Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

I'm the PP you quoted. This was over two years ago now, so I honestly don't remember, but if you've found something please post a link! I'm eager to look. Thank you!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

I will blame them because it will forever be inappropriate that they allowed and encouraged me to push for nine hours. I was so delirious and exhausted and ignorant I had no idea this was inappropriate. And I have permanent injuries as a result. So don’t ever tell me to shut up.

My mother had the same as you and told me not to fear c sections. Her biggest regret is going natural.

She has had multiple surgeries to repair internal and external damage.

Yes, she gave birth with midwives. My mom is 5 ft with huge babies.

I have had several natural deliveries but should I ever need a c section i wouldn't fight it.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

I will blame them because it will forever be inappropriate that they allowed and encouraged me to push for nine hours. I was so delirious and exhausted and ignorant I had no idea this was inappropriate. And I have permanent injuries as a result. So don’t ever tell me to shut up.

Anonymous wrote:

Anonymous wrote:My reasons were the same as many folks above, including a terrible experience with an OB practice in DC. My midwifery practice listened to me, and took time to know me as an individual patient.

Pregnancy and childbirth is unlike some other medical experiences, in that the comfort of the patient can have a profound impact on the outcome.

But it wasn't all touchy-feely. The midwives also took an evidence-based approach and took the time to explain the evidence for their decision-making.

For example, I had extremely well-controlled GD. Tested 4x a day, never blew my numbers after the GTT, controlled entirely with diet and exercise. The OB practice would have induced me at 38 weeks regardless of my numbers as a matter of protocol, but the midwifery practice let me carry to term based on the evidence around very well-controlled GD. They saw me as more than a checkbox, which let me carry my baby to term and have the birth I was hoping for.

THIS. Thank you. I already posted on this thread with my reasons for choosing a midwife (in a hospital) rather than an OB. I have found some of the other responses frustrating, and couldn't come up with the words for why - this is exactly correct.

If I'm going in for surgery, yup, I want the best possible clinician, not the best bedside manner. But childbirth is very different!

I do wish there was more research/comparisons between outcomes from an OB vs. a CNM in a hospital. When I was trying to look at studies about this in making my decision, there was a real dearth of information on this. Lots of studies on home birth with a midwife, but that's very, very different. And some that compared midwifery to OBs without accounting for location of birth at all, also very different. My instinct is that, yes, there are extreme cases of complex issues where midwives miss things, or can't handle something that pops up, and just the 10 mins it takes to get an OB in the room creates a negative outcome. But that there are also a fair number of people getting c-sections with OBs would wouldn't be getting c-sections if they had gone with a midwife, and a certain very small percentage of those will have negative outcomes because surgery always has risks. I'd love to see numbers on how this stacks up. Even the (agree, somewhat condescending) medical practitioner who commented on page two said "A midwife in a practice with physicians seems fine as there is backup easily available" and that's where I landed - but I'd love to see research on this, especially now that there are so many CNM working in hospitals.

Where did you look, and what search criteria did you use?

I just checked and I found a good amount of information on outcomes of hospital-based CNMs and OBs, including a recent study on outcomes with a total N ~1500.

Anonymous wrote:

Anonymous wrote:A caution from a medical professional - never confuse personality/bedside manners with medical skills/knowledge. Some of the loveliest, warmest doctors were terrible practitioners, but their patients loved them. One of the finest doctors I ever had the privilege to work with had terrible bedside manners - and the greatest assessment and interventional skills that saved many patients. Patients/family would complain that he didn’t smile enough, or didn’t tell jokes with them. You’re choosing someone to manage your child’s birth - why take a midwife over a trained/licensed physician? Seems foolish to me - this isn’t a cocktail party where you want to have a fun evening. A midwife in a practice with physicians seems fine as there is backup easily available. I’d go with an OB physician every time - I want the best trained, most educated professional who can step up in an emergency.

Yes +1. I had a midwife assisted birth for my first delivery (was planning an unmedicated vaginal birth) and it was a goddamn train wreck. I had unanticipated complications and needed physician collaboration and it was not handled well - there was role confusion, it was unclear who was in charge, they had different ideas about what to do, etc. The midwives I was with thought pushing for hours was totally fine and didn’t feel the need to warn me of the risks of prolonged second stage or pelvic floor injury so my mismanaged birth resulted with me having permanently injured my pelvic floor so badly I would need C-sections for all future births. I remember looking at my newborn’s bruises face from being stuck in the birth canal so long and regretting with every core of my being that I had prioritized my experience and emotional support needs over choosing the most skilled medical provider. It’s something I still regret to this day.

You again

Lady, get some therapy and stop blaming midwives for your birth experience.

Anonymous wrote:NP here. I find wait times to be a proxy in healthcare for the GAF level of the practice. I have One Medical for primary care and there isn’t a wait time— that’s the point of them, is what you pay for, and reflects their priority of patient experience (which, again, you pay for)

I saw three doctors in the course of my pregnancy— two had absolutely no wait times and the one time there was a delay if 15 minutes, the nurse came to the waiting room to apologize, offer a beverage or snack or reschedule if I was in a rush. If a practice is willing to constantly run late (and I mean constantly, not once over the course of a pregnancy), I am forced to conclude that either 1. It’s badly run or 2. They are prioritizing their profits over their patient experience. The latter is particularly concerning in OB care, because insurance reimburses more for a C-Section than vaginal delivery— if a practice won’t forgo two or three appointment slots per day in order to run on time (and look at your statement of benefits— not a ton of money in annual Pap smear) why would I trust them to forgo several thousand dollars to prioritize a vaginal delivery?

Nothing enrages me more than this propaganda PP is spouting. There's no point in arguing with you, was just too furious to not comment.

Anonymous wrote:"My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing."

I'm not going to copy and paste the whole thing, but why do you think the above is true? To people who don't have hours to wait for their healthcare providers, yes, long waits become bad care. If the office environment is such that it ignores patient privacy, or doesn't facilitate communication between front office staff and providers, yes, it becomes bad care.

The quality of healthcare is, to me, comprehensive (and most organizations who research that construct agree). Some aspects of care may be more salient than others, but it all goes into determining quality. Also, if you look at the first page of this thread, most of the women described some version of wanting personalized attention/being listened. One woman on the second page talked about wait times, clearly mentioning that she had experience working as a medical assistant in an OB practice, i.e., it was an informed decision. Why are you focusing on wait times as the reason to argue that the women on this thread can't tell what defines quality care when what PPs are actually mentioning is providers paying attention to them?

Because things long waits can be indicia that a doctor is spending more time with each patient and therefore falls behind as the the day progresses? Not convenient for the patient waiting to be sure, but it is something you would want if you were the patient being seen, yes? Do you ever notice that you rarely wait when you are the first or near the first patient of the day? This is because the extra 5 minutes the provider spends with each patient throughout the day has a cascading effect throughout the rest of the day’s schedule. Before you argue that the provider should just schedule more time between appointments, insurance doesn’t allow for that to be economically feasible. This is why more physicians, including OB/GYNs, are turning to the concierge model and/or no longer take insurance. You can have the beautiful office and no wait time, but there is a cost to that and that cost sometimes ends up being that fewer people have access to care.

I’m also the poster that said earlier in the thread that my good friend used midwives and I used an MFM and that each of our choices are equally valid based on our circumstances. She got the long appointments, the warm and welcoming provider, and the comfortable office visits. I got the interminable waits, the dumpy office, and gruff doctor. But I’m more than happy with that because I needed the best medical care available and those factors were not relevant to the competency of the care I received. My poorly mannered doctor was capable of listening and did listen everything I said but didn’t do anything if it was against his medical judgment, even if I wanted it and argued for it. I’m not denying that listening is important. I’m saying that warm and fuzzy does not necessarily mean good medical care and unpleasant does not mean bad medical care.

I’m not going to belabor this any longer because I’m sure that others on this thread are sick of us and, frankly, our conversation is not productive.

What I will say to OP, as an older mom who has been through this a few times before, is this: choose the care that is appropriate for you balancing what you want and your medical needs. Comfort is important, but it is not paramount. What is paramount is finding a provider you trust and who is appropriate for your medical needs. Most pregnancies are low risk and don’t need the level of intervention that is standard for a traditional OB practice. If you do need more care, it’s ok to acknowledge that and it’s ok to go with the @hole OB if she has the skills you need to keep yourself and your baby safe. Getting an epidural or c-section is not a failure and if you need them, don’t let anyone make you feel badly or “less than” about it. My best wishes to you for an easy pregnancy and a healthy baby.

Anonymous wrote:"My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing."

I'm not going to copy and paste the whole thing, but why do you think the above is true? To people who don't have hours to wait for their healthcare providers, yes, long waits become bad care. If the office environment is such that it ignores patient privacy, or doesn't facilitate communication between front office staff and providers, yes, it becomes bad care.

The quality of healthcare is, to me, comprehensive (and most organizations who research that construct agree). Some aspects of care may be more salient than others, but it all goes into determining quality. Also, if you look at the first page of this thread, most of the women described some version of wanting personalized attention/being listened. One woman on the second page talked about wait times, clearly mentioning that she had experience working as a medical assistant in an OB practice, i.e., it was an informed decision. Why are you focusing on wait times as the reason to argue that the women on this thread can't tell what defines quality care when what PPs are actually mentioning is providers paying attention to them?

I'm a brand new poster to this thread. I have been reading this back and forth with growing annoyance.

I am a woman that had a very normal, uncomplicated first pregnancy become a VERY abnormal very complicated very dangerous pregnancy at week 33 very suddenly. My primary MFM at Georgetown was Dr Zilbermann. He was an enormous d. After stepping in the room to do my first BPP after being hospitalized he pretty casually informed me I was at a high risk of stillbirth. He also managed my care so that I made it to almost 37 weeks and delivered a baby that was breathing on her own. He predicted her stay in the NICU to the day. Dr. Drassinower was MUCH nicer to me and I liked her a lot and I have nothing but good things to say about her, but I trusted Dr. Z more by the end.

I waited for no less than 45 minutes for every appointment I had at Georgetown. They had crappy food and a crappy parking facility and crappy admins. And they saved my life and the life of my baby. And I was so grateful for that that when pregnant with my second I happily waited for those appointments again, and more frequently because I was high risk.

At the end of the day if sh*t really hits the fan, the rest doesn't matter. You really do want that weird antisocial guy that seems to know exactly what's going on with you.

To be fair I also think that overall patient care is important and the two should not be mutually exclusive. In my third pregnancy I got that. I was in a smaller city at a prestigious hospital and never waited more than 10 minutes and had excellent care.

And so if I was choosing I would rank them 1) great environment and great doctors, 2) crappy environment and great doctors, 3) great environment with blah doctors, 4) crappy environment with blah doctors, 5) great environment with people who aren't doctors.

I know I personally am biased here because my pregnancy was basically like, worst case scenario, but I agree with the PP that people really do put an oversized amount of importance on things that do not really matter in the end. And for the record, I don't think that means black women should accept not being listened to or that there aren't problems with OB GYN care in this country. But the midwifery model (outside of those groups associated with hospital practices) is just insane to me. Midwives in the united states are not trained and monitored in the formal way they are in other countries and until that happens I just do not understand anyone that doesn't have an OB as backup. My pregnancy was so dangerous that there was a real possibility that both myself AND my daughter would have died. I'm so happy my jerky doctor saved our lives, even if I do wish he had been a little more gentle.

NP here. I find wait times to be a proxy in healthcare for the GAF level of the practice. I have One Medical for primary care and there isn’t a wait time— that’s the point of them, is what you pay for, and reflects their priority of patient experience (which, again, you pay for)

I saw three doctors in the course of my pregnancy— two had absolutely no wait times and the one time there was a delay if 15 minutes, the nurse came to the waiting room to apologize, offer a beverage or snack or reschedule if I was in a rush. If a practice is willing to constantly run late (and I mean constantly, not once over the course of a pregnancy), I am forced to conclude that either 1. It’s badly run or 2. They are prioritizing their profits over their patient experience. The latter is particularly concerning in OB care, because insurance reimburses more for a C-Section than vaginal delivery— if a practice won’t forgo two or three appointment slots per day in order to run on time (and look at your statement of benefits— not a ton of money in annual Pap smear) why would I trust them to forgo several thousand dollars to prioritize a vaginal delivery?

"My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing."

I'm not going to copy and paste the whole thing, but why do you think the above is true? To people who don't have hours to wait for their healthcare providers, yes, long waits become bad care. If the office environment is such that it ignores patient privacy, or doesn't facilitate communication between front office staff and providers, yes, it becomes bad care.

The quality of healthcare is, to me, comprehensive (and most organizations who research that construct agree). Some aspects of care may be more salient than others, but it all goes into determining quality. Also, if you look at the first page of this thread, most of the women described some version of wanting personalized attention/being listened. One woman on the second page talked about wait times, clearly mentioning that she had experience working as a medical assistant in an OB practice, i.e., it was an informed decision. Why are you focusing on wait times as the reason to argue that the women on this thread can't tell what defines quality care when what PPs are actually mentioning is providers paying attention to them?

My first baby was born with midwives at a birth center. She is 10 now. I chose midwives and an out of hospital birth because I was 27 years old and low risk. I actually started the pregnancy with an OB practice (the same one I'd been getting gyn care for years) and transferred mid-pregnancy because I wanted a different kind of prenatal care - care that includes all the standard medical care but was more personalized. With the midwifery practice I chose, my appointments were 45 minutes, with my midwife every time from start to finish, and I had plenty of time to feel comfortable with her. My baby was post-date and my midwife was supportive of waiting from 40-42 weeks until labor started on its own (whereas my OB practice told me that if I hadn't gone into labor on my own by 40w1d, I'd be admitted for induction). I was comfortable with the backup physician care and the hospital (midwife had privileges at the hospital and would stay with me if transfer was necessary), which was 5 minutes from the birth center. When labor did start naturally, it was a long labor (51 hours from first contraction to baby's arrival), and my midwife was able to suggest things (tub, massage, position changes, etc.) that helped move things along. She was also there with me, in the room, the entire time I was in the birth center (probably only about 40 hours total since the first bit was at home, where she consulted over the phone about when to come in). I have a family history of postpartum hemorrhage, so midwife was on the lookout for any signs of that. The followup care included calls from midwife every day for a week after the baby was born and a home visit at 3 days postpartum with lactation support (I needed some help with latch). Office visits to examine physical recovery at 2 and 6 weeks postpartum.

My second baby was born with the OB practice I left the first time. She is now almost 4. I chose to stick with the OB practice and Sibley because the birth center was too far from where we lived at that time. My experience with that pregnancy and birth were completely different from my first for a lot of reasons, mostly because it was a higher risk pregnancy and more medical management was indicated. Also, as a second time mom with a previous unmedicated vaginal delivery, I felt a lot more confident about how I would experience labor generally - it was no longer a huge unknown for me. I felt more confident in my own ability to advocate for myself than when my first child was born. I was induced for medical reasons and I was largely alone in the hospital room during the induction (my husband was at home with our older child until midday). Nurses would check in or come when I called them, but I think I saw the doctor once in the morning when the induction started, once midday to see how things were going, and then when I was ready to push. I was comfortable, at that time, with that limited contact from my actual doctor, but with my first baby, I wouldn't have been. Postpartum, I was in the hospital for a day and a half. After my OB stitched up the small tear that occurred during delivery, I saw him one more time before leaving the hospital. At that time, he did not visually examine my stitches and actually didn't ask me any medical questions at all. I think he made some jokes about the weather, told me the baby was cute, and then said he'd see me in 6 weeks for follow up/IUD. No one called me the day after I went home to see how I was settling in. It was like I ceased to exist once my baby was born.

I think that midwifery care should be the norm for low risk pregnancies and that everyone should start there and be referred up to a higher level of care (OB, MFM) if necessary. It would be helpful to normalize this birth choice so that women do not think it is an extreme thing to choose to work with a midwife during pregnancy. Postpartum care in the US is terrible. If women received even half the number of appointments that newborn babies have, I think many of the issues women have postpartum would be caught. I also think that pelvic floor therapy should be mandatory postpartum care for all women, but that's kind of another topic.

Anonymous wrote:I used midwives for both my births. I am low risk and both worked out of hospitals so there was a huge medical safety net. My reasons...

1) They listened to me
2) Appointments were on time and I got a full 30 minute appointment when it was my turn
3) They were evidence based. This is going to ruffle feathers but if you actually read some of the literature there are some things pushed by OBs that are not evidence based for low risk pregnancies.
4) They were supportive of not getting an epidural (like truly supportive) and of long labors. Extra great was they were supportive of you getting an epidural.
5) They did all the same testing in pregnancy that OBs do.
6) I got to drink orange juice instead of that awful s**t during the glucose test
7) They made me feel calm and confident about the birth but also did not ignore issues

It’s not accurate to replace the Glucola with orange juice for the GD screening. Your midwives should not be doing this, it does not yield accurate results. Fructose does not stimulate the body’s insulin response the way glucose does. So you could have had GD and just not known it. That’s why a standard test is administered. Altering the test does not yield accurate results. Signed, a mom who had GD

I used midwives for both my births. I am low risk and both worked out of hospitals so there was a huge medical safety net. My reasons...

1) They listened to me
2) Appointments were on time and I got a full 30 minute appointment when it was my turn
3) They were evidence based. This is going to ruffle feathers but if you actually read some of the literature there are some things pushed by OBs that are not evidence based for low risk pregnancies.
4) They were supportive of not getting an epidural (like truly supportive) and of long labors. Extra great was they were supportive of you getting an epidural.
5) They did all the same testing in pregnancy that OBs do.
6) I got to drink orange juice instead of that awful s**t during the glucose test
7) They made me feel calm and confident about the birth but also did not ignore issues

Anonymous wrote:

Anonymous wrote:

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Anonymous wrote:

Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

16:13 again. By the way, I’ll be sure to tell my Head of Department OB, who has some of the worst beside manner that I’ve ever seen, what terrible care he provided me when he saved my life. After all, I can’t honestly think that a condescending physician can possibly provide good medical care. I’ll be sure to pick the nice one next time over the better qualified one since some lady on the internet told me so.

Do what you want, but don’t presume to speak for me or anyone else. Where did I say I was talking about wait times? You picked something I didn’t even mention to make your point. Inasmuch as rudeness relates to things like not *listening* to patients, yeah, it does affect the quality of their care. How many times did Serena Williams have to insist that she had a PE postpartum before she got a provider to listen to her? But, right, that doesn’t matter.

My point was that things like patient-provider interactions DO matter for the quality of care. Systemic racism is one of the most extreme examples of how interactions matter. I didn’t say those interactions are the only part of it, but you also can’t discount them. Stop trivializing women’s experiences just because they don’t comport with your own.

Nice deflection. You sought to shame me for my opinions (those are your literal words “shame on you”) and you brought up racism when there was literally no one on this thread discussing racism. When your attempt to shame is addressed and you are told that I don’t need to be saved by you, you insist that I’m presuming to speak for you. I have no interest in speaking for you or for anyone other than those who have experienced what I have. Our voice matters and no amount of shaming from you will change that.

You keep arguing that we can separate how patients are treated from the quality of their care, but the studies on this topic suggest otherwise. I was calling out you presenting your opinion as fact, when, really, it’s your opinion. Yeah, I do think telling women that how they are treated by their providers doesn’t matter for their health outcomes is shameful. You assumed that I was presuming to speak for you; no, I was pointing out the complex relationship between patient-provider relationships and healthcare quality. The voices that aren’t being heard—in part because their providers aren’t *listening to them*—matter, too.

This article is somewhat lengthy, but I think lays the framework well for why patient-centered healthcare (the kind many women describe experiencing more often with midwives than physicians) matters for quality of care: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0888

You need to go back and read my post more carefully because you keep shifting your argument to fit your narrative. You make a lot of assumptions in every post to support your attacks on me. I never said listening is not important to patient care. You seem to believe that being talked down to = doctor failing to listen and that is not my point. It is also not my point that how a woman is treated never has any impact to outcomes. My argument is that inconveniences like long waits and office environment are not the markers of bad patient care, which, up until you responded was what we were discussing.

Your opinion - and yes, it is an opinion - that a condescending doctor cannot deliver good patient care is just an opinion, just as you assert my thoughts are opinions. But medical professionals need to exercise their judgment as well. A doctor, who is perceived as condescending because she does not agree with a woman’s specific demand on their medical care (refusing a medical necessary c-section is one) is not a bad doctor and is not a bad doctor who isn’t listening to her patient. Are there bad doctors out there? Of course, but bedside manner (i.e. the ability to convey information in a tone you perceive as desirable) is not the sole indicator of one.

You are free to make your own choices. I respect your choices but you seem incapable of respecting mine. Telling me that I should be ashamed and then bringing race into it? I don’t need your respect but I will not be called “shameful” for voicing a thought that you disagree with.

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Anonymous wrote:I was low-risk, aside from being in my mid-30s, and wanted to minimize unnecessary interventions. I went with a hospital-based midwife practice that was integrated within a larger OB-GYN practice. I ended up having some level of intervention with all three L&Ds (epidurals for two, NICU ped present at delivery for the third), and it was handled seamlessly. I went to an MFM practice for scans; when I developed complications late in my third pregnancy, the midwives transferred me to the OBs as needed.

I was fortunate that I had skilled medical professionals (CNMs) attending my births; included in their medical training is knowing when they needed to transfer care and/or involve a different provider. That also meant they were with me for most of my labors and all of the deliveries, which isn't typically the case when an OB is attending.

21:17 - can you stop patronizing women, please? Your "caution" is pretty thinly disguised.

+1

I went with a practice much like described above and ended up with a c-section by the OBs. The c-section wasn't because I chose a nice smile over a real medical professional because I'm a dumb laydee. It's because that's the way my birth went, and the trained medical professionals with decent human skills that I chose also had the medical knowledge and skill to handle my care correctly.

DP - there are stupid people everywhere of both sexes. 21:17 is speaking to women because it is women who are choosing who provides their care, not because they think women are dumb.

DP, but come on. That post was dripping with condescension. Do women really need to be reminded about not confusing personality with clinical acumen? Really?

Well, let’s see - just on this thread alone, the reasons given for choosing midwives include the doctor made me wait too long, he talked down to me, it felt like an assembly line, wanted someone loving. All legitimate reasons for choosing someone, and I completely respect that, but not a whole lot to do with clinical acumen. Pregnancy is a vulnerable time. We all want to be protected and nurtured but sometimes the person who can best protect our health and well being isn’t the person who can provide the nurturing. There’s nothing wrong with a reminder that there are times when these roles should be separated.

Another PP alluded to this, but the bolded is bullpuckey. We KNOW that health outcomes are impacted by interactions, and particularly for women of color (see that damning series by ProPublica on maternal mortality outcomes for more). Providers who *listen* to their patients and *trust* them ARE providing better care! You honestly think a condescending physician is providing good care? Shame on you.

Where do *you* get off comparing the health effects of systematic racism to the minor inconvenience of waiting too long for an appointment? Because that is what we are talking about here. The studies correlating maternal experience to outcomes are not talking about waiting room waits or rude doctors. No one here has said or even suggested that they picked a midwife because they felt that their race was affecting the medical care they received with an OB. If you can’t see the difference between built in systematic racism in healthcare and a doctor with poor bedside manner, I don’t know what to tell you.

Signed, a Woman of Color tired of others presuming to know what’s best for me

16:13 again. By the way, I’ll be sure to tell my Head of Department OB, who has some of the worst beside manner that I’ve ever seen, what terrible care he provided me when he saved my life. After all, I can’t honestly think that a condescending physician can possibly provide good medical care. I’ll be sure to pick the nice one next time over the better qualified one since some lady on the internet told me so.

Do what you want, but don’t presume to speak for me or anyone else. Where did I say I was talking about wait times? You picked something I didn’t even mention to make your point. Inasmuch as rudeness relates to things like not *listening* to patients, yeah, it does affect the quality of their care. How many times did Serena Williams have to insist that she had a PE postpartum before she got a provider to listen to her? But, right, that doesn’t matter.

My point was that things like patient-provider interactions DO matter for the quality of care. Systemic racism is one of the most extreme examples of how interactions matter. I didn’t say those interactions are the only part of it, but you also can’t discount them. Stop trivializing women’s experiences just because they don’t comport with your own.

Nice deflection. You sought to shame me for my opinions (those are your literal words “shame on you”) and you brought up racism when there was literally no one on this thread discussing racism. When your attempt to shame is addressed and you are told that I don’t need to be saved by you, you insist that I’m presuming to speak for you. I have no interest in speaking for you or for anyone other than those who have experienced what I have. Our voice matters and no amount of shaming from you will change that.

You keep arguing that we can separate how patients are treated from the quality of their care, but the studies on this topic suggest otherwise. I was calling out you presenting your opinion as fact, when, really, it’s your opinion. Yeah, I do think telling women that how they are treated by their providers doesn’t matter for their health outcomes is shameful. You assumed that I was presuming to speak for you; no, I was pointing out the complex relationship between patient-provider relationships and healthcare quality. The voices that aren’t being heard—in part because their providers aren’t *listening to them*—matter, too.

This article is somewhat lengthy, but I think lays the framework well for why patient-centered healthcare (the kind many women describe experiencing more often with midwives than physicians) matters for quality of care: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0888