occur unexpectedly can and should be referred to an obstetrician (are the exceptions, not the rule)
In some ways, I agree with you. A CNM caring for a laboring woman in the hospital can rapidly diagnose complications and refer them to an OB in a timely manner. But this only works if the woman is already in the hospital, if the midwife knows what she is doing well enough to diagnose the problem and the need for intervention, and she or he has a good working relationships with OBs such that the consultation can be made with minimal disruption. None of these criteria are met by home birth midwives and the result is an increase in neonatal deaths and injuries.
There is not TIME to “refer to an obstetrician” when a woman suffers uterine rupture, cord prolapse, amniotic fluid embolism, or, in many cases, postpartum hemorrhage. If the woman isn’t in the hospital already, with an obstetrician present or literally down the hall and able to be present within a minute, people die.
“promoted by the vision of childbirth as always risky”
I have to say, you give the OBs a lot of credit. Their vision of childbirth as risky was so effectively promoted, it existed hundreds of years before OBGYN existed as a profession.
“ambition to continue making as much money as possible”
And as we all know, anti-CS/NCB midwives/doulas/’educators’/etc make no money at all. And it’s not like it’s all pure profit, with no malpractice insurance.
sure, are not only doctors, is all the medical system (many heavy players who want to continue profiting)
How quickly some people forget history. It wasn’t that long ago that Childbirth was practically the number one cause of mortality of young women. Only 100 years ago, you had around a 1% marternal mortality rate during childbirth. You think 1% isn’t much? Try to find any currect activity with a 1% death rate.
Birth isn’t safe, it has never been safe and will never be safe. Can you have an uneventfull birth? Of course you can. Doesn’t mean it’s safe. Just like driving 140mph isn’t safe, but doesn’t always end up with an accident.
Shit, try to find any current common activity that has a 1/10000 death rate. You can’t do it. Anything with a death rate that high is considered very high risk. Sky diving? Not even close (about 50 times lower). Scuba diving? Ditto. How about drunk driving? That’s a really risky activity, right? It’s about the same as skydiving or scuba diving (on a per drive basis – the problem with drunk driving is not the absolute risk, it’s the prevalence)
Life insurance policies don’t cover skydiving deaths because it is too risky. Yet childbirth, for the mother, is 50 times more likely to result in death, and the risk to the baby is even higher.
People don’t grasp risk.
I recall last time we made a serious effort to find a comparable risk and all we could come up with was climbing Mount Everest.
Another example I’ve mentioned before: in early 1900s rural China, for example, the average life span for a man was 25, and for a woman it was 24. Why the difference? Lots of young women died in childbirth.
We take for granted these days that women have a significantly longer lifespan than men. This is a recent development though – for virtually the entire history of the species women have had a significantly shorter average lifespan than men, despite the fact that it was overwhelmingly men who, for example, fought in wars.
And in books like, say, by the Bronte sisters there always (!) is such a character as widower with kids.
Agree. 1% on average is risky (should be attended by obstetricians). 99% on average is not risky or very low risk (can and should be attended by midwives and should be referred to an obstetrician if an unexpected complication happens). For some doctors 100% is risky, which is totally false, excuse to continue profiting from childbirth.
I’m not sure where you got the 1% number. In rural Afghanistan in the 1990s, a time and place where obstetric care basically did not exist, about 1 woman in 6 died in childbirth.
Per the WHO, the 2014 neonatal mortality rate is 34/1000 (i.e. 3.4%) in Afghanistan (including the cities where the mortality is significantly lower). In Angola it’s 50 per 1000 (5%). Much higher, obviously, than the “1%” you’re claiming.
I think the risk is about 1% per birth – the lifetime risk to a woman of dying in childbirth was of course higher.
Yes. For example, sticking with Afganistan before 2000, where the risk of maternal death was ~1000 per 100000 live births, the proportion of women who died due to maternal causes was about 40-50%.
If you keep rolling that dice, eventually it will kill you outright, or you’ll pick up an injury that kills you.
But obstetricians and medical support is an “unnecessary cost” don’tchaknow.
They got it because someone else brought up that birth is risky, unlike their claim, and that about 100 years ago 1% of births resulted in the death of the mother.
1% maternal death rate doesn’t translate to “1% on average is risky”. There are other risks to take into account – death of the baby, serious disability of the baby, serious injury to the mother, serious pain and trauma (even if nobody is seriously injured) – these all add up to a pretty big number.
Even if you had a crystal ball and could accurately predict in advance which births were going to be problematic, what perceived advantage of being attended by a midwife causes you to say that anybody “can and should be attended by midwives”?
not anybody, but all that is expected, according to the evolution of pregnancy, will not have complication (and if this happens unexpectedly derives OB). That is the efficient way that is already running in many other countries with better health systems.
Efficient for saving money for the healthcare systems in the short run, yes. I would never dream of calling such healthcare systems better.
Efficient for lining midwives’ pockets, yet. Not so efficient for health of mothers and babies, though.
Efficient to provide quality service to the largest possible number of mothers and children (the financial resources are scarce, are not infinite). Unnecessary cost increases is not allowing that millions of women in the US and the world can access these services
As the UK malpractice payments in maternity care prove, sadly inefficient in providing quality service.
And from a moral perspective, denying a woman competent care so as to save the government money is quite as despicable as denying her competent care in order to save the health insurance company money.
But why bother with a midwife at all if 99% are not risky or very low risk? Why pay someone for a natural and safe experience that according to you, 99% of the time, can happen well on its own? Surely a mother, sister or friend who has been through the same experience could do just as good a job as a midwife, which according to your statistics, 99% of the time, is no work at all.
By this logic-which is your logic-money spent on a midwife is just as wasteful and exploitative as money spent on a doctor.
Could it be that midwives are indulging in money grubbing, particularly as in the US they end up costing as much or more than a hospital birth for those that have private insurance, since private insurers won’t support or subsidise their use?
first, the attention of the midwife is not limited only to childbirth, but also all previous and subsequent process. Regarding the birth itself, that be normal and natural doesn’t mean it doesn’t need support, and that be low risk doesn’t mean it will not scale to further complications if appropriate care by a trained professional is not provided.
So what are the risks for this before and after period? Greater or lesser than 99%safe? And surely if safe is so common anyone who has been thruogh it can see when it’s going wrong and seek help. And why is mother, sister or friend a less supportive companion than a stranger who for money becomes your ‘friend’?
You’re doing a bad job explaining why a midwife is better than no one at all. And you failed to address my financial point.
Is not a “friend”, is a trained and qualified professional to, throughout the whole process (before, during and after childbirth), provide support, promote healthy development, prevent further complications, resolve minor complications and refer a more complex care only when necessary, allowing to have an efficient system of primary care.
Regarding your “financial point”, in reformed health systems, obviously natural births attending for midwives are much less costly than cesarean sections by doctors in cases where they are not needed (which are the majority), for this reason, they are promoved in countries with better health systems. Strong political pressures from actual medical system in the US have prevented this from happening, that is why they continue having this flawed system.
Is not a “friend”, is a trained and qualified professional to,
throughout the whole process (before, during and after childbirth),
provide support, promote healthy development, prevent further
complications, resolve minor complications and refer a more complex care
only when necessary, allowing to have an efficient system of primary
care.
You mean, like an obstetrician.
obstetricians should intervene only in situations of risk or major complications that requiring surgery or more advanced treatments, so scarce human resources are efficiently used.
That’s why studies have shown repeatedly that obstetricians dealing with low risk patients have outcomes that are a few TIMES better than “midwives” dealing with low risk patients, right?
How do obstetricians threaten your outcome, fernando? Let me guess: the vast majority of women don’t want severely undertrained birth junkies getting their obsession and sexual high by attending their births, ala Ina May, so you’re scrambling for a way to present yourself as a better option?
Studies have shown repeatedly that obstetricians dealing with low risk patients are an unnecessary expense and inefficient use of resources.
Women themselvese, better informed and empowered along worldwide, are demanding care by midwives for low risk births (which are the majority), as they have experienced a more personalized service and greater quality.
Indeed? Which studies would those be? It cannot be the Netherlands ones since they show the opposite. It cannot be the Johnson and Daviss attempt to manipulate data since it also shows the opposite. The same with MANA.
Which studies do you mean?
some examples are good:
http://www.ncbi.nlm.nih.gov/pubmed/1635487
https://www.midirs.org/cost-canadas-midwife-shortage/
http://healthydebate.ca/2011/06/topic/cost-of-care/maternitycare
http://www.cbc.ca/radio/whitecoat/blog/let-midwives-gps-attend-low-risk-births-1.3201894
A bunch of opinion pieces and the abstract of a study that’s almost as old as I am. Yawn. At the time the study was conducted, internet was not even a thing, that’s how old they are.
I am not impressed. I fully expect that next time, you’ll try to pull out a study as old as my mom.
Plus, the study participants all saw an OB twice during their pregnancy. There goes the “only see an OB in an emergency.”
And this is a fine argument for the increased use of CNMs handling low-risk patients in a hospital setting in collaboration with an OB. I don’t have any problem with that.
It is not an argument for homebirth nor incompetent clowns like CPMs.
You don’t speak for all women.
No I’m not. And I’m a woman.
Cite even one study, please
Why? It seems to me that the ideal would be to have highly qualified attendants for all women from prior to conception through follow up care to ensure the best possible care throughout and reduce the risk of an emergency ever occurring. Why wait until it’s an emergency to call a qualified person when their care, if provided from the beginning, could avoid an emergency ever occurring?
The unnecessary increase in cost, making it impossible to expand the scope of the service (the financial resources are limited, not infinite). For low-risk pregnancies and early detection of major risks, midwives are highly skilled professionals, emergencies occur even if they are given the best care, are emergencies.
To teach preschool children are not going to use professors PhDs (which are few), would be an unnecessary increase in costs and an inefficient use of resources.
So we should be limiting women’s options? And that’s empowering , how?
options are now limited to women because of high costs, this must change.
You are suggesting we limit a woman’s options, just to the ones that you approve of. How are you any better than the “system” that you malign?
I don’t malign, it’s reality. Probably you don’t know the number of mothers and children who do not have access to quality services for the high costs of the current system.
It is obvious that you don’t frequent this blog and have no idea of the professions of those with whom you converse.
Also, would care to actually answer my question or are you not the expert on US insurance payment schemes that you claim?
Fernando, what country are you in, and what is the source of your “knowledge” about health care in the United States?
So you’re saying that women and babies aren’t worth the best care possible, because of an HR problem. Gotcha.
Exactly. Fernando can sacrifice her baby at the altar of cutting costs. Don’t ask me or others to sacrifice mine.
I’m saying that now a lot of mothers and children don’t receive the best care possible because unnecessary high costs, it is wrong and needs to change.
Unless you’re saying that pregnant women and unborn babies deserve less medical care than everyone else, you must agree that doctors should intervene only in situations of risk or major complications requiring surgery or more advanced treatments. In other words, no one should ever see a doctor at all, unless it is clear–even to less-qualified healthcare practitioners (nurses, midwives…)–that the person is very seriously ill and requires immediate surgery or other advanced treatment.
That makes no sense at all. Part of the art of medicine is DIAGNOSING problems in the first place, and also PREDICTING that a person who doesn’t currently have a problem is likely to develop it. Most people are willing to pay extra to have a highly qualified, deeply experienced person (a doctor) perform those tasks, and that is why we have set up a system where we DO see doctors for routine physicals, minor complaints, and normal life developments such as pregnancy.
In major complications (that may have been detected early) that they require more advanced treatments. Well-trained midwives perform these functions perfectly in better health systems. Is false then that it’s necessary only when the patient is seriously ill or requires immediate surgery
That makes no sense, Fernando. I understand that you’re not a native English speaker, so I’ll give you another chance. Try again.
So you’re saying I shouldn’t be able to see my OBGYN unless you deem it worthy of the expense ? And above you were saying it was OBs who compromised care in the name of money…
But Fernando is all about “empowering women,” certainly not restricting women’s choices…
No, I’m saying that many women do not have the option of receiving professional care because of high costs. An efficient health reform, would allow many of them to access these services.
Yeah, we’d be a lot better with socialized medicine, no doubt.
A trained and qualified professional isn’t there to “support” you through a safe and natural delivery, they’re there to monitor you just in case it turns threatening which it does on a horrifyingly regular basis, at which point they either call the more qualified professional who’s a beep away, not a car ride away, or they ARE this more qualified professional, aka obstetrician.
Careful, you’re losing your way in your scrambling to explain why obstetricians are not needed in most cases but midwives are of vital importance as “supportive” people. Looks like the risk is so low that the only way to justify employing midwives at all is assigning them “suppportive” duties, aka pretending that they’re your best friends, that they hold the space, that they preserve a sacred bond between your labouring self and the universe or something, amirite fernando?
reads everything, the support is only one of the activities mentioned.
“Support”–Fernando must live in NZ and know midwife Jane (who you might remember as the midwife who believed support is what laboring women need, not epidurals and who has never experienced labor pain herself but had c-sections. After that bit of insight she proceeded to delete all her comments and sent her mother here to defend her)
I’ll clue you in to something…a care provider who is your “friend” is not a professional. Full stop.
Name me one complication of pregnancy or childbirth that can be prevented by a midwife. And I mean actually prevented by the midwife–not prevented by a midwife calling an obstetrician to come solve the problem.
I have to defend midwives a little here. Complications that can be prevented by a midwife: Neural tube defects can be prevented by a midwife prescribing prenatal vitamins. Iron deficiency anemia can be prevented by same. Gestational diabetes can be managed by a midwife, in consultation with an endocrinologist (which, really, an OB would likely need as well if it were at all complicated) preventing hypoglycemia and excessively large fetuses. Rh alloimmunization can be prevented by a midwife by giving appropriate Rhogam.
In short, a midwife can perform at the level of a family practitioner, able to manage the relatively simple cases. That is, a well trained CNM working within the scope of her or his practice can successfully manage low risk pregnancies, including prevention of some complications and management of others. OBs sometimes also hand off cases that get out of their scope of practice to… more specialized OBs (maternal fetal medicine specialists) so I don’t see the lack of ability to cover every case as a reason that midwives should not exist as a profession. One might question whether they have any real advantage or whether we might be better off just training more OBs versus trying to have a two tiered system, though.
Fair enough, but I think you’re stretching a bit there–no one needs a midwife to “prescribe prenatal vitamins” to prevent neural tube defects, for instance. You can buy those vitamins at your local Walgreen’s without a prescription. And something that a midwife can only do “in consultation with an endocrinologist” is by definition something a midwife can’t do herself/himself–she needs a doctor.
No, not sure what kind if midwife you are talking about as direct entry midwives are only interested in women “during the child bearing year”. They can’t prescribe meds or do surgery, so they can’t do women’s healthcare. Being an OB/GYN means caring for women with fibroids, stress incontinence and endometriosis. Sure that isn’t as fun as getting to catch babies, but it’s what being a women’s healthcare professional means.
“Being an OB/GYN means caring for women with fibroids, stress incontinence and endometriosis.”
Perfectly put. OBGYNs care for women throughout their entire lives.
“1% is risky” is wrong.
1% is DEAD without medical intervention.
This doesn’t count injury and disability for the woman, and stillbirth, injury or disability for the baby. Those numbers are *much* higher.
Amazingly, since we value women, and we value babies, we do C-sections on women who are likely to have trouble, and most women want to give birth in hospital, in case they need interventions too. Shockingly, *most women* value their lives and that of their babies.
The other night, I was watching Saving Private Ryan. Fortunately, I missed the opening scene of the landing on D-Day. It’s gruesome.
The D-Day invasion was intense and bloody. Quick quiz: without looking it up, what was the fatality rate for troops landing on the beaches in Normandy on June 6, 1944?
a) < 1%
b) 1 – 5%
c) 5 – 10%
d) 10 – 20%
e) 20 – 33%
I will let you know that it was less than 33%
I gotta run, but the answer is b. 2.8% to be specific.
That’s right, the massive carnage that was the Normandy invasion on D-Day had a fatality rate less than 3%. And that WAS massive carnage. Of course, the casualty rate (all wounds) was a lot higher, but that goes with it.
A death rate of less than 3% is (properly) characterized as carnage.
1% what? A 1% chance of death? That’s not “risky (should be attended by obstetricians)” that is something to be avoided altogether!!!!!! You know what has a 1% mortality rate? Climbing Mt Everest. About 1% of the people who try to climb Mt Everest end up dead.
You think that you only need an OB if childbirth is as dangerous as climbing Mount Everest?
read the initial comment: 1% mortality rate 100 years ago, what it is now 1% chance of death (high risk) but a much lower rate of mortality since then (not 1%).
Huh? Mortality rate is the death rate.
I don’t think you understand the concept of risk very well. Any mother, even without obvious markers of risk, could end up being that 1 in 100. Your argument is like saying only 1 in a million lottery tickets will win the jackpot, so only the lucky people need to buy tickets, and the other 999,999 can save their money. There’s no way of knowing which one is that ticket.
This is not a lottery. Most problems are detected early and can be referred to obstetricians in advance. And those exceptional unexpectedly submitted may well be referred to an obstetrician at the right time. Caesarean sections have secondary consequences on the health of the mother and the child, so should be avoided unnecessary interventions.
http://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections
Most problems in labor happen quickly and without warning and need to be treated immediately.
The other problem is that you have to be able to DETECT problems that occur. Picking up fetal distress isn’t as effective with a doppler, it needs good monitoring. Fernando whines about cost, but what would be the cost of equipping every midwife with all the tools needed for adequate monitoring?
See my post below. That is exactly what we do now, except that OBs do more of it.
But as I said, it’s a fine argument for the using CNMs in the hospital in collaboration with OBs. It’s not an argument for out of hospital birth nor use of incompetent morons like CPMs.
I agree with childbirth in the hospital, I think is the best, but the present system must change to fully integrate midwives, and they should seek to formalize their training in all types (US MERA is a breakthrough and soon should show results)
The present system can completely incorporate midwives, just as it can handle NPs. More and more places are using midwives. I don’t think there is much resistance to that at all, except by CPMs and those who insist on doing homebirths.
I agree, CNMs (through their body the ACNM) have not done near enough to prevent morons from claiming a midwife title and pretending that they are anything like the good, qualified midwives in the US. They need to become much stronger at getting ride of imposters who are a serious shitstain on the profession.
All you need to do to “formalize” the training of midwives is to eliminate the CPM.
I don’t entirely agree. Current CMs are highly qualified also. One solution would match the training of CPMs to the CMs and turn them into a single title.
Nah, make them all be CNMs. It’s the best solution.
Yes. We have a perfectly good title that allows one hospital privileges. Ain’t broke, don’t fix it; it’ll be a lot easier when only CNMs can call themselves ‘midwives.’
And enough CNMs have drunk the Kool-Aid to satisfy the woo-tastic.
While midwives have only the title of CNM, they will continue being considered nurses and they will continue attending only 8% of births, thus maintaining this inefficient system. It is necessary to continue to promote independent midwives, giving them independence to serve all normal and low-risk births in hospitals as in the better health systems. Surely you are one of the obstetricians who defends the current system to ensure only their interests, despite that this maternal health system is one of the worst in developed countries, hurting mothers and children.
Why do you say that? NPs are also “considered nurses” but their share of the workload is increasing all the time! Hasn’t prevented a massive shift to NP care in our health system.
I’m of the opinion that all midwives should be nurses. That midwifery needs to be viewed as a nursing specialisation. It’s more than the birth – there are two patients with potentially complicated health issues. Midwives need to recognise and deal with more than just delivering a baby.
No. Worldwide, the midwife is totally different from a nurse. The nurse have the image globally as a dependent of the directions of a doctor, and the midwife is not that.
Maybe, but when midwives also function as primary providers of women’s healthcare they should be well versed in basic patient care. Things like the critical thinking you develop as a nurse on a med/surg floor can’t be taught, you must actually work as a nurse and have a solid clinical background to be a well rounded primary health care provider. When midwives study only about pregnancy and birth, they are more likely to miss the big picture and not spot the small signs that mean something is wrong.
So?
You’ve got a very old view of nursing and a very modern view of midwives. You’ve also got a very odd view of what happens outside the US.
Nice. Another alias for Fernando.
That doesn’t follow.
You have yet to prove it is inefficient.
It is necessary to continue to promote independent midwives
Why?
You have not demonstrated that this is part of what makes them better, and more than one person has offered evidence that it is a flaw in those systems rather than a benefit.
Character attacks. Cute. Now knock it off.
Do you have any evidence of this?
so…….you are saying that nurse midwife don’t do enough birth because……we consider them nurse?
And that if we remove the ‘nurse’ part we will use them more?
Why? How?
Are we talking only removing ‘nurse’ from the name, or changing the program entirely?
If we change the program, is it going to be easier (since now they don’t have to be nurses) or harder?
And then, supposing you make the program harder or keep it the same, how is simply removing ‘nurse’ from the name supposed to make them be used more?
Or are you supposing we should create yet another credential of lower education midwives and just put those less qualified people everywhere?
“giving them independence to serve all normal and low-risk births in hospitals as in the better health systems.”
Please tell us what system you consider better. Which do you believe the US should copy?
We’re 4th best in the world for neonatal/perinatal mortality, so I’m puzzled by your claim that our maternal health system is “one of the worst in developed countries.” Could it be you’re just spouting opinions with no basis in fact???
If they want a more prestigious title, they can go to medical school and become doctors.
What’s the point of that? We already have a title, CNM, with specific educational and practical training requirements. Any CPM in America is free to apply for admission to the educational programs needed to become a CNM. Some states also have the “CM” qualification you mention–and again, any CPM in America is free to apply to those educational programs too.
But they apparently don’t want to. They prefer ignorance and woo.
I’ve wondered about that. I’m not sure what the advantage is of the CM. Are there more potential school placements than in the CNM programs? How does it differ from master-entry programs that lead to the CNM? I don’t know enough about it to have an opinion.
CM allows independent formation, as in many countries, which would increase the number of well-trained midwives. CNM’s and CM’s at the end should be integrated into the concept of “midwife”, which is recognized worldwide.
I’m not quite sure what you mean by “independent formation.” Do you mean that they don’t need to complete a nursing degree before a midwifery degree? Because they still require an ACME-accredited education and a master’s degree. Again, my question is whether or not wider acceptance of the CM credential would actually increase the workforce.
Moreover, the problem in the U.S. isn’t that there are too few skilled providers; the problem is that those providers are not practicing in places that have the greatest need. You can increase the number of midwives (and MDs) all you like, but until you can get them to practice in underserved areas, you’re still going to have enormous disparities in both cost and quality.
I don’t disagree with that, but it is no panacea. One of the largest problems is the lack of access to skilled (i.e., obstetric or CNM) care in underserved areas. Midwives have no more incentive than OBs to practice in those areas. Moreover, some populations in those areas are more likely to need more skilled care, which means simply increasing access to APRNs there doesn’t fully address the problem.
Why?
fernando “but the present system must change to fully integrate midwives”
I’m curious. Are you, by chance, a foreign (outside of the US, non native English speaking) trained midwife who recently immigrated to the US? Are you looking for better job opportunities here?
Or are you just tossing out criticism of a system that does not involve you and that you do not understand for entertainment purposes only?
At the right time. Lovely. Tell me, when is it the right time to transfer a uterine rupture diagnosed by a birth junkie at home? When is it the right time to transfer a river of blood that’s going to kill the new mother in 7 or 8 minutes? When is it the right time to transfer a baby who cannot be resuscitated at home?
You know it’s homebirth that we’re discussing here, right?
No wonder you do not understand. I am saying that all low-risk births in hospitals should be staffed by highly trained midwives. I’m not talking about home births, that is another matter.
Highly trained midwives with golden hearts, huh? Supportive dears, unlike those greedy obstetricians.
A birth cannot be “staffed”. Units can be staffed. And the healthcare system in the UK is having a great problem with those supposedly low-risk births attended by those supposedly highly trained midwives. In addition, I have a problem with some of those highly trained midwives, otherwise known as disgusting heartless bitches, resorting to name-calling and dismissing a loss father whose child their supposedly highly trained peers killed in a midwife-led unit – and staying amongs the leaders of the midwife community in the UK. Sheena Byrom is one of the bitch midwives I have in mind. She even authored a book about compassionate care. Looks like they’ve got you totally fooled with their siren song. They dismiss the deaths they cause and they ridicule the parents they left childless – and I’m supposed to hold them as example when handing authority to their peers? Thanks but no thanks.
But even if you are talking about hospital births, your numbers are wrong. 99% of births should be delivered by midwives and only 1% need an obstetrician? You have no idea what you are talking about. Even in countries like the UK which use many more midwives, the midwives don’t deliver 99% of babies. Nowhere close. And the UK has terrible outcomes. Sure, they “save money” but using midwives, but the cost savings are totally wasted many times over on all their legal settlements for poor outcomes. The midwives are supposed to detect and refer on complicated cases, but they repeatedly fail to do so it. “Penny wise, pound foolish” as the saying goes.
It’s not a completely separate matter. The Netherlands and UK midwifery systems argue that the midwifery model is more affordable precisely because they can do home births.
Even if 99% of births in the US were attended by midwives in the hospital, the costs would be about the same, because the physician fee is minuscule compared to the hospital fee.
YES!!! This is what I’ve been trying to explain to fernando. I do not think she understands the way the payment system really works.
Like the highly-trained midwives in the UK, who routinely deny women who are screaming in agony the epidurals they want?
As of now, the risk of ‘complication’ during birth is higher than 1%. That number was simply the death of mothers 100 years ago.
Birth has many risks: Maternal death, baby death, PPH, ischemic injury, uterine tupture, placental abruption, shoulder dystocia, etc etc etc.
What people need to understant is that doctor are not saying 100% of birth will have complication.
What they are saying is 100% of birth have a risk of going badly. There are NO WAY to know in advance who is going to have complication and who isn’t. Even the absolute healthiest woman in the world is not immune to every single possible complication during childbirth.
Some women are indeed very low risk. But that still not 0. Someone has to be ‘the statistic’ and should that happen to be you, do you really want to be 40 minutes away from the hospital?
Who are you to be saying “should”?
Wait another 50 years and they will be saying women and babies never actually died before, it all started with doctors scheduling evil c-sections to get rich.
Probably while women give birth in the completely natural manner: Push the baby out your vagina without pain relief while suspended in microgravity on a chartered Virgin Galactic flight that comes with jacuzzi and backup flight plan to a level XVI trauma center where they can beam the baby out, just in case something goes wrong*. Just like the cave women did it.
*Which it won’t, because you have Done Your Research. Unlike those sheeple who just schedule the teleportation birth up front. Not to mention those women who (shudder) use a uterine replicator…
However, I’m sure we can all agree that the 3D baby printer was a debacle.
and it’s not necessary to wait 50 years, in much less time some will be saying that 100% of births should be attended by cesarean, otherwise is certain death, so without doctors the humanity will not be able to have children and will disappear.
Who is this “some” and what are they basing their statement on?
Furthermore, if they’re correct, so what? Humanity has already reached the point that the vast majority of us could not survive without agriculture, city planning, management of infectious disease etc. And we’ve done it successfully.
thanks to cesareans humanity will continue to exist, thanks to doctors we won’t disappear, sure, ok.
Not going to answer the question, eh? Who is “some” and what is their evidence that we’ll be at 100% c-sections in 50 years? And if so why should we care? Would you rather let women who need c-sections die so that humanity will only evolve in directions you approve of?
humanity, no. my sister and nephew would probably have died, though. A uterus with that much ovarian cancer on it isn’t so good at pushing a baby out. I’m very grateful for her ob’s and her oncologist’s work to try to keep her from disappearing over the last 8 years. Anecdotal, sure, but I don’t care.
Even if 100% of births were done by c-section, humans would not lose the ability to have babies naturally. The same way that even when 100% of birth HAD to happen naturally, the inability to have children did not disappear.
But really, that’s an idiot argument.
And you know what? Should c-section ever become safer than vaginal birth in every way medically possible, then by all mean, c-section should become the norm. Should you still be allowed to have a vaginal birth if you want to? Absolutely. So long as you are aware of the higher risk and accept it.
Yes, the reason childbirth throughout history has been so risky is because of section overuse. Now the rates are lower than at any time in history, so is mortality. That’s exactly how it works.
True, the cesarean rate in developed countries pretty much correlates with former childbirth mortality/morbidity rate. Makes perfect sense to me.
How bout we go through those one by one?
1) “Cultural advancement and higher information and empowerment women currently have, which allows [them] to avoid abuse”
Abuse of whom, by whom? Are you suggesting that the women who buy into the Crunchy Alternative Mama™ culture were the ones most “abused” by the medical system before cultural advancement led to their empowerment (or maybe it was the easier access to the MDC forums?), and that by having more information about alternative providers, more links to pages with crunchy talking points, and more forums where they reinforce each others’ worldviews, they can avoid such “abuse”? These women are overwhelmingly (though not exclusively of course) well-to-do, white and possess bachelors’ degrees. They are statistically one of the LOWEST risk groups for abuse.
2) Not necessary according to whom? Internet midwives who’ve never met the women, after the fact, hearing only parts of the story? Women who read during pregnancy that cesareans were evil, one of the worst possible outcomes of a pregnancy, and obviously overused because the rate is higher than a since-retracted WHO stat from years ago? ICAN chapter leaders who quote each other?
3) “the wrong vision to see other professionals such as competition”
I’m not a doctor and I’m obviously not speaking for doctors, but….no. The number of women who choose a non-nurse midwife for their prenatal care and birth is so low that it doesn’t really affect obstetricians’ patient load. If anything, casual observation shows that the natural crowd love to cannibalize their own– how, for example, do CPMs react to “freebirthers”? How do chiropractors react to people who want to cure everything with TCM?
4) “the ambition to continue making as much money as possible”
Very few doctors who practice in hospitals operate on a fee for service model. Most are on salary, work in group practices, and rotate the off-hours call shifts with the other providers in their group. In the hospital itself, the nurses provide most of the hands-on care; doctors have to work a lot HARDER if a birth has trouble and higher-skilled interventions are needed. The much higher price tag of a cesarean includes a longer hospital stay, the additional nursing staff in the OR, the fee for the anesthesiologist, the actual cost of the drugs and surgical equipment, the nursing staff in the recovery room. Yes, the ICD code for a surgical delivery may garner more reimbursement than a vaginal delivery, but not enough to account for the huge difference in cost.
In short, an obstetrician isn’t going to recommend cesareans to get rich. You know how people get rich? Investing. My dad’s best friend is a GP. The bulk of his income comes from investment properties including shares in developments, flipping houses, and owning a few vacation homes near his own house that he rents out.
1. Agree, the abuse still continues because the highest risk group is not yet empowered. It’s a matter of time.
2. Not necessary according to the reality, that for technological advances can be predetermined.
3. The number of patients currently opt for midwives is low (imposed system), but it can and should be higher in a more efficient system. That’s fear of some obstetricians that only safeguard their interests. You’re not a doctor, because of that, you don’t know.
4. In general, more Caesareans, even if they are unnecessary, higher personal incomes and more jobs for the set of obstetricians, that’s what really matters to some bad doctors, profit themselves from the childbirths, that’s not correct.
Why did you chose a man’s alias?
I don’t answer to troll but I am very curious about that.
Re 4: Actually, in the US, most insurances pay a “bundled” amount for pregnancy and delivery care, no matter how complicated the pregnancy and delivery. So OBs actually make less money for doing a c-section than for a “natural” delivery. Of course, they lose far more money by not doing a c-section and having a bad outcome, so they do them when necessary, but there is no immediate economic motivator for doing more c-sections. Quite the contrary. I can not comment on the situation in other countries so perhaps you have a partial point elsewhere.
You forget to private practice, you win much more money with Caesareans, that’s the point. Please, we shouldn’t try to hide the obvious, the desire to keep getting good profits is what drives many obstetricians.
No, I didn’t say anything about the type of practice at all. Insurance in the US, regardless of the type of insurance, will only pay a certain amount for pregnancy care and delivery, regardless of the type of delivery. The fact that you don’t seem to grasp this is evidence that you don’t know much about obstetrics, at least in the US.
Exactly. Pregnancy and delivery is a “global fee.” The obstetrician gets paid the same amount for the whole pregnancy regardless of how many times the woman is seen or what type of delivery she has. The hospital may bill separately and recoup some of the extra cost associated with a cesarean but the doctor does not. In this current payment model, if your goal was only to make more money, you’d see the women as infrequently as possible and do a vaginal delivery. Quite the opposite of what fernando is saying doctors do and what their motivations are.
Didn’t you know that by making more money, “reward” to doctors with “incentives” to serve the largest possible number of cesareans?. It seems you don’t know the various economic interests behind the whole system, ¬¬
Citation badly needed.
You need to look up Pablo’s First Law of Internet Discussion, because you are about to step in it big time.
Fernando, can you explain the various reimbursement systems in the U.S. and how they apply to obstetrics?
Clearly you didn’t grasp the explanation of global fees at all. As you said above, “You’re not a doctors so you don’t know.”
Clearly you didn’t grasp the not-so-obvious ways to profit with the cesareans system
Then please enlighten us all how, using a global fee system (the current model of payment in the US), an OB would profit more by doing csections. Since you’re such an expert…
Not true, doctors who accept Medicaid actually are given incentives if they can keep their c-section rates down. There is tremendous pressure in the form of hospital policy around that issue.
Medicaid also pays for CPMs and home births where I live, and I find that appalling.
are you sure? read this:
http://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections
Is that the same Johnson as Johnson and Davies?
I would rather take the advice of my obstetrician in the room with me than some study by a couple of health economists. I am not a faceless statistic to my own doctor.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/EED-Brief.pdf
http://www.hca.wa.gov/medicaid/ebm/Documents/toolkit_for_reducing_caeserean_sections.pdf
A good break down of incentive and risk with regard to reducing c-section deliveries
There are many economic interests behind, you know.
Can you please clarify this statement and give me one solid example? Full disclosure: I trained to be a home birth midwife and saw many choices made in the economic interests of the midwife , who had everything to lose if her client proved to need more skilled care than she could provide. I also think that midwifery systems in the UK (where there have been many recent avoidable injuries and deaths recently) and the Netherlands (where midwives who care for low risk women have worse numbers than OBs caring for high risk women) need overhauling as well.
read this:
http://rhrealitycheck.org/article/2013/07/02/why-on-earth-do-u-s-families-pay-more-for-maternity-care-than-anywhere-else/
Cost of care alone is meaningless if you don’t also consider outcomes and long term after effects like birth injuries, brain damage, and pelvic floor damage. European countries like the UK and Netherlands are having problems by shunting pregnant women and babies to less trained providers. The care is cheaper only if you don’t consider the costs of bad outcomes, became there are more of them. And the human tragedies due to this bean counting are appalling. Google Furness and Morecambe Bay.
I was talking to a Dutch co-worker last week, and she independently brought up the shocking state of perinatal mortality there and how there’s quite an outcry in the circles she moves in to do something about it.
The UK spends probably more than it saves in payments to parents of dead and injured babies. We’ve seen that even in the hospital, midwives in both countries can compromise care.
Complete OT but I was reading your comment while headed across the 520 to UVillage (passenger!). Made me laugh thinking you know this route well : )
Oh man, memories – I was working at the UVillage Starbuck’s all night while the returns were coming in for the 2000 election. (Yes, I was a barista for a year while I was transferring programs – they have excellent benefits. I was working minimum-wage hourly, and got full health care, including my BC pills…)
Omg-we have crossed paths. Best memories of wedding planning at that Starbucks in 2000 and still my favorite place to take my dad after a day spent at the UW Bookstore and then we walk all over U Village after lunch. There is a huge parking garage on the Montlake side now and place with the best soup dumplings. That was the destination today. Would not have wanted to be one of those “hospital is 10 minutes away” midwife transfers today, traffic nightmare on 405 but ok once you got to the bridge on 520.
That is an opinion piece and again, doesn’t factor in the real and long term costs of injury and death.
Why A U.S. Obstetrician Says Some Women May Be Better Off Having Baby In U.K:
http://commonhealth.wbur.org/2015/06/why-a-u-s-obstetrician-says-some-women-may-be-better-off-having-baby-in-u-k
http://www.skepticalob.com/2015/06/dr-neel-shah-wants-us-to-emulate-this-system-of-obstetric-care.html
The payout for US birth related injuries and deaths is 1/3 that of the UK.
Ah, yes, Dr. Neel Shah. We’re very familiar with him here:
http://www.skepticalob.com/2015/06/are-hospitals-the-safest-place-to-have-a-baby-without-question.html
http://www.skepticalob.com/2015/06/what-message-do-we-send-to-women-when-we-deride-their-c-sections-as-air-bags-that-explode-in-your-face.html
http://www.skepticalob.com/2015/06/its-morally-repugnant-to-recommend-saving-money-by-forcing-women-to-labor-in-agony-at-homebirth.html
http://www.skepticalob.com/2015/06/dr-neel-shah-wants-us-to-emulate-this-system-of-obstetric-care.html
Neel Shah is a fuckwit. He appears not even to understand that the majority of midwife attended births in the UK take place in a hospital, for starters.
As Bombshellrisa suggests, the incentive/disincentive works both ways. From the news article you suggested we read:
“Johnson and Rehavi also analyzed disparities in medical settings where doctors were paid a flat salary. In these cases, Johnson and Rehavi found there was a disincentive to perform the surgical procedures, which typically involve more time. In these settings, more of the mothers who were physicians received C-sections than mothers who were not physicians. Presumably, Johnson says, this means that some nonphysician mothers who needed C-sections did not get them in these settings.”
I think, Fernando, you’re falling into the trap of oversimplifying a complex issue of which you have minimal understanding.
And the global fee that we were trying to explain to Fernando above is an example of a flat salary. That is how the vast majority of OB’s get paid. Fernando is disproving her own argument.
And do you know what percentage of medical settings “only” flat salaries are paid? the reality is different, read this:
http://rhrealitycheck.org/article/2013/07/02/why-on-earth-do-u-s-families-pay-more-for-maternity-care-than-anywhere-else/
and also pays attention to the following:
“Rosenthal explains that the reliance on OBs is actually one of the reasons that maternity care in the United States is so expensive. In most other developed countries, maternity care is left primarily to midwives who charge must less; OBs are only brought in when there are complications. In the United State, where the average vaginal delivery cost $9,775 in 2012, only 8 percent of births are attended by midwives, compared to 68 percent in Britain (where the average vaginal delivery cost $2,641) and 45 percent in the Netherlands (where the average vaginal delivery cost $2,669)”
The article has nothing to do with the argument you seem to be making that physicians do too many sections due to financial incentives. It outlines the ridiculous way health care (in this case maternity care) is billed in the U.S.– each service billed separately, and different for the insured vs. the un- or underinsured. As a solution, it suggests that midwifery care will be cheaper than OB care (which may be true–there is no support for the claim in the article other than comparing costs across countries, which is problematic to say the least), but it vastly oversimplifies the problem.
It was already clear that obstetricians in many medical settings (the vast majority) are paid more for C-sections.
The article was to show a reflexion about high costs of maternity care in USA, and that the reliance on OBs is actually one of the reasons that maternity care in the United States is so expensive.
I’ll bite: how many is the vast majority and what’s your source? Because I can’t find any current breakdown of the number of OBs that are salaried vs. private practice, nor of what percentage of those in private practice ha e patient panels that are majority global fee or capitated.
Since you continue to disagree with multiple physicians (some who have obstetrical experience) on the issue of how they are paid (since apparently you know how their paycheck is determine more than they do), please provide us with any source to prove your claim. Why on earth would you not believe a US physician telling you how they are paid? Are you suggesting we are lying?? You may have read some two year old article that leads you to your conclusion but we as physicians actually have contracts with insurance companies who tell us how they will pay us. I think part of your problem (besides the fact that you persist in being willfully ignorant) is that you are confusing payment to hospitals with payment to physicians. I don’t think you understand how the payment system in the US works and you refuse to listen to people who have inside knowledge.
Two particular cases do not describe the whole picture in USA. Obviously that no obstetrician who is reading this will write “yes, I bill additional fees for cesareans,” just keep silent. But it has been and remains a widespread practice, and not just in the US but worldwide. We must also say that I do not hold that financial incentives to obstetricians have been the only cause of the proliferation of unnecessary cesareans, there are many others.
You keep saying there are many reasons other than financial for unnecessary caesareans. Would you like to provide some examples?
So you do think we are lying. Thanks for at least coming clean with that. You’re a schmuck. I can guarantee we understand the payment structure in the US much better than you do. It just doesn’t fit in with your storyline, so you simply ignore the facts. The costs that you quoted above for the cost of Csection vs. vaginal delivery are hospital fees. Physician services are billed separately to the insurance as a global fee. The physician payments are much less than hospital fees. So your issue should be with how hospitals bill, not with how physicians are paid. But that wouldn’t fit the “evil doctor” script, now would it?
In case you’d actually like to see an example, here is one common insurance company’s policy on how they pay physicians for prenatal care an deliveries. (This is pretty much universally how all insurance companies do it.)
http://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/providerinformation/AZ-OBBillingGuidelines.pdf
Being honest. These bundled payments have occurred with the recent changes in healthcare reform, precisely because in recent times was tending to unfairly increase in caesarean sections, partly because the economic incentives received obstetricians.
Fernando? Is that you?
Must be. Same choppy English patterns.
Dr. Tuteur, can we get an IP check here?
Different IP addresses, but same South American city.
Somehow I doubt that’s a coincidence. Same person.
Yeah, Fernando. You can’t just enter in another Disqus alias, append “Dr.” to the front, and immediately be in the perfect disguise.
No, it wasn’t.
Also, for pete’s sake, learn to spell “reflection”.
And what we keep trying to explain to you is that your article, which is over 2 years old, is no longer reflective of how the vast majority of OB’s are paid, which is a global fee for the entire pregnancy and delivery.
The difference in cost you are seeing is more a function of a private, for-profit system versus universal health care. Most Canadian women give birth under the care of an OB, and the average cost of an uncomplicated vaginal delivery is more in line with the UK and Dutch than with the US.
Is there an obstetrician who has ever been paid $9,775 for a delivery?
Anyone? Anyone? Bueller?
Of course not. Fernando doesn’t understand the difference between hospital charges and physician charges. He doesn’t understand the difference between the way the health care market works in the US, Britain, and the Netherlands.
Read the article again, information relates to the average total cost of the intervention. The article was to show a reflexion about high costs of maternity care in USA, and that the reliance on OBs is actually one of the reasons that maternity care in the United States is so expensive. However, it is also clear that many obstetricians charge more for caesareans when payments are not fixed. The article itself describes an example: “…When I started going to my OB, again years before I was pregnant, she was on my insurance plan and visits cost a mere $10 co-pay. By the time I got pregnant, however, she had stopped taking all insurance because the reimbursement rates were not keeping up with the increasing rates of her practice—especially her insurance. She charged a flat fee of $7,500 for the entire pregnancy and delivery with a $500 surcharge if I had a c-section.”
Women paying out of pocket for OB services is basically unheard of in the US, with the exception of lay midwifery (CPM) services (who, by the way, keep their entire fee as income, not paying malpractice or any other fees, in sharp contrast with physicians). The US operates under a insurance driven model. Under the new healthcare law, pretty much everyone is required to have insurance and all insurance plans are required to offer maternity services. In this day and age, private practice is not financially feasible anymore because of insurance company fee schedules and the vast vast majority of doctors are salaried employees of a healthcare system or a group practice. In other developed countries, like the UK (which I will be the first to admit, I am not an expert in; I’m sure Dr. Kitty or another UK doc could chime in for specifics), medicine is socialized and doctors are salaried. Therefore, there is no financial motive to do one type of delivery over another. You have no argument.
So what? What is your point?
Just so you know, the number of doctors in the US who (like the one in your example) do not accept any insurance is exceptionally small. On the order of 1%, last I heard. So this is not a phenomenon that is having any significant impact on medical costs.
I’m glad we now have a third doc here to try to explain this to Fernando. He/she is a bit thick and not understanding multiple explanations of the concept. I am growing weary of repeating myself.
Medical prices across the board are far higher in the US than the UK and the Netherlands, because we have far more uninsured people, and their costs get passed along to those with insurance.
Everything medical costs more in the US than in the UK or other European countries, regardless of who the care provider is. A medication that costs $5/pill in the UK can easily cost $90/pill in the US. A 15-minute appointment with an OB costs easily $150 in the US, vs. $25 in France, and a visit with a midwife (a real US midwife, i.e. CNM) is likewise 3-5 times as expensive in the US as it is anywhere else.
Long story short, the numbers you are citing don’t mean what you think they mean.
The real cost of doctor visit is higher than what patient pays out of pocket in European healthcare systems which are subsidized by government but I believe that many medical services are more expensive in US anyway. Most of blood tests are ridiculuosly expensive compared to what private labs charge here. At the same time, generic OTC drugs are cheaper in US than in my country, like ibuprofen costs several times less.
The real cost is higher than the out of pocket cost, yes, but that’s true of any system of insurance. I’d have to double check, because it’s been a while since I looked into it, but from what I recall, real costs are still lower in Europe than they are in the US.
12 generic Ibuprofen tablets cost 30p OTC in the UK.
14 Doxycycline tablets costs the NHS less than £2.
A month’s supply of generic Simvastatin costs the NHS less than £2.
A month’s supply of Pregabalin (any stength) costs the NHS £75.
Those are ones I know off the top of my head.
The NHS spends £500 PER BIRTH on insurance.
Midwifery care may be cheaper, but the med mal and negligence claims are getting both more common and more expensive as a result.
You know, I just checked out this Homebirth midwife’s site. http://barefootbirth.com/home-birth/ She charges $6000 for a home delivery.
I absolutely guarantee you, with 100% certainly, that not a single OB in the US makes $6000 off of management of a pregnancy, labor and delivery, be it vaginal or a section.
Tell me again how midwives will save us money?????
JCAHO also requires hospitals report csection rates and use them as a quality measure.
Exactly!
In 2008 the c section rate in the UK was 24%. The vast majority of those would have been performed in the public health system where there is no financial incentive to do c sections. How would you explain this?
because financial incentives are not the only reason, there are many other, Why Is the National U.S. Cesarean Section Rate So High?:
http://www.childbirthconnection.org/article.asp?ck=10456
What are the other reasons?
Yes there are many other reasons to do CSections, most of them totally valid. Who are you to say they aren’t? Has it ever occurred to you that we have the CSection rate that we do because mothers are older and have more pre-existing health conditions, e.g. diabetes or hypertension, that make them higher risk pregnancies? It is silly to assume that all of these CSections being done, or even a majority, because someone has a tee time to get to.
And mothers are living longer and having fewer children, which changes the risk/benefit tradeoff of C-sections.
Ever hear of a Mother in the USA suffering with a Fistula? No? Right. Because we prefer a small scar on the tummy rather than a putrid leaking hole from our rectum into our vagina.
“A woman who has had a C-section typically stays in the hospital longer, two to four days on average, compared with a woman who has a vaginal delivery. Having a C-section also increases a woman’s risk for more physical complaints following delivery, such as pain at the site of the incision and longer-lasting soreness.
Because a woman is undergoing surgery, a C-section involves an increased risk of blood loss and a greater risk of infection, Bryant said. The bowel or bladder can be injured during the operation or a blood clot may form, she said.
A review study found that women who have had a C-section are less likely to begin early breastfeeding than women who had a vaginal birth.
The recovery period after delivering is also longer because a woman may have more pain and discomfort in her abdomen as the skin and nerves surrounding her surgical scar need time to heal, often at least two months.
Women are three times more likely to die during Caesarean delivery than a vaginal birth, due mostly to blood clots, infections and complications from anesthesia, according to a French study.
Once a woman has had her first C-section, she is more likely to have a C-section in her future deliveries, Bryant said. She may also be at greater risk of future pregnancy complications, such as uterine rupture, which is when the C-section scar in her uterus ruptures, and placenta abnormalities. The risk for placenta problems continues to increase with every C-section a woman has.”
Only when it is really necessary is the recommendation
The statistics of maternal death and c/section are confounded by mothers who are sick prior to the c/section. Not causation related…but mothers who are already quite deathly ill prior to the surgery. And you , Fernando lack compassion for mothers and babies whose lives have been saved by a c/section. Low risk is a hindsight diagnosis.
Got news for you-even women with straight forward vaginal deliveries stay in the hospital 2-4 days.
“only when it is really necessary is the recommendation”
So at what point is a caesarean really necessary? If a baby has a 50% chance of dying unless a c section is performed then was that c section really necessary? How about 10% chance? What if the chance of a baby dying is 1 in 100 with vaginal delivery and 1 in a thousand with c section – does that mean the c section was necessary? Where do you draw the line?
And what about the mothers opinion? What if she would prefer to take a slightly higher risk herself rather than risk her baby?
There’s so much talk about how we need to lower the c section rate, but (other than maternal request c sections which make up a small proportion) no one seems to be able to say which c sections are unnecessary.
Everything in medicine is based on risk vs. benefits. A CSection is done when the benefits of one (like, gee, a live baby) outweigh the risks. Sure, I have a higher risk of placenta accreta or placenta previa after my CSection, but I sure do love my live, healthy daughter. She was well worth the risk. Just mentioning the risks without discussing the ways in which it is beneficial is meaningless. There are risks to any medical procedure, including vaginal delivery. Most of us here are quite well versed in the risks of both delivery methods. I don’t understand the point of your post.
Okay, and how exactly is the OBSTETRICIAN making more money on those complications?
The hospital, not the doctor, bills for the room stay and all associated costs (nursing care, painkillers, food, supplies).
Surgery to repair the bowels or bladder would be performed by a GI specialist or urologist, respectively, not an obstetrician.
Formula companies would make money off a woman choosing not to breastfeed, not an obstetrician.
Nobody in the medical field makes more money off of a longer prescribed recovery period.
All of the risks of a cesarean are read to women well in advance, unless it’s a life-threatening emergency, which it sometimes is. They’re not reasons NOT to do a cesarean if indicated.
And who decides when it is really necessary? You?
Why do you think any of those are necessarily a bad thing?
I had a C-section because my DD was stubbornly transverse and not a candidate for a version. I was breastfeeding her within 5 minutes of her birth, while I was stitched up. Though I should add that breastfeeding has limited benefits in a first-world country, so unless it’s mom’s preference, who the hell cares, anyway?
Staying in the hospital for four days afterwards is a BENEFIT in my book, and one of the reasons I’d consider not trying for a VBAC next time. In the US, we don’t have health visitors like you do in the UK. Nor do we have parental leave except at the discretion of the company, and DH’s doesn’t offer it. (I agree that’s horrible and needs to change, but that’s another issue.) Once I’m home, that’s it. No help, no support, nothing–I’ll be wrangling a toddler AND a newborn by myself. At the hospital, I have experienced caregivers a touch of a call button away. I have people who can tell me “that’s normal” or “huh, let’s run a test” rather than waiting a week to see a pediatrician. I have people bring me hot, nutritious food three times a day that I don’t have to prepare or clean up after. Those same people will change my sheets, watch the baby while I take a shower, and make sure I’m taking my medications on time. How is ANY of that a bad thing?
Yep, I’m more likely to have a C-section in the future, partly for medical reasons, but also because it’s a lot more feasible for those of us in the modern world. I live an hour or more from my OB and hospital. I don’t have anyone who could drive me to them except DH, which means his taking off of work. A scheduled C-section means not laboring an hour from home or on the road for an hour, all the time hoping my uterus isn’t rupturing and my baby dying inside me because I don’t know what “normal” labor feels like. It means that DH won’t get into trouble at work for taking off several times for false labor, or having to leave in the middle of something important or urgent to drive me to the hospital, or trying to find last-minute childcare for DD. DH being able to tell work a month in advance “I’ll be taking off on these dates, have someone cover for me” is a lot more workable.
Lastly, vaginal birth has its risks, too. Tearing is no joke. From what I understand, I recovered a lot faster than any of my vaginally-birthing friends. It didn’t hurt to sit, use the bathroom, or have sex with my husband. Fourth-degree tears aren’t especially repairable, either, even by experienced surgeons. The anus simply doesn’t go back to what it was, and fecal incontinence for the next 70 years ain’t high on my list of things I want to experience. I’ll take a nearly-invisible (think hair’s breadth and as long as my finger) scar over the inability to control when I poop or to enjoy sex any day of the week.
And the risks of vaginal delivery are, of course, many:
– Tearing. Something like 90% of women have some tearing, and around 5% have horrific tearing (3rd-4th degree), which requires surgical repair… but surgical repair isn’t always succesful.
– Permanent damage to the pelvic floor. Nerve damage, muscle damage (including shearing, tearing muscles off the bones they are attached to–which cannot be repaired). This can cause urinary and fecal incontinence and a reduction or loss of ability to experience sexual pleasure. Long term (10-20+ years), it can cause the vagina, bladder, rectum and/or womb to prolapse. In the latter case that may require a hysterectomy.
– Uterine inversion. The womb can turn inside out and come out with the baby. This is rare, but when it happens it can kill the mother. Even when it doesn’t it is an extremely serious complication requiring surgical repair.
There are risks no matter which way you give birth. That’s why women must be free to decide for themselves which way to give birth (which risks they want to take).
“Only when it is really necessary is the recommendation”
Who decides when it is “really necessary,” fernando?
You? Armchair VBAC enthusiasts who post on the internet? Who?
Isn’t this a decision best left to the woman and her care providers, to decide according the the current circumstances?
Trick question. It’s never necessary.
Fernando,
Yes I spent 48 hours in the hospital after my second CS and 72hrs after my first.
Do you know what I was doing for those days?
Lying in a very comfy electric hospital bed, nursing my newborn, being waited on hand and foot, with restricted visitors, no housework and nothing to do but get to know my baby.
Personally, I prefer the peace and quiet of hospital to being at home, especially with baby#2.
I nursed both of my babies in recovery, within 30minutes of delivery, EBF my daughter for over a year, and my son is only six weeks old, but all the signs point to a similar situation with him.
Bladder and bowel injury is less common with a planned CS than with a long, obstructed labour and instrumental delivery, which was the most likely outcome if I hadn’t chosen the surgeries.
I didn’t want a home birth.
I didn’t want midwifery care.
I didn’t want vaginal delivery.
I could have had all of those things if I wanted them- I’m in the UK.
Even with a hard push for home birth and midwifery led care and “normal ” this and “natural” that there will always be those of us who either don’t want those things, or are risked out of them.
Since placenta praevia, uterine rupture, placenta accreta and blade or bowel damage caused by CS are much, much less common than pelvic organ prolapse and incontinence caused by vaginal childbirth , incontinence and prolapse frequently requiring surgical repair or hysterectomy, I’m pretty happy with my choice.
You know what? I had this whole reply planned, and then I thought more. Why or how I had a c-section, is my own business, along with my doctor. Because it’s my body and I don’t need to justify or explain to anyone, especially some man, any decisions or choices I make about it. So you can go fly a kite.
I only had a section because I knew they’d give me loads of medicinal heroin afterwards.
Now you’re catching on.
I remember one time I had some sort of infection, and the doctor gave me an antibiotic, and he says, “This should be ok and shouldn’t make you loopy or anything.” I was like, “Well, what’s the fun in that?” Dude, if you are going to give me a prescription, give me something good!
For some reason, I am reminded of Mitch Hedberg
It happens. I’ve seen it. The result of a 4th degree tear misdiagnosed as a 3rd degree and thus not properly repaired. It’s very rare though, thanks science.
Umm…..why do you care overmuch?
If your goal was only to make more money, you’d do only gyne. Or go into plastics in the first place.
Or not spend all that money and time in medical school and be a direct-entry midwife.
With a good deal less risk of nasty malpractice lawsuits, at that. While I have no doubt that someone *can* screw up in a gyn practice, I’d think it’s a lot harder to do than in ob, and with less bad results. (I.e., dead and injured babies, quite understandably, tend to translate to mega-bucks if you present the situation to a jury, while, say, a painfully-placed IUD wouldn’t.)
Here in Texas, which is the worst state for malpractice lawsuits, a huge number of OBs are stopping doing OB/deliveries because of the obscene malpractice insurance rates even if they’ve never had a claim against it. GYN? Better hours (no 2 AM deliveries), less risk, etc.
I heard dermatology.
Being honest. These bundled payments have occurred with the recent changes in healthcare reform, precisely because in recent times was tending to unfairly increase in caesarean sections, partly because the economic incentives received obstetricians.
It’s obvious this is Fernando. Thanks for making it clear you’re a troll.
Dr. Ryan “recent changes in healthcare reform”?
Recent? What do you consider recent?
My OB received a global fee for both of my pregnancies. My older child is 11 this year.
Whaaat? My first is 8 years old, and I know that his delivery was bundled.
My 13-year-old was delivered under a bundled fee. By a midwife. The hospital bill was a little over $14,000.I assume my insurer’s negotiated payment was significantly less. That was a teaching hospital. My daughter was delivered four years later, also under a bundled scheme for the OB portion. The hospital (private, non-teaching) billed out at $24,000 for a NSVD with no epidural. In the same city. The problem doesn’t seem to have a lot to do with how much OBs are charging.
These bundled payments have been in place for at least 15 years where I live, and yet the c-section rate hasn’t dropped one bit. I guess the driver wasn’t financial after all.
The truth is that c-sections have gone up substantially under ALL payer schemes in ALL countries worldwide except in the most extremely impoverished and war torn. They have gone up in private pay systems, in single payer systems, in fee for service systems, in global pay systems, in systems where midwives do the majority of deliveries, in systems that use very few midwives.
Why? Because the risks of c-section have gone down because of better anesthesia and technique, while the risks of vaginal birth have gone up with more older, heavier and first time moms. And at the same time, people’s risk tolerance has gone down. More and more women do not want to risk their pelvic floors with forceps or their babies’ brains with prolonged or risky labors.
My oldest is 14. I was embarrassed when I read the insurance statement and felt horrible about how little my OB made from my pregnancy and c/s birth.
“The desire to keep getting good profits is what drives many obstetricians”? Do you have proof for this Hateful belief? Or are you some sort of bigot? The young people I know that are studying and sacrificing everything for a career in medicine are decent human beings, taking on economic debt because they are the brightest and best in their class and because they believe they can be of service to the next generation. You, on the other hand are an anti-intellectual bigot.
weird, my ob only mentioned C-section once when discussing possible complications fairly early on. Even with pre-e for 14 of 18 hours of labor, I still gave birth through the more common exit. In a hospital.
Are you here in the United States, Fernando?
What’s the current workforce need and projections for OBs and midwives?
It depends on whether a good health reform is made, or the current system remains deficient
What is the current situation in the U.S.?
1. Empowered to do what? Make the choices you’d like them to make?
2. Could you be specific? Which cesareans that could be prevented currently aren’t?
3. I think I have to break this one up, too, because there’s so much BS in it:
a. What the heck is an “imposed system”? Are you suggesting that women aren’t choosing midwives because someone’s forcing them not to? Are you making a distinction between hospital-based CNMs, whose care is fully covered by insurance, and CPMs, whose services are not?
b. “Can and should be higher”???? How dare you say women SHOULD choose something different if it is their choice? I chose midwives (CNMs) both times for my pregnancies. Loved them, and would choose them again. If another woman wants an obstetrician, what right do I or you or anyone have to tell her she can’t?
c. You’re implying that obstetricians are controlling who chooses midwives and who chooses OBs.
d. “You’re not a doctor, because of that, you don’t know.” And you know because you ARE a doctor? I don’t think so. Unless you’re an epidemiologist or sociologist who studies this stuff for a living, you know as little as or less than I do on the subject, yet you’re claiming to know how OBs are motivated and why the majority of women are making different healthcare decisions than you think they should.
4. Let’s assume by “profit” you mean simply “income.” That begs two questions: should obstetricians NOT get an income? And more importantly, are your precious CPMs working for free?!?
And NO, if an obstetrician is on salary, they do NOT get paid more by doing more cesareans. Just like as a teacher my salary doesn’t go up if I have more kids in my class. Because that’s not how “on salary” works.
What abuse? Please be more specific.
Childbirth is *always* risky. Most get through fine, but you never know what roll of the dice you’ll get with this specific pregnancy. My bp was fantastic all through pregnancy and I only gained 10 or 15 pounds. Pre-e was not expected.
ok, let me explain better: “…promoted by the vision of childbirth as always VERY HIGH risk. And very high-risk delivers are only a very small percentage. Most are low-risk deliveries, that could be perfectly attended by highly trained midwives
I don’t know too many who would disagree, to an extent. However, there are two caveats
1) that they are “highly trained” midwives. No CPMs. Get rid of them. and
2) The culture in Great Britain has shown that even this can fail, because midwives fall into a natural childbirth ideology that prevents proper care.
I don’t know anyone who would object to increasing the scope highly qualified midwives working in collaboration with OBs. Unfortunately, what we see are unqualified midwives or midwives pushing an agenda that prevents proper care. For example, failure to transfer care at the proper time.
I’m sure you agree that neither of these is acceptable, right?
Get rid of them? NO. Enhance, formalize and promote their training as in other countries with best ratios in the system of maternity care. Are needed more independent midwives well trained, are an excellent way to cover the current shortage.
Why? There is already a group of highly trained professional midwives in the US. They’re called CNMs and are the best of the best.
But why bother? We already have properly trained midwives in the US. (for the sake of argument) Include CMs if you want. So what is the point of the CPM? The ONLY purpose of the CPM is to allow people to practice as midwives without proper training. If they are going to do proper training, you don’t need CPMs.
Because there is a shortage of midwives. Rigorously improving and formalizing the training of CPM´s, we would have more options to have highly qualified midwives who are currently required, as happens in other countries that provide maternity services higher quality
ONCE AGAIN, THEY DON’T PROVIDE HIGHER QUALITY MATERNITY SERVICE! JUST BECAUSE THEY HAVE INCORPORATED MIDWIVES THAT DOESN’T MAKE THEIR SERVICES HIGHER QUALITY!
Who the hell need CPMs? Why bother with improving and formalizing their training? They can just become CNMs and then they’ll have the training by definition. But I can see you’re more concerned about pandering and catering the needs of CPMs before the needs of patients.
Why do you assume that everybody who is going to give birth WANTS to be attended by a midwife and wants to give birth at home? Or that those of us who have already had kids have somehow “missed out” by having our baby in the hospital and some even by *GASP* c-section? I had a scheduled c-section because a couple of the OB’s in my OB’s practice thought that my pelvis was a less than optimal shape for vaginal birth. (Too “flat”). I was not actively discouraged from attempting a vaginal birth, my OB was perfectly willing to let me have a trial of labor, but she did mention that I *might* wind up requiring CS. I opted to schedule the CS because I didn’t want to be tired out and exhausted from labor and THEN go into a CS. I also NEVER entertained the thought of trying a home birth. I personally think those that aspire to that level of risk and lunacy are barking mad. You don’t have to agree; in fact, I don’t care if you agree. But the constant litany of “Homebirth and Midwives are OMG the BEST and you can’t be one of the cool kids if you didn’t have one” and the subtle and often not so subtle denigration of anyone who thinks differently is starting to wear thin.
Maybe it’s because I’m a doctor or maybe it’s because of my personality, but when I had my son I preferred the way that the doctors in general interacted with me compared to the midwives. I found several of the midwives to be somewhat patronising whereas the doctors took the time to explain everything to me and spoke to me as an equal. As for home birth, even if everything had gone smoothly I would have had a terrible experience. I found the knowledge that there’s an operating theatre and NICU close by much more reassuring than being at home.
I found the knowledge that there’s an operating theatre and NICU close by much more reassuring than being at home.
EXACTLY. You and I seem to be the type that prefers actual safety to the illusion of safety that people get from being in comfortable and familiar surroundings.
My son was born at 35 weeks and I barely made it to the hospital. The NICU team was right there and the nurse who put in my IV told not to worry, everything they would need to help baby and me was in the room or right outside the door. Not “really close” or “10 minutes away”. Turns out we didn’t need anything, my son didn’t need help other than a nurse to keep putting his hat back on (he agrees with Carla Hartley’s hatting theory) and the reassurances to my husband by everyone that yes, it’s perfectly ok to have a baby be red and screaming at birth.
The hat thing made me LOL. DD was the same way; her goal throughout her hospital stay was, to her way of thinking, to get that stupid hat OFF! It annoyed her seriously that we kept replacing it. To this day, she loathes hats and headbands.
No other country lets anyone like CPMs legally practice midwifery. We do not need extra kinds of midwives. We need people who genuinely want to be midwives to get the necessary training to be good ones–in other words, go to school and become a CNM. End of story.
There’s only a shortage of midwives if the majority of women prefer to see a midwife and create demand for it.
A shortage? I never wanted to see one and the hospital still had one arrive to catch the baby, even as my ob stood 5 feet away
The training is already ‘formalized’ (and ‘enhanced’ over the joke that is CPM training). If they want to be real midwives, they are all free to become CNMs.
The problem is low-risk does not equal no-risk, and in obstetrics things can go wrong in seconds.
I was perfectly low risk throughout my pregnancy and through most of my labour. If everything had remained uncomplicated then my son would have been delivered by a midwife in hospital and I think most people here would agree that that would be perfectly appropriate. But whilst pushing my sons heart rate started dropping (turned out to be a nuchal cord). That’s when the midwife called in the obstetrician. Luckily we got him out quickly with the help of an episiotomy and he suffered no harm. Straight after delivery, I began to bleed. The obstetrician and midwife were onto it straight away, but even so I lost 1.6litres of blood. My haemogloblin dropped from 144 to 80 and I needed a blood transfusion for symptomatic anaemia the following day.
In low risk patients, they can receive perfectly appropriate care I a hospital setting by fully trained midwives (not midwives who are only required to see a handful of cases before qualifying and whose certifying body suggests treating shock with homeopathy). But if things go wrong, and they always can, you need access to equipment and expertise that just isn’t available at home. If I had given birth at home, there’s a reasonably high chance that I could have died and that my son could have died or been brain damaged.
Its a moot point to me, laddie. I’m already high risk on age alone.
Today 9/30/15, my son Robert Anthony was born via CS. He weighed in at 7.5lbs. He was born in a hospital, delivered by my OB, who by the way held my hand while I received spinal, was perfect. All of my nurses were great as well.
I enjoyed my experience and wouldn’t change a damn thing!
Thank you all for your help!
I am waiting for my Rhogam shot, I am A-, baby is like daddy A+.
Congratulations! And welcome to the world, Robert Anthony!
Rhogam is a great advancement.
We had a older neighbor who almost lost her baby at birth due to RH disease. Baby needed a full blood transfusion (apparently the only treatment available in the 50’s). Baby survived, but it was traumatic all around. She feared for future births (so she didn’t have any).
Things are so much better now that there is Rhogam! People forget just how bad the “good old days” could be.
Congratulations!!!
Mazal tov!
Congratulations!
Congratulations! The hardest part is now to begin, figuring out how to care for little one, but you have a great start!
Congrats to you! Welcome, little one!
Yay! Congratulations! Glad you and little one are well and everything from the care to the experience was good!
Awesome! Congratulations on the safe arrival!
Congratulations! Hope your postpartum is restful, your recovery easy, and baby a good eater and sleeper!
Congrats! Hope you and your little one are doing well and getting some rest!
Great news!
So happy for you!!
OT: http://www.katielewphotography.com/blog/2015/9/25/stillwater-ok-birth-photographer-baby-ottos-birth-story
Home water birth. From the article, “Baby was slow to start, so mom breathed into him to clear the excess fluid from his lungs.” !!!!! What kind of moronic “midwives” have the mom do baby resuscitation??!! This is ridiculous!!
I guess it makes it even easier to blame mom if baby doesn’t do well.
This brings Rixa Freeze’s resuscitation of her third child’s birth a few years ago…
What the whatting what? Is this for real?
Blowing into the lungs to “clear the excess fluid”?? SHows the mentality of these people. Up is down.
I’m only surprised they didn’t try squirting colostrum down his throat.
https://mamanaturalbirth.com … So yes, I thought this may be of interest to you Dr. Amy, she’s a very popular blogger who is now teaching birth “classes”
I shuddered- as- having had a PPH and appreciating the medical team who saved my life – these courses look dangerous to the naive natural birther. :/
Irony of ironies, she had both of her children in a hospital-based birthing center, which most of her readers would not have access to.
I’d love to know what her remedy is for “placenta positioning.”
Spinning placentas?
Rebozo scarf and birth affirmations.
Maybe she means positioning it for the photo after the birth, like a flower arrangement?
“Maura has attended over 100 natural childbirths (so she’s seen it all)”
Hahahahahaha! Over 100 births to see it all? Hahahahaha!!!!
She doesn’t know what she doesn’t know with so little experience.
To be fair, 100 SOUNDS very impressive. Until one stops bragging and starts thinking that bad outcomes are measured per thousand. Unless you’re a homebirth loonie drooling over all the HVBACs, for example, that you have attended. Ah well, the outcomes are just great. Just ask MANA.
With 100 births (much less the 40 NARM requires for the CPM credential), the chances are slim that a midwife has seen many life-threatening complications. Eventually, someone is going to be her first cord prolapse/PPH/shoulder dystocia/flat baby, etc. and she will never have seen one, much less handled one. If she’s exceptionally well prepared (for a homebirth midwife), she may have drilled one, but it isn’t likely.
And she’s alone (with maybe an apprentice of her own or a doula) with a panicking partner, x minutes from equipment she may need or anyone who could possibly help.
I’ve said it before: homebirth midwives should be the most experienced and best trained. Instead, they’re the absolute opposite.
And then instead of either a) calling for an ambulance and calling the ER from the car while someone else drives. or b) getting the person to the car and flooring it to the hospital, they may get on Facebook or Twitter to crowdsource a solution. FYI option b, floor it to the hospital, was what my grandma chose to do when my mom when into premature labor with my transverse, placenta previa brother in 1966. Result- Live brain-intact brother, live mom, emergency C-section and hysterectomy due to uterine rupture.
So, she’s been practicing for 4-6 weeks? That’s about how long it takes for my OB to attend 100 births.
That was what I said to my wife when I looked over the site.
“Epidurals are injected in the spinal cord, but significant amounts enter the mom’s bloodstream and are passed to baby via the placenta. Take one glance at a newborn after an epidural birth vs. a baby after a natural birth… There’s a big difference.” Wow. That is a lot of nonsense packed into two sentences. How does this explain my sleepy non-epidural babies and my wide awake, CS born nephew? Or all those barely crying, blue or gray water birth babies?
“Or all those barely crying […] water birth babies?”
They don’t cry because the water birth was so *gentle*, doncha know, so they had no “reason” to cry.
I shudder to think I used to believe that was true and marveled at birth stories where babies born in water didn’t utter a peep and the “mama” described the baby as “content” and “peaceful” – how many of those were because the baby was having trouble and they were all too misinformed to know better?
Hey, she said “there’s a big difference” she didn’t say in what way!
I can’t help but think it would be a blessing if this WERE true… being born vaginally really seems like it should HURT LIKE HELL for the baby! The force exerted on their skulls alone… -shudder-
Not coincidentally, I remember reading a study once that babies born by C-section are observably calmer–read, less random bouts of crying.
Not to mention, epidural are not injected into the spinal cord, they’re injected into the epidural space. This woman clearly hasn’t got a clue what she is talking about.
That was the biggest piece of crap in the sentence. She has no clue indeed and she is “teaching” her misinformation to pregnant women.
Your nephew was wide awake from the birth TRAUMA. Shall surely never recover. Obviously if he had had a “gentle” natural homebirth he eouldnt have been so damaged. Did you know some natural births are SO GENTLE the babies are born sleeping?! Sometimes they never even wake up
Hey, they brought us the medical marvel that is jaccuzi birth. That certainly wasn’t a thing before the 20th centrury.
They call those “the mid wife’s epidural”.
Jacuzzis – the place babies were made in the ’70s becomes where they’re delivered in the aughts.
There’s a whole group (albeit small) of NCB lunatics who believe that Rhogam is harmful, and come up with so many justifications to avoid it. Some even think they can change their blood type through diet. (http://www.laurapower.com/page9.html) <—check out this quack
There is some whole level of resume padding going on for Dr. Laura Power.
– She has “NIH” written in bold and states she attended the FAES-NIH graduate school. That’s probably true, but FAES-NIH is not a degree-granting institution. There doesn’t seem to be any check to see that a person actually is qualified to take the classes offered.
– I can’t figure out where she got her Ph.D through. International University in California doesn’t offer a Ph.D in nutrition. She has two publications – the 1992 paper coauthored by a faculty member at U of Maryland that is probably the result of her MS work and a paper she authored alone in 2007 using data collected from 1985-2005 from the clinic she worked at. In that paper, her sponsoring institution is her business. Without any publications, I find it extremely suspect that she graduated from any Ph.D program.
Looking up PhD theses is my specialty. However, I get a 404 error on the link above. The name is Laura Power? Any other options?
remove the parentheses from the URL, that may be the problem, as it was when I clicked.
She’s published twice under Laura Power on the publications listed at
http://www.laurapower.com/page9.html
There are two PhD theses for someone named Laura Power in ProQuest’s Dissertation Database. Any legitimate PhD granted in the US will be included in Dissertations Abstracts (mine is there; so is Dr. Laura Schlessinger’s, Martin Luther King’s and even Bill Cosby). Neither is from International University.
It wasn’t California International University – that doesn’t have a friggin PhD program!
The only option I can figure is Alliant International University, but they don’t have any nutrition PhDs deposited, either. It’s bullshit.
That was my conclusion as well. She should have had at least one publication from her thesis work; I don’t know of a program that lets you defend without at least one lead author publication. The Ph.D in nutrition programs I found in California – Loma Linda, Berkeley and Davis – are high powered enough that publications would be a given and she would have named the institution in the article. Instead, her only post-master’s publication is based on her clinical work. Also, she didn’t name her adviser as an author in the paper which would not go over well in any program I know of.
It’s not that she is required to have a publication from her thesis work, it’s that she is required to have a friggin thesis in the first place. No evidence of such. Any legitimate PhD thesis in the US will be deposited in Dissertation Abstracts. She has nothing there.
I can’t even imagine how many health problems it would cause if diet changed blood type.
The real problem is, this author can;t imagine them. WOrrying.
The sad part is that their mantra comes out in full force on the birth boards on Baby Center. At around 28 weeks, there were dozens of posts questioning the safety of Rhogam. While thankfully most moms posted in support of it, there were quite a few who instead advocated “do your research.” Terrifying, especially given that the original posts were generally from first-time moms who were clearly scared, but getting duped into questioning its efficacy.
(I’ve had four Rhogam shots between my two pregnancies, with another due in the next few weeks.)
The story of the discovery of the Rh factor and the development of Rhogam so quickly is one of medicine’s great success stories.
My great-grandmother lost her fifth child because of the RH factor. Yes, she had four living children even with this, but that cannot lessen how devastated she was to lose that one baby. If the Rhogam shot had been invented, she would have gladly taken it. I’m pretty sure she would rip these crazies a new one.
Some yea s ago I had a fundamentalist couple who refused Rhogam, preferring prayer. They also were against contraception, since it wasn’t part of God’s plan. After each of her first four births, they crowed about the efficacy of prayer. But, by the fifth pregnancy her titers went sky high. Baby was very sick with jaundice;parents forbade any treatment bur prayed day and night. Baby survived. However no subsequent pregnancy resulted in a living child. The parents shrugged. “God’s will”.
I have no idea what can be done with parents like this.
Horrid. Seems they get to pick and choose a lot re skyfriend’s creation though, in a way I would think is downright disrespectful.
God created testing and life-saving treatments and drugs, surely, so using them would, you’d think, be no big deal.
I always feel the Muslims sum that one up best: Allah will provide, but tie your camel.
I am so stealing that.
You cannot force someone to have a treatment they refuse.
I’ve also seen Jehovah Witnesses exanguinate, although if the patient is a child the hospital can usually get a court order. Then I’ve seen parents refuse to take a child who has received blood, home.
From the promo of her whacky book about blood groups:
” it presents Dr. Power’s 25 years of research statistically correlating blood types to 3 kinds of food allergies, plus lectins, supported by her
U.S. patent (# 7,601,509), her peer-reviewed journal article”
“25 years of research results in “article” (singular).
Oh, there’s so much more to her quackitude. Here’s a message that I just sent to Steve Barrett at Quackwatch:
She also lists that she has been doing legal work pro se since 2011. AAA can weigh in, but I interpret that in two ways:
1) Either she has had legal problems, and has been fighting them, or
2) She’s trying to do legal stuff and can’t find any legitimate lawyer to represent her.
I suspect that someone with the know-how could find her cases. I suspect that she is as much a quack in law as she is in everything else.
I’m going to send it to Orac.
Awesome. I will be on the lookout for articles from Orac and/or Quackwatch.
I found her name because I was looking for people who claimed they could change blood type via diet. Aside from lay-people discussing that, basically her name was the only one connected with it, so I followed that to her site. It appears that she’s the one who made up that whole idea.
I was totally waiting for this to be a blank post with only a title. 🙂