Reply to Trying to understand the midwife route

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous] An important question: would you rather have a more qualified provider who may be more inclined to give you a C-section if they are concerned with your labor, or a less qualified provider who might not appropriately respond to a critical situation when necessary by doing needed interventions because they view the trajectory of your labor as “normal” or don’t want to transfer your care? [/quote]

I chose #3 for my two births: Qualified midwives who would respond to a critical situation when necessary by having a qualified OB do needed interventions. Of course it would be dangerous to have a midwife unwilling to transfer care when necessary, just as it would be dangerous to have a GP unwilling to transfer a patient to a specialist when necessary. 
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It’s nice to think that midwives always transfer care when they are supposed to but I’m living proof that they don’t and I know a number of other women on the same boat. Until CNMs divorce themselves from the CPMs and CMs and stop making natural physiologic childbirth the most important aspect of care, and remove some of the dogmatic views that they entrench in women during their training, the profession will continue to have bad apples who don’t know their scope. Unlike PAs, midwives are all about their own professional autonomy.

But sure, 60 hour poster, your kid didn’t get brain damage so I’m sure you feel like you made the best choice. But I bet you would have sued your midwife if anything was wrong with your baby. [/quote]

60 hour poster here. This is really fair. Obviously, I'm super supportive of midwives - have done it, will do it again. But I think this thread has actually really achieved its goal, which is to tease out what the real difference is. I imagine the whole thing is really helpful to the OP. There are degrees - certainly there are going to be really hands on OBs. Really risk-averse, highly trained midwives. Midwives who are too quick to transfer. OBs that go above and beyond to avoid a c-section. The world is a complex place. But there are some overarching, general differences in approach that I think this thread really teases out in a productive way, as to generally, what the two experiences are like.

One thing I will add, that goes with your brain damage point - I could not find studies/stats that specifically dug into the difference in safety between a Certified Nurse Midwife in a hospital vs. an OB in an hospital. All the studies I found were about midwives in birthing centers or at home, compared to OBs in hospitals. As midwifery comes back in a big way and grows in popularity, I would really like to see a comparison of outcomes (and particularly, adverse outcomes) between these two groups in a hospital setting.

One final point that you alluded to, but is worth spelling out for the OP, is the difference between Certified Nurse Midwives (CNM), Certified Professional Midwives (CPM), Certified Midwives (CM), and non certified midwives. In doing my research, there is a HUGE difference between these in training and preparation, and my love of midwives is limited exclusively to CNM, the highest level of midwifery training. I would never, ever, use one of the types. Something for anyone considering the midwifery route to consider. [/quote]

You can’t easily compare outcomes because OBs will always see women with health complications and risk factors that midwives cannot see. Midwives will always see healthy low risk women. OBs see always going to be managing complex and high risk pregnancies. By virtue of those facts alone, midwives can and should have better outcomes. The OBs will always be the one performing C sections, forceps, and vacuum deliveries. So you can’t compare the outcomes to find a group superior because it’s like comparing apples and oranges.

Also, midwives are not growing in a big way. They deliver a tiny fraction of babies in the US. And the studies that demonstrate how safe midwifery care is are frequently from Europe and do not translate to the US. In those countries the midwives have more rigorous training, do not see women with risk factors, and have much more aggressive transfer protocols. The midwives are also fully integrated into their hospital and health systems, unlike in the US which has three tiers of midwives who are all in alliance with each other despite the massive differences between their education and training.

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85% of all pregnancies are healthy and low-risk, and 90%+ of pregnancies and births are managed by OBs in hospitals. By virtue of those facts, OBs should have better outcomes. Instead they have an embarassingly high maternal mortality rate compared to other countries, an infant mortality rate that has been stagnant for 20 years, a ~20% rate of birth trauma, and childbirth is more dangerous now than it was for the previous generation, all despite the "advances" in technology i.e. skyrocketing rates of medical management and intervention.

Sometimes the way labor is managed by medical providers has unintended effects, even if it makes all the logical sense in the world that it should be helpful. Everyone is quick to blame modern women for being too unhealthy, fat or old to have babies safely, but there is something called iatrogenic harm in medicine and it has a role, too. If you've had a lot of dealings with doctors chances are good you've experienced it firsthand through overdiagnosis, overtreatment, incompetent or uncaring providers, or medical mistakes. It's no surprise more women are opting for the low tech high touch midwife model: choosing a provider with medical expertise who treats new moms as human beings whose experiences matter, and who don't view the day your child is born as simply another medical event like having a tumor removed.[/quote]

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