Comments on: Doctor or Midwife: Which Would You Choose? http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/ Facts Plus Stories Equals Knowledge Tue, 31 May 2011 00:40:53 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Consumer Reports Maternity Health Care Quiz | Utah Childbirth Directory http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-10723 Consumer Reports Maternity Health Care Quiz | Utah Childbirth Directory Sat, 24 Jul 2010 04:54:44 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-10723 [...] Another good article is “Doctor or Midwife: Which Would You Choose?“ [...] [...] Another good article is “Doctor or Midwife: Which Would You Choose?“ [...]

]]> By: Shelley Binkley http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-277 Shelley Binkley Thu, 05 Mar 2009 15:18:54 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-277 @Tony I'm really glad you brought up that point! Here are the statistics: Although the c-section rate has risen from 5% in 1970 to 31% @ present time, the incidence of cerebral palsy has INCREASED, not declined. A lot of research has been done on C.P. and the weight of evidence shows C.P. is most often caused by prematurity and intrauterine "events" that occurred prior to the onset of labor. Less than 1% of cerebral palsy has been found to be attributable to intrapartum asphyxia (lack of oxygen during labor). C-section during labor for "abnormal fetal heart rate tracings" has NOT reduced the incidence of cerebral palsy. TY for the stimulating comment--you gave me an idea for another blog post! Please keep commenting and asking questions. @Tony I’m really glad you brought up that point! Here are the statistics: Although the c-section rate has risen from 5% in 1970 to 31% @ present time, the incidence of cerebral palsy has INCREASED, not declined. A lot of research has been done on C.P. and the weight of evidence shows C.P. is most often caused by prematurity and intrauterine “events” that occurred prior to the onset of labor. Less than 1% of cerebral palsy has been found to be attributable to intrapartum asphyxia (lack of oxygen during labor). C-section during labor for “abnormal fetal heart rate tracings” has NOT reduced the incidence of cerebral palsy. TY for the stimulating comment–you gave me an idea for another blog post! Please keep commenting and asking questions.

]]> By: Tony Spencer http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-275 Tony Spencer Thu, 05 Mar 2009 02:50:43 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-275 But perhaps this rise in c-sections is attributable to good doctors just doing their part to prevent cerebral palsy. *wink wink* :) But perhaps this rise in c-sections is attributable to good doctors just doing their part to prevent cerebral palsy. *wink wink* :)

]]> By: Tony Spencer http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-274 Tony Spencer Thu, 05 Mar 2009 02:45:48 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-274 Ah I see. Hmm. Perhaps we need some new legislation that will allow for the doctor and clinic to be protected if the patient chooses to sign a contract. Tort reform never seems to get any legs in this country though so I won't hold my breath. Ah I see. Hmm. Perhaps we need some new legislation that will allow for the doctor and clinic to be protected if the patient chooses to sign a contract. Tort reform never seems to get any legs in this country though so I won’t hold my breath.

]]> By: Shelley Binkley http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-273 Shelley Binkley Thu, 05 Mar 2009 02:37:39 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-273 @Tony It's not a silly question. An indemnifying contract for doctors would be unenforceable in most if not all states. Even if a person "signs on the dotted line" as with any informed consent document, this does not indemnify the healthcare provider against "malpractice" claims. TY for the feedback, very interesting. @Tony It’s not a silly question. An indemnifying contract for doctors would be unenforceable in most if not all states. Even if a person “signs on the dotted line” as with any informed consent document, this does not indemnify the healthcare provider against “malpractice” claims. TY for the feedback, very interesting.

]]> By: Tony Spencer http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-266 Tony Spencer Tue, 03 Mar 2009 02:37:01 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-266 <blockquote>Doctors also bear the brunt of the malpractice risk: people don’t sue midwives, they sue doctors. So doctors may be more likely to practice defensive medicine for fear of being sued.</blockquote> This may sound silly but I wonder if any patients have ever signed a contract indemnifying the doctor performing the delivery in advance so as to minimize the risk of unnecessary c-section. It seems reasonable enough to me for mothers and fathers that feel strongly enough about the merit and professional history of a doctor they've interacted with in the months preceding the birth.

Doctors also bear the brunt of the malpractice risk: people don’t sue midwives, they sue doctors. So doctors may be more likely to practice defensive medicine for fear of being sued.

This may sound silly but I wonder if any patients have ever signed a contract indemnifying the doctor performing the delivery in advance so as to minimize the risk of unnecessary c-section. It seems reasonable enough to me for mothers and fathers that feel strongly enough about the merit and professional history of a doctor they’ve interacted with in the months preceding the birth.

]]> By: Shelley Binkley http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-206 Shelley Binkley Fri, 06 Feb 2009 17:08:26 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-206 @Pam--Wow! Pam thank you so much for the insightful and thought-provoking comment on this issue. I guess the history of obstetrics in the U.S. is that it took the approach of seeing pregnancy as a disease state rather than as a normal extension of women's health. I think that accounts for the patriarchal approach to pregnancy in the U.S. vs. in Australia, New Zealand and other countries. I'd like to do more research into learning why the medical model for pregnancy dominated the evolution of obstetrics in the U.S. vs. in other developed nations during the 1900's. More on this later..... @Pam–Wow! Pam thank you so much for the insightful and thought-provoking comment on this issue. I guess the history of obstetrics in the U.S. is that it took the approach of seeing pregnancy as a disease state rather than as a normal extension of women’s health. I think that accounts for the patriarchal approach to pregnancy in the U.S. vs. in Australia, New Zealand and other countries. I’d like to do more research into learning why the medical model for pregnancy dominated the evolution of obstetrics in the U.S. vs. in other developed nations during the 1900′s. More on this later…..

]]> By: Pam http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-205 Pam Fri, 06 Feb 2009 04:03:38 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-205 An age old debate. It is difficult to choose. A midwife means 'with woman' and as a rule work in partnership with women. Midwives have a duty to empower women to believe that normal birth is achieveable and is safe. Midwives are best in the role of being soley responsible for normal pregnancy which proceeds to normal vaginal birth without complication and being responsible for normal uncomplicated postnatal period. Unfortunately as argued by medical staff 'normal' can only be diagnosed in retrospect it cannot be assumed to be anticipated. The medical perspective is to anticipate and plan for the worse case senario and the concept of "Foreseable harm", which was first coined by Justice Benjamin Cardozo in 1916 serves as the basis for all mal practice suits in the U.S. reinforces that attitude. This attitude of lawyers makes pregnancy and childbirth incredibly complicated for those responsible for delivering care. I work in an entirely different system and value myself as an autonomous practitioner in my own right and I am no doctors 'hand maiden' to provide all the one on one support and then have someone in a white coat swan in at the last moment 'catch' the baby and then leave me to clean up. I believe there is room in the U.S. system for midwives but only with adequate legislation, governance, and professional bodies in place to monitor training and professional development. An obstetric nurse may have 10yrs experience working in a hospital but believe me it is no substitue for actually being responsible for someones care, identifiying deviations from the normal and then ensuring that the correct referral is made at the correct time. I had 10yrs labour ward experience in the UK before coming out to New Zealand but to actually carry a caseload of 50-60 women a year provide 24hr/7days a week on call and only have 2 obstetricians to work with on a unit which takes care of 500 women a year was a different matter. The obstetricans did 1 in 2 on call and I was only expected to call them when i had a real problem they expected me to already have done blood work already know that we would be going to theatre so they would meet me at the theatre door ready to go. I had no room for error and I could not call them out on a whim. Being married to a Doctor makes for some interesting debates in our household on the subject of pregnancy and childbirth mostly we agree but there are times when we have to agree to disagree. This is a good post it raises some interesting points and i don`t envy anyone having to make the choice, what i firmly believe in is informed choice and then the person taking responsibility for that choice. We can all make a judgement in retrospect. An age old debate.
It is difficult to choose. A midwife means ‘with woman’ and as a rule work in partnership with women. Midwives have a duty to empower women to believe that normal birth is achieveable and is safe. Midwives are best in the role of being soley responsible for normal pregnancy which proceeds to normal vaginal birth without complication and being responsible for normal uncomplicated postnatal period. Unfortunately as argued by medical staff ‘normal’ can only be diagnosed in retrospect it cannot be assumed to be anticipated.
The medical perspective is to anticipate and plan for the worse case senario and the concept of “Foreseable harm”, which was first coined by Justice Benjamin Cardozo in 1916 serves as the basis for all mal practice suits in the U.S. reinforces that attitude. This attitude of lawyers makes pregnancy and childbirth incredibly complicated for those responsible for delivering care.
I work in an entirely different system and value myself as an autonomous practitioner in my own right and I am no doctors ‘hand maiden’ to provide all the one on one support and then have someone in a white coat swan in at the last moment ‘catch’ the baby and then leave me to clean up.
I believe there is room in the U.S. system for midwives but only with adequate legislation, governance, and professional bodies in place to monitor training and professional development. An obstetric nurse may have 10yrs experience working in a hospital but believe me it is no substitue for actually being responsible for someones care, identifiying deviations from the normal and then ensuring that the correct referral is made at the correct time.
I had 10yrs labour ward experience in the UK before coming out to New Zealand but to actually carry a caseload of 50-60 women a year provide 24hr/7days a week on call and only have 2 obstetricians to work with on a unit which takes care of 500 women a year was a different matter.
The obstetricans did 1 in 2 on call and I was only expected to call them when i had a real problem they expected me to already have done blood work already know that we would be going to theatre so they would meet me at the theatre door ready to go. I had no room for error and I could not call them out on a whim.
Being married to a Doctor makes for some interesting debates in our household on the subject of pregnancy and childbirth mostly we agree but there are times when we have to agree to disagree.
This is a good post it raises some interesting points and i don`t envy anyone having to make the choice, what i firmly believe in is informed choice and then the person taking responsibility for that choice.
We can all make a judgement in retrospect.

]]> By: Hot Health Links: Green Your Cycle & More http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/comment-page-1/#comment-201 Hot Health Links: Green Your Cycle & More Tue, 03 Feb 2009 06:58:41 +0000 http://healthewoman.org/2009/01/22/doctor-or-midwife-which-would-you-choose/#comment-201 [...] Dr. Binkley at Health E Woman is considering the differences between a midwife and a doctor. [...] [...] Dr. Binkley at Health E Woman is considering the differences between a midwife and a doctor. [...]

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