childbirth ob vs midwife

[Guest guest]

Dr Bhate,

 

In this debate between Mid-wives vs MDs,

we should also understand a few inticacies of " western Medicine".

 

# 1) It is not that the practice by mid-wives is different than that of an MD,

but that it is a Practice of Medicine by non-MDs. It is important to correctly

understand this statement. Since there is allegedly all this money in the

practice of Medicine, Nurses and other professionals, who would like to practice

medicne have become mid-wives, or advanced practiotioner nurses or

nurse-anesthetists, etc. I am not debating the merits or demerits of such

practice, I am only stating the obvious.

 

However,

 

#2 ) all these allied health practitioners are governed by the same regulations

by the health authorities, and are "sued" the same way by lawyers, and therefore

their practices are very similar. And so are their charges for these procedures.

 

#3 ) Many MDs hire such allied professionals, and many allied professionals

prefer to have an MD to " cover them legally".

 

# 4) When two practitioners compete for the patient, it is natural to advertize

differently, in order to attract one sort of care or different class of

patients. Let us not take the advertizing that seriously.

 

Finally, where hundreds of women delivered in the fields naturally, it is not

such a big risk to be deliverd by one or the other class of health professional.

Many even deliver in a taxi or a private car, at the hands of absolute

non-professionals,

 

However, there is a certain risk associated with every pregnancy. Every woman

presumes that that could be her own delivery. And therefore they seek a better

trained professional, at a hospital with neonatal ICU, etc.... Especially the

educated women and those with better salaries prefer better care. They choose

the obstetrician. An Ob-Gyn is not thrust on them.

 

It is easy to tell a woman to bear the pain, but only she would know if it is

bearable or not. Many that did not want an epidural, ask for it, when faced with

that pain. Men can argue this point however, only women who have delivered can

really speak on this issue. Again, personal experiences are personal biases. if

you had a quick delivery, with no complications, one might think that the

epidural may not have been necessary. If one had a prolonged delivery and lot of

pain, one would thank the epidural for painless or reduced pain during the

process, and if one has a complication, then one tends to blame everything that

happened.

 

Every Obstetrician looks at every delivering woman from the same view points as

you. Namely, is an epidural really required ( not every woman needs it or gets

it ), although a majority do get it, is a C-section really needed, and is not

performed unless absolutely needed, and thirdly, how to handle a woman with a

previous section. Many deliver per-vaginum, but some cannot, either due to the

size of the baby, or problems with the birthing canal, or because of the

possibility of rupture of the uterus, or because of abnormal position of the

baby.

 

The care rendered by all professionals is therefore very same, and inter

dependent,

The discussion in this column is overly simplistic.

So, I find the comparison very amusing.

 

>> Keeping birth normal: the midwifery skill of being with women in

> pain

>> Thursday 30th June 4pm-5.30pm

>>

>> Room 1.60 Franklin Wilkins Building

>>

>> Stamford Street

>>

>> SE1 9NN

>>

>>

>>

>> Nicky Leap

>>

>> Director of Midwifery Practice, South Eastern Sydney and Illawarra

> Area Health Service

>>

>> Associate Professor of Midwifery, University of Technology, Sydney

> and visiting Senior Research Fellow, Nightingale School of Nursing

> and Midwifery, King's College, London.

>>

>>

>>

>> Throughout the centuries, women have asked midwives to be alongside

> them in labour to keep birth safe and to offer comfort and support

as

> they face pain and uncertainty. In recent years, the western

approach

> has been to offer what I shall call a 'menu' of options for 'pain

> relief' in the interest of promoting 'informed choice'. This paper

> explores how the offering of 'the pain-relief menu' can be

> counterproductive to the midwifery skill of 'keeping birth normal'

> and how such an approach can inadvertently undermine women's

> confidence in their ability to give birth without intervention.

> Respecting physiology and the important role of pain in labour

> enables midwives to be alongside women, encouraging them to find

> their inner strength without resorting to pharmacological pain

> relief. This skill is fundamental to midwifery and is in direct

> opposition to the nursing and medical skills of 'pain relief'.

 

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Durgesh Mankikar,MD