Those professions are incomparable, that is why I am asking you to not put them close. The only similarity is the place( vagina) where they work. No one is questioning the importance of MW, but you can compare qualifications of someone receiving 2 years specific training and bachelors in whatever and an OB with their 12 years of medicine and health related subjects, requiring very competitive grades, not even counting the high school. Did you know, that you cant become a doctor with community college education? In order to even complete premedical studies, future OBs have to study a lot and very well in high school too, which MW don't even have to do at all. So, please don't compare them MWs are more personable and can say all cutesy stuff, but I also would prefer someone who can actually distinguish between a heart attack and an anxiety
But you are questioning the importance of midwives by attacking their profession. Certified Nurse Midwives have to complete 4 years of nursing school, pass RN licensing, gain experience by working in labor and delivery, and then get a master's degree in midwifery (which requires an excellent academic record to get into), and then pass boards to become a Certified Nurse Midwife. Being a midwife is much more than being "personable" and saying "cutesy stuff." A midwife is not the right care provider for every pregnancy, but there is no reason that a midwife is not just as qualified to attend a normal, healthy birth as an OB.
Please don't put OB's and midwife's training and education level close to each other. There at least 6 years difference and OB's is much much harder
OBs are able to handle high risk situations and perform surgery, so they require more training. This does not make a CNM any less qualified to assist a mother with an uncomplicated pregnancy in giving birth. Any CNM worth her salt can also assess when additional medical intervention is needed, and will transfer their patient to a hospital in that case. OBs have their place in birth, and so do midwives.
This is not snark, I'm honestly curious. So, I've never even met a midwife, CNM or anyone like that so I know really nothing about them. This is my second pregnancy and I've been with my OBGYN for over 10 years so I never even considered other options. If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
I live in the UK, if you are having an uncomplicated pregnancy our entire care is from widwives. I personally do not feel at all that this is to my disadvantage, in fact having a midwife who has attended 1000's of birth's both natural (including home births) and medically assisted gives me great faith that they know what their talking about!
I am now 35 weeks and have not seen a ob once. If I had developed any pregnancy complications only then would I need to.
What would be interesting is to see if this difference in womens care between the uk and US has any influence on statistics e.g. what percentage of women have cs when compared? X
Please don't put OB's and midwife's training and education level close to each other. There at least 6 years difference and OB's is much much harder
OBs are able to handle high risk situations and perform surgery, so they require more training. This does not make a CNM any less qualified to assist a mother with an uncomplicated pregnancy in giving birth. Any CNM worth her salt can also assess when additional medical intervention is needed, and will transfer their patient to a hospital in that case. OBs have their place in birth, and so do midwives.
This is not snark, I'm honestly curious. So, I've never even met a midwife, CNM or anyone like that so I know really nothing about them. This is my second pregnancy and I've been with my OBGYN for over 10 years so I never even considered other options. If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
Many CNMs work closely with OBs and transfer care in case of emergency or high risk pregnancy. But studies have shown that when patients are randomly assigned to either OBS or midwives, the rates of intervention across the spectrum (episiotomy, epidural, c-section etc) are lower for the women who labor under the care of midwives. So, I think if you're interested in having an intervention-free labor and delivery then it might make more sense to go with a CNM.
I live in the UK, if you are having an uncomplicated pregnancy our entire care is from widwives. I personally do not feel at all that this is to my disadvantage, in fact having a midwife who has attended 1000's of birth's both natural (including home births) and medically assisted gives me great faith that they know what their talking about!
I am now 35 weeks and have not seen a ob once. If I had developed any pregnancy complications only then would I need to.
What would be interesting is to see if this difference in womens care between the uk and US has any influence on statistics e.g. what percentage of women have cs when compared? X
The US has one of the highest CS rates of any developed country, over 30%. The U.K. rate is 22%. The WHO recommendation is 15%. Women who receive OB care are more likely to be induced into labor or have their labor augmented to speed it along, which increases risk of CS. Women who receive midwife care are less likely to undergo medically unnecessary induction. Midwives are generally more supportive of unmedicated birth, or birth with fewer medical interventions in the case of a normal, uncomplicated pregnancy. My birth center refers about 30% of its patients to hospital for birth, either before labor begins (due to pregnancy becoming high risk, breech, induction at 42 weeks, etc) or transfer during labor due to maternal exhaustion, fetal or maternal distress, etc. Their CS rate is below the national average for women who go into labor naturally.
I live in the UK, if you are having an uncomplicated pregnancy our entire care is from widwives. I personally do not feel at all that this is to my disadvantage, in fact having a midwife who has attended 1000's of birth's both natural (including home births) and medically assisted gives me great faith that they know what their talking about!
I am now 35 weeks and have not seen a ob once. If I had developed any pregnancy complications only then would I need to.
What would be interesting is to see if this difference in womens care between the uk and US has any influence on statistics e.g. what percentage of women have cs when compared? X
That's has been noted within the documentary, as well as with several independent studies. It is a lot higher percentage of C/S here with our mostly OB care system.
The part that kills me and that no one pays attention to is we have a much higher rate of maternal AND infant mortality rates than elsewhere in the first world who rely on midwifery care exclusively. But you know, OB's are clearly ALWAYS a better choice because we're told that all the time.
Please don't put OB's and midwife's training and education level close to each other. There at least 6 years difference and OB's is much much harder
OBs are able to handle high risk situations and perform surgery, so they require more training. This does not make a CNM any less qualified to assist a mother with an uncomplicated pregnancy in giving birth. Any CNM worth her salt can also assess when additional medical intervention is needed, and will transfer their patient to a hospital in that case. OBs have their place in birth, and so do midwives.
This is not snark, I'm honestly curious. So, I've never even met a midwife, CNM or anyone like that so I know really nothing about them. This is my second pregnancy and I've been with my OBGYN for over 10 years so I never even considered other options. If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
Many CNMs work closely with OBs and transfer care in case of emergency or high risk pregnancy. But studies have shown that when patients are randomly assigned to either OBS or midwives, the rates of intervention across the spectrum (episiotomy, epidural, c-section etc) are lower for the women who labor under the care of midwives. So, I think if you're interested in having an intervention-free labor and delivery then it might make more sense to go with a CNM.
Are CNMs allowed to perform episiotomy, epidural or c section ( I'm not questioning their ability, but licensing requirements)? If not, wouldn't that explain why women who labor under the care of a CNM don't/ can't have these medical interventions rather than those who labor under the care of an ob?
Even if someone is interested in an intervention free labor and delivery, wouldn't it always be better to be laboring under the care of an OB who can perform medical interventions in case the mother changes her mind during labor/ or circumstances change that require immediate intervention? Unless you mean that OBs 'push' for more intervention than CNMs. If that's the case, I can see what you are saying but if not, I still don't get why laboring with a CNM instead of an OB is better for some bc it seems like CNM's ability is still just a subsection of OB's ability, and CNMs aren't providing any benefits that OBs cannot provide.
The practice I use has dual care. OB and CNM. Both are present when you labor and deliver. Both can deliver babies, unless you require a C-section. Then the OB is doing the surgery and CNM is assisting. I love the dual practice. I am of the belief that this experience can be cooperative and peaceful. The joint team has always been supportive, informative and respectful of my wishes. The issue I have with this documentary is it pits providers against each other and demonizes the medical field. Its always a great idea to be informed on your care, but flexible.
Please don't put OB's and midwife's training and education level close to each other. There at least 6 years difference and OB's is much much harder
OBs are able to handle high risk situations and perform surgery, so they require more training. This does not make a CNM any less qualified to assist a mother with an uncomplicated pregnancy in giving birth. Any CNM worth her salt can also assess when additional medical intervention is needed, and will transfer their patient to a hospital in that case. OBs have their place in birth, and so do midwives.
This is not snark, I'm honestly curious. So, I've never even met a midwife, CNM or anyone like that so I know really nothing about them. This is my second pregnancy and I've been with my OBGYN for over 10 years so I never even considered other options. If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
Many CNMs work closely with OBs and transfer care in case of emergency or high risk pregnancy. But studies have shown that when patients are randomly assigned to either OBS or midwives, the rates of intervention across the spectrum (episiotomy, epidural, c-section etc) are lower for the women who labor under the care of midwives. So, I think if you're interested in having an intervention-free labor and delivery then it might make more sense to go with a CNM.
Are CNMs allowed to perform episiotomy, epidural or c section ( I'm not questioning their ability, but licensing requirements)? If not, wouldn't that explain why women who labor under the care of a CNM don't/ can't have these medical interventions rather than those who labor under the care of an ob?
Even if someone is interested in an intervention free labor and delivery, wouldn't it always be better to be laboring under the care of an OB who can perform medical interventions in case the mother changes her mind during labor/ or circumstances change that require immediate intervention? Unless you mean that OBs 'push' for more intervention than CNMs. If that's the case, I can see what you are saying but if not, I still don't get why laboring with a CNM instead of an OB is better for some bc it seems like CNM's ability is still just a subsection of OB's ability, and CNMs aren't providing any benefits that OBs cannot provide.
CNMs do not perform Surgery, and an anesthesiologist performs an epidural if it is a hospital birth. Midwives can perform episiotomies, but practice generally is to avoid episiotomy unless absolutely necessary (i.e., to get a baby out fast due to fetal distress, not to prevent tearing, of which the evidence suggests the opposite effect). Midwives can perform fetal resuscitation, repair most tears (4th degree are generally transferred to hospital), and can administer pitocin to stop maternal hemorrhage. Some midwife births are in hospitals that provide epidurals and medical interventions, some are at freestanding birth centers or home births. If a patient needs a c section or certain other interventions, they are transferred to the care of an OB. Midwives can attend births where the mother recieves an epidural at a hospital.
The statistics are comparing countries with mostly OB care to countries with significantly more midwife care. C section rates and maternal death rates are significantly better in developed countries with more midwife care than in the US.
OBs tend to jump to medical intervention in the case of a slowly progressing labor, and may recommend induction before 42 weeks in a normal pregnancy when it may be a better outcome to wait and give the mother an opportunity to go into labor naturally. Mothers who go into labor naturally have a lower CS rate than those who are induced from the start.
I have nothing against OBs, but the fact is that a normal, healthy pregnancy does not generally require the kind of medical intervention that is often given in a hospital by an OB, and if it does, then a midwife can transfer her patient to an OB. I myself prefer to be under midwife care with a hospital nearby available for emergent situations. I cannot speak to the safety of home birth, but at a birth center with nurses and nurse-midwives, my care during birth was not lacking in any way. They were vigilant in monitoring baby's heart rate and my vitals every 15 minutes and while I pushed, and if there had been red flags, they would not have hesitated to transfer me to hospital care.
Please don't put OB's and midwife's training and education level close to each other. There at least 6 years difference and OB's is much much harder
OBs are able to handle high risk situations and perform surgery, so they require more training. This does not make a CNM any less qualified to assist a mother with an uncomplicated pregnancy in giving birth. Any CNM worth her salt can also assess when additional medical intervention is needed, and will transfer their patient to a hospital in that case. OBs have their place in birth, and so do midwives.
This is not snark, I'm honestly curious. So, I've never even met a midwife, CNM or anyone like that so I know really nothing about them. This is my second pregnancy and I've been with my OBGYN for over 10 years so I never even considered other options. If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
Many CNMs work closely with OBs and transfer care in case of emergency or high risk pregnancy. But studies have shown that when patients are randomly assigned to either OBS or midwives, the rates of intervention across the spectrum (episiotomy, epidural, c-section etc) are lower for the women who labor under the care of midwives. So, I think if you're interested in having an intervention-free labor and delivery then it might make more sense to go with a CNM.
Are CNMs allowed to perform episiotomy, epidural or c section ( I'm not questioning their ability, but licensing requirements)? If not, wouldn't that explain why women who labor under the care of a CNM don't/ can't have these medical interventions rather than those who labor under the care of an ob?
Even if someone is interested in an intervention free labor and delivery, wouldn't it always be better to be laboring under the care of an OB who can perform medical interventions in case the mother changes her mind during labor/ or circumstances change that require immediate intervention? Unless you mean that OBs 'push' for more intervention than CNMs. If that's the case, I can see what you are saying but if not, I still don't get why laboring with a CNM instead of an OB is better for some bc it seems like CNM's ability is still just a subsection of OB's ability, and CNMs aren't providing any benefits that OBs cannot provide.
This. OBs are trained for high risk pregnancies, and when you're a hammer everything starts to look like a nail. I know some OBs are very supportive of natural birth, so I'm not trying to paint them all with the same brush of vilify anyone. But I think that midwives are trained to see birth more as a natural, normal experience not necessarily a medical event. In my experience, midwives are more experienced with natural methods of pain relief and natural ways to get labor moving if it seems to have stalled. The midwives I work with are hospital-based, so all medical interventions are available if needed, but they're much less likely to be used unless absolutely necessary.
I think part of the issue with this video is that it's almost ten years old. At my hospital a lot of the issues that are being brought up in the movie are being addressed by my hospital. Their c section rate is lower than national average and on a downward trend. They practice baby friendly procedures like delayed cord clamping and imediate skin to skin as the norm. I think the good things about this movie is getting women to research all of their options. Educated women have pushed for changes in the system and have gotten to them. That said this video certainly has a definite point of view about medical interventions that I don't agree with.
Just adding my personal experience on the OB vs midwife debate. I am also in the UK where midwife led care is the norm. I had an uncomplicated pregnancy and was classes as low risk, when I went into labour I was under the care of a midwife. My labour didn't exactly go as planned (Baby was unexpectedly discovered to be breech when I was already 7cm and was beginning to show distress). At the point it became obvious that I was going to need an emergency c-section it was less than 5 mins from my midwife calling the doctor to me being prepped for surgery, and less than 20 mins before I had my daughter in my arms on the operating theatre. The point I'm trying to make is here it's not a case of midwife OR doctor, it's midwives and doctors working together as midwives are trained to know when to call in the cavalry and in most hospitals the birthing centres and delivery wards are only a stone's throw apart in case something does go wrong. Just added to the point someone else made earlier, even though I ended up with an emergency section I still had skin to skin immediately after birth (whilst lying in the operating theatre bring stitched up) as did my SO (in the recovery room) and apart from the few mins it takes to do all the usual immediate post birth baby checks my daughter was in my or my SO's arms the whole time, in the operating theatre, recovery room and then as we were transferred to the ward.
Just adding my personal experience on the OB vs midwife debate. I am also in the UK where midwife led care is the norm. I had an uncomplicated pregnancy and was classes as low risk, when I went into labour I was under the care of a midwife. My labour didn't exactly go as planned (Baby was unexpectedly discovered to be breech when I was already 7cm and was beginning to show distress). At the point it became obvious that I was going to need an emergency c-section it was less than 5 mins from my midwife calling the doctor to me being prepped for surgery, and less than 20 mins before I had my daughter in my arms on the operating theatre. The point I'm trying to make is here it's not a case of midwife OR doctor, it's midwives and doctors working together as midwives are trained to know when to call in the cavalry and in most hospitals the birthing centres and delivery wards are only a stone's throw apart in case something does go wrong. Just added to the point someone else made earlier, even though I ended up with an emergency section I still had skin to skin immediately after birth (whilst lying in the operating theatre bring stitched up) as did my SO (in the recovery room) and apart from the few mins it takes to do all the usual immediate post birth baby checks my daughter was in my or my SO's arms the whole time, in the operating theatre, recovery room and then as we were transferred to the ward.
I think this is an ideal situation, and I wish more hospitals had birthing centers in or next to them and midwives practicing. My birth center was literally across the street from a hospital (not part of it, but they had an agreement to take transfers), and it was comforting to have that back-up in case I needed medical intervention.
I come from a country with an emphasis on midwifery care and I can say that it's not a case of "nurse OR doctor". Often, they take different roles and have different training. A midwife often is your primary contact and so you have a strong relationship with them, they are able to triage issues and make recommendations to the OBs. The OBs monitor, order and review tests (such as US, blood tests etc) and decide on how much intervention is necessary at any given time, supported by the midwife. I'm a twin pregnancy (high risk), so I see an OB more than a lower risk pregnancy. This is a scientifically supported model of care that results in better outcomes for babies and mothers. The post partem care is usually handled the same way and can be done at home or a hospital/clinic setting.
It's also about the differences between a country with universal health care. In a country where everyone has access to public care run by government organisations or hospitals, there's slightly different issues that present themselves. There are so many patients who's care is not in any way limited by insurance (unless you elect to buy insurance and go through as a private patient in a public hospital like me or through a private hospital). As such, the time of public, specialised OBs is at a premium (they are more expensive obviously) and so there are more midwives. The midwife usually liaises with the publicly provided social workers, dietitians, physios, psychs and other care providers. OBs generally focus on the medical. Our midwives have a graduate degree on top of a 3-4 year nursing degree and have to deliver 40+ babies and follow a number of pregnancies from start to finish before they're qualified. My student midwife has already been present for 3 "natural" twin births and one assisted.
Its culturally different, it's medically different and essentially a different model of care
Re: The Business of Being Born - rant
If the bolded part is true, it seems like OB and CNM have the same ability except that OBs have more abilities like being able to deal with high risk, surgery, and unexpected complications during birth. My question is, if that is true, and even though the probability of having complications during birth is low, because no one can actually predict how the birthing process will go, what is the actual benefit of going with a CNM rather than an OB?
I am now 35 weeks and have not seen a ob once. If I had developed any pregnancy complications only then would I need to.
What would be interesting is to see if this difference in womens care between the uk and US has any influence on statistics e.g. what percentage of women have cs when compared? X
The part that kills me and that no one pays attention to is we have a much higher rate of maternal AND infant mortality rates than elsewhere in the first world who rely on midwifery care exclusively. But you know, OB's are clearly ALWAYS a better choice because we're told that all the time.
Even if someone is interested in an intervention free labor and delivery, wouldn't it always be better to be laboring under the care of an OB who can perform medical interventions in case the mother changes her mind during labor/ or circumstances change that require immediate intervention? Unless you mean that OBs 'push' for more intervention than CNMs. If that's the case, I can see what you are saying but if not, I still don't get why laboring with a CNM instead of an OB is better for some bc it seems like CNM's ability is still just a subsection of OB's ability, and CNMs aren't providing any benefits that OBs cannot provide.
LFAF Summer 2016 Awards:
The statistics are comparing countries with mostly OB care to countries with significantly more midwife care. C section rates and maternal death rates are significantly better in developed countries with more midwife care than in the US.
OBs tend to jump to medical intervention in the case of a slowly progressing labor, and may recommend induction before 42 weeks in a normal pregnancy when it may be a better outcome to wait and give the mother an opportunity to go into labor naturally. Mothers who go into labor naturally have a lower CS rate than those who are induced from the start.
I have nothing against OBs, but the fact is that a normal, healthy pregnancy does not generally require the kind of medical intervention that is often given in a hospital by an OB, and if it does, then a midwife can transfer her patient to an OB. I myself prefer to be under midwife care with a hospital nearby available for emergent situations. I cannot speak to the safety of home birth, but at a birth center with nurses and nurse-midwives, my care during birth was not lacking in any way. They were vigilant in monitoring baby's heart rate and my vitals every 15 minutes and while I pushed, and if there had been red flags, they would not have hesitated to transfer me to hospital care.
It's also about the differences between a country with universal health care. In a country where everyone has access to public care run by government organisations or hospitals, there's slightly different issues that present themselves. There are so many patients who's care is not in any way limited by insurance (unless you elect to buy insurance and go through as a private patient in a public hospital like me or through a private hospital). As such, the time of public, specialised OBs is at a premium (they are more expensive obviously) and so there are more midwives. The midwife usually liaises with the publicly provided social workers, dietitians, physios, psychs and other care providers. OBs generally focus on the medical. Our midwives have a graduate degree on top of a 3-4 year nursing degree and have to deliver 40+ babies and follow a number of pregnancies from start to finish before they're qualified. My student midwife has already been present for 3 "natural" twin births and one assisted.
Its culturally different, it's medically different and essentially a different model of care
Expecting Double Trouble, April 2016