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It's only uncomplicated until it's not. The solution to avoiding unnecessary surgery is not to physically locate farther away from all surgery. Midwives can d

by adamtj 12y ago

It's only uncomplicated until it's not. The solution to avoiding unnecessary surgery is not to physically locate farther away from all surgery. Midwives can do their work in a hospital room down the hall from surgical facilities just as easily as they can in your bedroom 20 minutes away from major life-saving surgery.

eitally 12y ago
This is, of course, the obvious counter-argument, but even in cases of complication it's usually not a problem getting EMS there in time. In parts of the US, midwifery is illegal, but there are places like this (http://www.ncbirthcenter.com/ http://www.ncbirthcenter.com/) that provide midwife services in a natural, homelike setting, but which also have hospital privileges and an OB/GYN on staff in case anything goes wrong. There's another important bit, too. Doulas (http://www.dona.org/mothers/ http://www.dona.org/mothers/) are becoming much more popular, in an effort to provide a similar kind of support through labor & delivery as a midwife might, but within a hospital setting. We used one with our two children and it was really calming to have someone around who wasn't hospital staff AND had experienced hundreds of births AND was there to do whatever my wife needed throughout. My mother-in-law is a retired nurse midwife who delivered >600 babies in England & Scotland during her career before moving to the US. I don't know if it's still true, but she tells us that in the UK, midwives have special privileges for things like transportation -- free bus/train/subway, and the ability to hail a cab and get a free ride if it's necessary. This may not be true any longer. She relocated in 1969.
- inglesp 12y ago
  Can you expand a bit on what you mean by "midwifery is illegal"? To me, that sounds as odd as "dentistry is illegal" ...
  - deleted 12y ago
    [deleted]
  - pyre 12y ago
    This could be a translation error, but "birth nurses" seem to be called "midwives" in the UK whereas that's not the case in the US (at least as I understand it).
    - wiredfool 12y ago
      There are different certifications. One in the US is Certified Nurse Midwife, essentially they are RNs with a certification in midwifery as well. They can have privileges at hospitals, which is a very useful backup in cases where something goes wrong in a non-911 sort of manner. There are also Certified Midwifes, which have a somewhat less medical oriented training and may not be able to bring patients into a hospital as 'their patient'.
      - pyre 12y ago
        (A little late but...) I said that because, for example I stubbled across a UK show called 'Midwives' and it was about a maternity ward. Most of the people there are what I would call 'nurses' in the US, even if they are Nurse-Midwives by certification. I was expecting the show to be about something more akin to home-births. I have an aunt that's a neo-natal nurse, and I've never heard her refer to fellow nurses as midwives (but I've never directly asked her before).
  - scott_karana 12y ago
    I suspect he means that in some jurisdictions, you need to be a licensed medical practitioner of some sort, so the traditional "on the ground" experience of midwives by itself won't qualify.
    - DanBC 12y ago
      In the UK a midwife is a qualified registered specialist nurse. It's a protected term - you can't call yourself a midwife withoutthe qualification and registration. Most midwives are employed by the NHS. Obviously they're not doctors - they can't prescribe medication or perform surgery.
  - ensignavenger 12y ago
    See https://en.wikipedia.org/wiki/Home_birth#United_States https://en.wikipedia.org/wiki/Home_birth#United_States for a bit of insight into the US legal situation.
- lsaferite 12y ago
  In the case of my daughter, an uncomplicated pregnancy almost resulted in her death. She had severe MAS when she was born and could not use her lungs. It took a team of nurses and a doctor to keep her alive long enough for a medivac to another hospital with a NICU3. She ended up on ECMO (life-support) for 10 days and a respirator for another week after that. I have zero doubt that had she been born at home she would have died or had severe brain damage before she could get to a facility capable of saving her. I am a huge opponent of having children away from medical facilities. As the GP said, it's uncomplicated until it isn't.
glaugh 12y ago
Just to clarify: I think you're saying that the best societal answer is what you suggest. I agree (as I agree with eitally). The best if-you're-pregnant-right-now solution, though, is different, since currently very few hospitals allow birth in their physical location without a hospital physician. The calculus in that case is probably a tradeoff of unlikely but very bad outcomes (death by homebirth) vs quite likely somewhat-bad outcomes (unnecessary Caesarean, unnecessary rushing, etc., by hospital), I'd think.
- lsaferite 12y ago
  Our son was delivered at a hospital by a midwife that was part of a team of 2 midwives (CPNP/CNM) and 2 doctors (OB/GYN). If things got beyond her capability she could call in the doctors for backup. Our daughter was delivered by one of the doctors due to him being on call. So, nurse midwifes do deliver in hospitals. I actually think they are not allowed to do home births or they can lose their license. (In the US)
jagermo 12y ago
Agreed. This is how it is done in most hospitals in Germany. When we had our child in May there were two midwifes with us during the process, the doctor joined once it got serious. We could have had the child at home or at a birthing house, however we wanted to have the security of knowing that there is surgery available if something should go wrong (the hospital had a special icu for babies, I don't know the english phrase for it, but they basically could do every procedure that might have been necessary). In addition to that, we really enjoyed the "we don't have to do shit" during the next three days (we got a familiy room, so I could stay with my significant ohter and child. Giving birth at home would have added to the stress (cleaning, getting food, trying to keep visitors away until we had slept a little etc), so for us the hospital was perfect. That beeing said, I have tremendous respect for midwives. They do a hard job with really shitty hours and a lot of responsibility. And they get screwed over with the insurance, especially in Germany (the premiums for insurance skyrocket while the payment doesn't (http://www.huffingtonpost.co.uk/-camalo-gaskin/the-other-uproar-in-germa_b_5603329.html) http://www.huffingtonpost.co.uk/-camalo-gaskin/the-other-upr...)

by adamtj 12y ago

eitally 12y ago

This is, of course, the obvious counter-argument, but even in cases of complication it's usually not a problem getting EMS there in time. In parts of the US, midwifery is illegal, but there are places like this (http://www.ncbirthcenter.com/ http://www.ncbirthcenter.com/) that provide midwife services in a natural, homelike setting, but which also have hospital privileges and an OB/GYN on staff in case anything goes wrong. There's another important bit, too. Doulas (http://www.dona.org/mothers/ http://www.dona.org/mothers/) are becoming much more popular, in an effort to provide a similar kind of support through labor & delivery as a midwife might, but within a hospital setting. We used one with our two children and it was really calming to have someone around who wasn't hospital staff AND had experienced hundreds of births AND was there to do whatever my wife needed throughout. My mother-in-law is a retired nurse midwife who delivered >600 babies in England & Scotland during her career before moving to the US. I don't know if it's still true, but she tells us that in the UK, midwives have special privileges for things like transportation -- free bus/train/subway, and the ability to hail a cab and get a free ride if it's necessary. This may not be true any longer. She relocated in 1969.

inglesp 12y ago
Can you expand a bit on what you mean by "midwifery is illegal"? To me, that sounds as odd as "dentistry is illegal" ...
- deleted 12y ago
  [deleted]
- pyre 12y ago
  This could be a translation error, but "birth nurses" seem to be called "midwives" in the UK whereas that's not the case in the US (at least as I understand it).
  - wiredfool 12y ago
    There are different certifications. One in the US is Certified Nurse Midwife, essentially they are RNs with a certification in midwifery as well. They can have privileges at hospitals, which is a very useful backup in cases where something goes wrong in a non-911 sort of manner. There are also Certified Midwifes, which have a somewhat less medical oriented training and may not be able to bring patients into a hospital as 'their patient'.
    - pyre 12y ago
      (A little late but...) I said that because, for example I stubbled across a UK show called 'Midwives' and it was about a maternity ward. Most of the people there are what I would call 'nurses' in the US, even if they are Nurse-Midwives by certification. I was expecting the show to be about something more akin to home-births. I have an aunt that's a neo-natal nurse, and I've never heard her refer to fellow nurses as midwives (but I've never directly asked her before).
- scott_karana 12y ago
  I suspect he means that in some jurisdictions, you need to be a licensed medical practitioner of some sort, so the traditional "on the ground" experience of midwives by itself won't qualify.
  - DanBC 12y ago
    In the UK a midwife is a qualified registered specialist nurse. It's a protected term - you can't call yourself a midwife withoutthe qualification and registration. Most midwives are employed by the NHS. Obviously they're not doctors - they can't prescribe medication or perform surgery.
- ensignavenger 12y ago
  See https://en.wikipedia.org/wiki/Home_birth#United_States https://en.wikipedia.org/wiki/Home_birth#United_States for a bit of insight into the US legal situation.
lsaferite 12y ago
In the case of my daughter, an uncomplicated pregnancy almost resulted in her death. She had severe MAS when she was born and could not use her lungs. It took a team of nurses and a doctor to keep her alive long enough for a medivac to another hospital with a NICU3. She ended up on ECMO (life-support) for 10 days and a respirator for another week after that. I have zero doubt that had she been born at home she would have died or had severe brain damage before she could get to a facility capable of saving her. I am a huge opponent of having children away from medical facilities. As the GP said, it's uncomplicated until it isn't.

glaugh 12y ago

Just to clarify: I think you're saying that the best societal answer is what you suggest. I agree (as I agree with eitally). The best if-you're-pregnant-right-now solution, though, is different, since currently very few hospitals allow birth in their physical location without a hospital physician. The calculus in that case is probably a tradeoff of unlikely but very bad outcomes (death by homebirth) vs quite likely somewhat-bad outcomes (unnecessary Caesarean, unnecessary rushing, etc., by hospital), I'd think.

lsaferite 12y ago
Our son was delivered at a hospital by a midwife that was part of a team of 2 midwives (CPNP/CNM) and 2 doctors (OB/GYN). If things got beyond her capability she could call in the doctors for backup. Our daughter was delivered by one of the doctors due to him being on call. So, nurse midwifes do deliver in hospitals. I actually think they are not allowed to do home births or they can lose their license. (In the US)

jagermo 12y ago

Agreed. This is how it is done in most hospitals in Germany. When we had our child in May there were two midwifes with us during the process, the doctor joined once it got serious. We could have had the child at home or at a birthing house, however we wanted to have the security of knowing that there is surgery available if something should go wrong (the hospital had a special icu for babies, I don't know the english phrase for it, but they basically could do every procedure that might have been necessary). In addition to that, we really enjoyed the "we don't have to do shit" during the next three days (we got a familiy room, so I could stay with my significant ohter and child. Giving birth at home would have added to the stress (cleaning, getting food, trying to keep visitors away until we had slept a little etc), so for us the hospital was perfect. That beeing said, I have tremendous respect for midwives. They do a hard job with really shitty hours and a lot of responsibility. And they get screwed over with the insurance, especially in Germany (the premiums for insurance skyrocket while the payment doesn't (http://www.huffingtonpost.co.uk/-camalo-gaskin/the-other-uproar-in-germa_b_5603329.html) http://www.huffingtonpost.co.uk/-camalo-gaskin/the-other-upr...)