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Something I think people should be aware of is how the resurgence of midwifery in the Western world is a response to our increasing negligence in taking care of

Something I think people should be aware of is how the resurgence of midwifery in the Western world is a response to our increasing negligence in taking care of expectant and birthing mothers. In the United States, my sister giving birth today is almost twice as likely to die in childbirth as her mother was thirty years ago. A few months ago Ars Technica covered a study on the reasons why, and it boiled down almost entirely to doctors and nurses neglecting their patients or even straight-up ignoring them. https://arstechnica.com/science/2018/07/why-do-so-many-moms-die-and-suffer-in-the-us-stupid-negligence/ https://arstechnica.com/science/2018/07/why-do-so-many-moms-... I would absolutely urge anyone to hire a midwife to attend a hospital delivery. It's the only way to guarantee at least one professional in that room cares.

b_tterc_p 8y ago
Maybe. I’m not sure I believe that. Recall that a greater proportion of births are now coming from poorer people in worse conditions and often worse health to begin with. If you are middle class+, You’re probably at top tier rates competitive with the rest of the world. Mortality rates are often twice as high for non whites in America likely due to wealth effects. https://www.kff.org/other/state-indicator/infant-mortality-rate-by-race-ethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/other/state-indicator/infant-mortality-r...
OneFamousGrouse 8y ago
This might be true in the US but hardly in the entire "western world". Here in France you can give birth in a hospital without ever having a doctor intervening, only midwives, and it is not a new thing.
- lsaferite 8y ago
  My wife's obstetrician's office is about half ARPN-CNMs (Certified Nurse Midwife). She saw the Dr for a few appointments, but mostly the CNMs. A CNM delivered our son in the hospital. The CNM had the Dr available to her if things went badly. For our daughter, we came to the hospital with my wife 9cm dilated and the CNM was unable to get there fast enough. In the end it was good that the Dr was there instead as she was born not breathing and eventually ended up on life-support. Even in that case the CNM was the primary care provider for the entire pregnancy. We live in the US. I think not enough women use CNMs, but it's not some universal thing that you have to use an obstetrician in the US.
- Fredej 8y ago
  Yeah, same thing in Denmark. When my girlfriend gave birth, we had 3 midwives assisting. When she lost what they deemed to be too much blood, they called in a doctor to take a look. Everything was fine. If she hadn't passed some specified threshold for bloodloss, we would not have seen a doctor (or a nurse, come to think of it) at all throughout the birth. Only midwives.
- dotancohen 8y ago
  Same in Israel. For all three of my children's hospital births, only a midwife was present. In the first two, by my request, she instructed me what to do instead of doing it herself. And being in a hospital there was a doctor on call should any issues have come up.
Pandavonium 8y ago
Is this in the US? Are midwifes an optional thing? I've had experience with births in Australia and the UK where hospital midwifes led the process, from antenatal to birthing and postnatal.
- falsedan 8y ago
  Midwifes are an optional thing in the US; lots of hospitals are OBN/GY-lead & they handle all the ante-natal, post-natal, and delivery stuff. We found one of the few midwife-led hospitals in the Bay Area and had a very similar experience to the NHS Scotland midwife-led birthing centres.
- cylinder 8y ago
  I think he is confusing midwife with doula. You don't hire a midwife to join you at the hospital. I think in the US, they are referred to as nurses more than midwives in hospitals. Here in Aus it's all midwives. Therein lies a bit of the problem as the profession should be seen as different to conventional nurses.
  - TeMPOraL 8y ago
    I don't think he's confusing anything; doulas aren't medical personnel. Not sure how much this is regional, but in Poland, you absolutely can hire a midwife at some maternity hospitals. It's an extra private service, through which you can select a particular midwife from the hospital to be available to you for consultations and be there to lead and care for you during birth.
  - lsaferite 8y ago
    In the US it depends on what your obstetrician's office has in many cases. The practice my wife chose has about 50% APRN-CNMs (Certified Nurse Midwife). We had a CNM for our first delivery and the Dr for the second (timing didn't allow for the CNM to make it to the delivery).
DanBC 8y ago
As a counter to this point there have been scandals in England (eg Morcambe Bay, but there are others) where midwives killed babies through a combination of incompetence and arrogance, creating a dysfunctional culture that promoted midwifery to the exclusion of other professions - all because they had an unrealistic belief about "normal birth". Normal birth is defined here: https://betterbirths.rcm.org.uk/resources/read/defining-normal-births https://betterbirths.rcm.org.uk/resources/read/defining-norm... Here's the Kirkup report: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/408480/47487_MBI_Accessible_v0.1.pdf https://assets.publishing.service.gov.uk/government/uploads/... Here's the RCOG response: https://www.rcog.org.uk/globalassets/documents/news/rcog-response-to-kirkup-report.pdf https://www.rcog.org.uk/globalassets/documents/news/rcog-res... The RCM dropped their campaign around "normal births" shortly after Kirkup, and launched "better births": http://www.rcmnormalbirth.org.uk/ http://www.rcmnormalbirth.org.uk/ A news report that's a nice summary: https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth https://www.theguardian.com/society/2017/aug/12/midwives-to-... In England it seems the safest option is to have a mid-wife led birth with medical help available. Having a consultant obstetrician available appears to decrease rates of intervention, not increase them.
- Causality1 8y ago
  Oh definitely. Giving birth outside of a hospital is a bad idea.
  - spraak 8y ago
    Not at all. Hospitals are lately notoriously unclean and eager to intervene and interrupt. A home setup can be very clean and healthy, and the hospital can still be there as a backup if extra equipment is required. Our midwives were quite equipped, though. Oxygen, IVs, fetal monitors, etc. Most of all, it's comforting at home, especially at such an important time
    - otabdeveloper1 8y ago
      > Most of all, it's comforting at home, especially at such an important time Birth is serious business and you should be thinking about your child's welfare, not tickling your own selfish comfort receptors.
sgent 8y ago
The US has 2 levels of obstetrics professionals -- MD/DO and Certified Nurse Midwife. CNM's are nurse practitioners with a Masters or Doctorate degree. They don't do surgery, and the smart ones don't do births outside the hospital. In the US you also have "Professional Midwives", Doula's and Certified Professional Midwifes -- none of which have any real health care training requirements. In most other countries when they speak of midwifes, they mean nurse midwives.
lemming 8y ago
Here in NZ, midwife care has taken over to the point where you can no longer get a doctor involved in your primary care at all unless you go fully private obstetric care, which isn't even available where I live. Midwife-led care has become a weird sort of political and social issue here. It's intricately tied into a narrative about how natural childbirth is better, regardless of the evidence, and much of the culture surrounding it is basically dogma. It's also heavily gender-based - I've never heard of a male midwife here, and a lot of the muttered suggestions about the general terribleness of conventional medical ante-natal care clearly paints male doctors as the bad (or at best, uncaring) guys. There was a study released detailing that our support is not anywhere near as good as we would like to believe (see https://www.stuff.co.nz/life-style/parenting/pregnancy/birth/110638963/the-maternity-study-health-officials-and-the-college-of-midwives-fought-to-undermine https://www.stuff.co.nz/life-style/parenting/pregnancy/birth...), which the Ministry of Health got involved in trying to quash and ultimately succeeded in having ignored. I understand the midwives' vested interest in trying to control this narrative, but the only reason I can think of for the Ministry to get involved is that they like midwife-led care because it's cheaper, or that they don't want to admit that going as far as we have down this route might not have been the best idea. We had a terrible experience with midwife care, and if we were able to have another child (we're not, in part because of the first delivery) we would move somewhere that allowed us to have actual medical professionals involved in our care. There's a really worrying narrative in all of this, along the lines of that doctors are either incompetent or somehow uncaring about childbirth or women's issues relating to it. Massive reduction in maternal and neo-natal death and complication rates is one of the most amazing results of modern medicine and science in general, ever. I'm still embarrassed to admit how I got sucked in by the alternative narrative despite being someone who likes to look at evidence.
- lsaferite 8y ago
  Are your midwives the equivalent of APRN-CNMs in the US? Most people that talk about midwives never specify the type of midwife and that can vary wildly.
  - lemming 8y ago
    I don't know - I don't know what APRN-CNM means and I wouldn't know how to evaluate whether the training here is equivalent or not. Midwives here receive 4 years of training I believe.

b_tterc_p 8y ago

Maybe. I’m not sure I believe that. Recall that a greater proportion of births are now coming from poorer people in worse conditions and often worse health to begin with. If you are middle class+, You’re probably at top tier rates competitive with the rest of the world. Mortality rates are often twice as high for non whites in America likely due to wealth effects. https://www.kff.org/other/state-indicator/infant-mortality-rate-by-race-ethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/other/state-indicator/infant-mortality-r...

OneFamousGrouse 8y ago

This might be true in the US but hardly in the entire "western world". Here in France you can give birth in a hospital without ever having a doctor intervening, only midwives, and it is not a new thing.

lsaferite 8y ago
My wife's obstetrician's office is about half ARPN-CNMs (Certified Nurse Midwife). She saw the Dr for a few appointments, but mostly the CNMs. A CNM delivered our son in the hospital. The CNM had the Dr available to her if things went badly. For our daughter, we came to the hospital with my wife 9cm dilated and the CNM was unable to get there fast enough. In the end it was good that the Dr was there instead as she was born not breathing and eventually ended up on life-support. Even in that case the CNM was the primary care provider for the entire pregnancy. We live in the US. I think not enough women use CNMs, but it's not some universal thing that you have to use an obstetrician in the US.
Fredej 8y ago
Yeah, same thing in Denmark. When my girlfriend gave birth, we had 3 midwives assisting. When she lost what they deemed to be too much blood, they called in a doctor to take a look. Everything was fine. If she hadn't passed some specified threshold for bloodloss, we would not have seen a doctor (or a nurse, come to think of it) at all throughout the birth. Only midwives.
dotancohen 8y ago
Same in Israel. For all three of my children's hospital births, only a midwife was present. In the first two, by my request, she instructed me what to do instead of doing it herself. And being in a hospital there was a doctor on call should any issues have come up.

Pandavonium 8y ago

Is this in the US? Are midwifes an optional thing? I've had experience with births in Australia and the UK where hospital midwifes led the process, from antenatal to birthing and postnatal.

falsedan 8y ago
Midwifes are an optional thing in the US; lots of hospitals are OBN/GY-lead & they handle all the ante-natal, post-natal, and delivery stuff. We found one of the few midwife-led hospitals in the Bay Area and had a very similar experience to the NHS Scotland midwife-led birthing centres.
cylinder 8y ago
I think he is confusing midwife with doula. You don't hire a midwife to join you at the hospital. I think in the US, they are referred to as nurses more than midwives in hospitals. Here in Aus it's all midwives. Therein lies a bit of the problem as the profession should be seen as different to conventional nurses.
- TeMPOraL 8y ago
  I don't think he's confusing anything; doulas aren't medical personnel. Not sure how much this is regional, but in Poland, you absolutely can hire a midwife at some maternity hospitals. It's an extra private service, through which you can select a particular midwife from the hospital to be available to you for consultations and be there to lead and care for you during birth.
- lsaferite 8y ago
  In the US it depends on what your obstetrician's office has in many cases. The practice my wife chose has about 50% APRN-CNMs (Certified Nurse Midwife). We had a CNM for our first delivery and the Dr for the second (timing didn't allow for the CNM to make it to the delivery).

DanBC 8y ago

As a counter to this point there have been scandals in England (eg Morcambe Bay, but there are others) where midwives killed babies through a combination of incompetence and arrogance, creating a dysfunctional culture that promoted midwifery to the exclusion of other professions - all because they had an unrealistic belief about "normal birth". Normal birth is defined here: https://betterbirths.rcm.org.uk/resources/read/defining-normal-births https://betterbirths.rcm.org.uk/resources/read/defining-norm... Here's the Kirkup report: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/408480/47487_MBI_Accessible_v0.1.pdf https://assets.publishing.service.gov.uk/government/uploads/... Here's the RCOG response: https://www.rcog.org.uk/globalassets/documents/news/rcog-response-to-kirkup-report.pdf https://www.rcog.org.uk/globalassets/documents/news/rcog-res... The RCM dropped their campaign around "normal births" shortly after Kirkup, and launched "better births": http://www.rcmnormalbirth.org.uk/ http://www.rcmnormalbirth.org.uk/ A news report that's a nice summary: https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth https://www.theguardian.com/society/2017/aug/12/midwives-to-... In England it seems the safest option is to have a mid-wife led birth with medical help available. Having a consultant obstetrician available appears to decrease rates of intervention, not increase them.

Causality1 8y ago
Oh definitely. Giving birth outside of a hospital is a bad idea.
- spraak 8y ago
  Not at all. Hospitals are lately notoriously unclean and eager to intervene and interrupt. A home setup can be very clean and healthy, and the hospital can still be there as a backup if extra equipment is required. Our midwives were quite equipped, though. Oxygen, IVs, fetal monitors, etc. Most of all, it's comforting at home, especially at such an important time
  - otabdeveloper1 8y ago
    > Most of all, it's comforting at home, especially at such an important time Birth is serious business and you should be thinking about your child's welfare, not tickling your own selfish comfort receptors.

sgent 8y ago

The US has 2 levels of obstetrics professionals -- MD/DO and Certified Nurse Midwife. CNM's are nurse practitioners with a Masters or Doctorate degree. They don't do surgery, and the smart ones don't do births outside the hospital. In the US you also have "Professional Midwives", Doula's and Certified Professional Midwifes -- none of which have any real health care training requirements. In most other countries when they speak of midwifes, they mean nurse midwives.

lemming 8y ago

Here in NZ, midwife care has taken over to the point where you can no longer get a doctor involved in your primary care at all unless you go fully private obstetric care, which isn't even available where I live. Midwife-led care has become a weird sort of political and social issue here. It's intricately tied into a narrative about how natural childbirth is better, regardless of the evidence, and much of the culture surrounding it is basically dogma. It's also heavily gender-based - I've never heard of a male midwife here, and a lot of the muttered suggestions about the general terribleness of conventional medical ante-natal care clearly paints male doctors as the bad (or at best, uncaring) guys. There was a study released detailing that our support is not anywhere near as good as we would like to believe (see https://www.stuff.co.nz/life-style/parenting/pregnancy/birth/110638963/the-maternity-study-health-officials-and-the-college-of-midwives-fought-to-undermine https://www.stuff.co.nz/life-style/parenting/pregnancy/birth...), which the Ministry of Health got involved in trying to quash and ultimately succeeded in having ignored. I understand the midwives' vested interest in trying to control this narrative, but the only reason I can think of for the Ministry to get involved is that they like midwife-led care because it's cheaper, or that they don't want to admit that going as far as we have down this route might not have been the best idea. We had a terrible experience with midwife care, and if we were able to have another child (we're not, in part because of the first delivery) we would move somewhere that allowed us to have actual medical professionals involved in our care. There's a really worrying narrative in all of this, along the lines of that doctors are either incompetent or somehow uncaring about childbirth or women's issues relating to it. Massive reduction in maternal and neo-natal death and complication rates is one of the most amazing results of modern medicine and science in general, ever. I'm still embarrassed to admit how I got sucked in by the alternative narrative despite being someone who likes to look at evidence.

lsaferite 8y ago
Are your midwives the equivalent of APRN-CNMs in the US? Most people that talk about midwives never specify the type of midwife and that can vary wildly.
- lemming 8y ago
  I don't know - I don't know what APRN-CNM means and I wouldn't know how to evaluate whether the training here is equivalent or not. Midwives here receive 4 years of training I believe.