Conference moira::parenting_v3

       *************** MODERATOR REMINDER **************

This topic is for the discussion of midwives vs. Ob/Gyns in general.
If you want to give an opinion on any particular doctors or midwives, 
please send the basenoter EMAIL.

Thanks.

     Carol duBois, PARENTING co-mod

    Pam, 
    
    I am due in April, and it is also my first pregnancy.  I am going to 
    the Concord Nurse Midwifery at Emerson Hospital.  I highly recomend them.
    You can setup an appointment just for an interview.
    
    Before I decided on the CNM, I was faced with the same dilemma that
    you are.  I was somewhat apprehensive about not having a "Dr." for my 
    1st pregnancy.  I talked to several of my friends that had recently
    delivered.  Some of them had gone to Dr's and some to midwives.  One of
    my friends switched from a Dr. to a Midwife in the middle of her
    pregnancy.
    
    I am really happy with my choice.  The midwives are experts at
    delivering babies.  I feel that I am getting more attentive care than I
    would be with a doctor.  They never rush the visits, they are very
    thorough, no question is silly, and they encourage your spouce to
    participate as much as possible in this experience.
    
    When I go into labor, one of the midwives will arrive at the
    hospital/Birthing Center as soon as I do, or shortly thereafter.  The
    midwife will stay in the birthing room with my husband & I, if that is
    what we want, or they will be close by and available when we need them. 
    This is really important to me!  If I were going to a Dr. he wouldn't
    even be called to the hospital until I were 10 cm dialated. 
    
    My vote is definitely for the midwives.  But you should set up some
    interviews and decide what is best for you.  I am really happy with
    Emerson Hospital as well.  They give tours of the birthing center once
    a week.
    
    
    Barbara

    
    
    I'm due the beginning of May with my second pregnancy.  With my first,
    I had a doctor.  This time I'm going with a mid-wife.
    
    I absolutely loved my first doctors, but as -.2, they aren't around
    while you're going through labor.  Mine stopped in here and there but
    didn't actually come in to stay until I was delivering the baby.  The
    nurses in the hospital were in and out and there was only one other
    woman delivering while I was there.  I didn't like the feeling of being
    left on our own.
    
    My sister had her first baby with a mid-wife and she told of how
    they're there with you the whole time.  They've gone through your
    pregnancy with you, unlike the nurses staffed at the hospital.  And
    their job is delivering babies!  I really like the personal attention.
    And besides, there is always a doctor on call (within the same
    practice) that is there in case of an emergency.
    
    Another reason I chose a mid-wife is because of episiotomies (sp?).  I
    was sore for about 5 days from my first.  The mid-wives that I'm seeing
    right now don't do them routinely.  I'd like to deliver without one this
    time if its possible.
    
    Good luck with whatever you decide.  
    
    Susan

    I went this route with this midwifery, and was so impressed; the people
    are wonderfun, the hospital is great, I would not consider it any other
    way,and even arranged my new health care situation around them.  In
    general, it is a great way to give birth, not what my mother feared
    "oh, you're not going to give birth in a shack, are you" ;-) ...  All
    the facilities necessary are immediately available, but not used if you
    don't need them.  I needed intervention due to slight complications
    during birth, and Dr. Lea attended, but did not take over; I started
    and finished with the midwife.  Best experience of my life!
    
    Adrienne
    

    I had a doctor for my first pregnancy/delivery and a midwife for my
    second.  I really found no difference between the two.  
    
    Just because you chose a midwife, it doesn't necessarily mean she'll be
    with you through your whole labor.  At the time of my delivery for my
    second baby, there were 3 other patients of my midwife's in transition 
    at the SAME TIME, so she was dividing her time, to say the least.  I
    found that my doctor was with me more with my first delivery than the
    midwife during the second.
    
    -Alison
    
    

This note is being entered for a member of our community who wishes to
remain anonymous at this time.

Please note that she is only asking for *locations* of places where she
can use a midwife.  If you have any comments on specific midwives,
then please send me mail and I will forward them to her.

Thank you.

      Carol duBois, PARENTING co-moderator

****************************************************

I hope that you in the parenting community can help me.

A couple of notes in this conference have mentioned midwifes and the comments
seems to be overall positive. But where to you go (in the Boston area) to
deliver your baby if you want to have a midwife assisting at the birth?

I do know about the North Shore Birthing Center, (it is affiliated with Beverly
Hospital) and it is covered by my HMO (their charge is $2310), but it is rather
a long drive from where I work/live, and since they do want you to come in for
checkups at least for the last 2 months of your pregnancy, it seems that North
Shore is not an option for me.

(I do have HMO-NET coverage, so to go outside my HMO for care could be a
possibility if there are any other birth centers with midwifes around in
this area, though I would have to pay some part of the cost myself.)

At the risk of blowing her cover, could the anonymous noter reveal her location?

    I believe the Newton-Wellesley Hospital, is the only Boston area
    hospital that allows midwives to deliver babies in their hospital.
    
    My OB/GYN office has a team of 4 midwives in their practice.
    Women's Health Associates, in Wellesley, MA.  (617) 237-0080.
    
    Linda

    Without knowing her location, perhaps calling the larger hospitals that
    deliver in the Boston area, like B&W, Mt. Auburn in Cambridge etc. 
    They likely have midwives on staff, and birthing centers available.
    Doesn't Newton Wellesley or Framingham offer these services as well?
    
    I know there is a building associted with, but not physically attached
    to Milford Hospital that is a birthing center. 
    
    I do feel a little cheated because I am considered high risk, and ther
    is no way in my lifetime I'd ever be able to experiece a birthing room
    or center delivery.  I am envious of all who can utilitze midwives.
    
    Isn't there a listing in the yellow pages under midwives, or by asking
    your HMO provider for a list of them?
    
    Lyn

    
    	I know that Leominster Hospital has some type of mid-wife
    	program.  It's pretty new, and it looked like a great 
    	program.  You might want to call there to get more info.  
    
    	Ellen

    [Still out on leave...spending a rare hour in Notes]
    
    I delivered my daughter in July at Mt. Auburn Hosp. in Cambridge
    using the services of Mt. Auburn Midwifery Assoc. (M.A.M.A. for
    short, cute, eh?)
    
    Their phone number is (617) 499-5141. The practice is made up of
    several (six?) midwives, and they do all their deliveries at 
    Mt. Auburn or Somerville Hosp. I was very happy with them and
    with the hospital as well.
    
    Send me mail if you want any more info.
    
    Lucy

    
    I go to the Concord Nurse-Midwifery Associates at Emerson Hospital
    in Concord, Ma.  They are a group of 3 nurse-midwives, and I alternate
    who I see for each prenatal visit.  When I deliver, I will use Emerson
    hospital's birthing room, and the nurse-midwife on call.  I'm very
    happy with them.  Their number is (508)369-0680.  They will send you
    some literature, and I'd be happy to give you more information.
    
    Patty

    I delivered both my children with mid-wives at Malden Hospital.  
    
    The first was with Dr. Sorger in Malden, he has 2 midwives I believe.
    The midwives do everything unless there is a problem, then they call
    the doctor in.(ie. c-section etc.)
    
    The second was with Dr. Levine whose office is in Arlington.  He has
    3 midwives and all were excellent.  I would definitely use them again.
    
    I prefered Dr. Levine for personality reasons but both seem equally 
    competent.  Dr. Sorger delivers at New England Memorial hospital as
    well.
    
    I am having #3 in March and am using the Concord Midwifery since we
    moved.  They seem fine as well.  I really appreciate te extra attention
    you seem to get with a midwife, and the doctors are always nearby in
    emergencies.
    
    Good Luck!

    We had our 1st Midwife birth at Franklin County Hospital in Greenfield. 
    Our 2nd Midwife birth was at Leonard Morse hospital in Natick.

    Both experiences were wonderful.  In each case, there was no doctor
    necessary or present (although they were readily available if problems
    arose).

    L.

    	My wife had her first 3 in hospitals using an OB/GYN.  She was
    	very unhappy with the hospital routine, and chose to do the
    	4th as a home birth.  

    	Home births by midwives are illegal in mass.  We used a midwife
    	from NH.  (Home births themselves are not illegal.  An OB/GYN
    	can do it, for instance, but good luck finding one who will.
    	And there is nothing stopping you from doing it yourself!)

    	To make a long story short, Linda delivered her 4th in our
    	bedroom after 2 hours of labor.  Peter was 10 lb. 12 oz. 
    	and 23 inches long.  No fetal monitor.  No "prepping."  No 
    	enemas.  No stirrups.  NO EPISIOTOMY!!!  No drugs.  No silver 
    	nitrate in the baby's eyes.  No circumcision.  No wake-up every 
    	4 hours for temperature and blood pressure check.  No hospital 
    	food.  No hospital beds.  No pre-defined visiting hours.  

    	Instead, Linda had the comfort of her own surroundings.
    	The bed she has come to love.  The food SHE wanted to eat.
    	She slept when she wanted to sleep, and got up when she wanted 
    	to get up.  She had the people she wanted present at her delivery.
    	(Her sister was a nurse at the hospital we would have otherwise
    	gone to, yet she was not allowed to be at the delivery of our
    	other kids unless she was on duty AS THE ATTENDING NURSE for 
    	those deliveries.  She missed them all.)   Our kids got to see
    	it.  Her mother was there.

    	This is the route she would choose again if we would ever have
    	another one.

    	BTW, John Hancock (our insurance at the time) would not pay the 
    	costs.  They would have paid for a CNM midwife delivery in a
    	hospital (the only legal CNM delivery in Mass is in a hospital.)

    	The total cost for the home birth was $700 for the midwife, and
    	$100 for her apprentice assistant.  This occurred 2/3/88.

    	Joe Oppelt

RE: .15

>    	Home births by midwives are illegal in mass.

    Just wanted to clarify things.  Unless things have changed radically in
    the last few years that I haven't heard of (a period when Mass. has
    undergone general liberalization on this issue) this is absolutely and
    completely untrue.

    It is legal for anyone to supervise a home birth.

    There is, however, a regulation (note not a law) of the authority which
    lisences nurses, which says that principle supervision of a home birth
    is grounds for revoking their licences.  Someone who is trained as a
    midwife (even as a nurse and a midwife) who does not wish to practice
    as a nurse in general (including as a nurse-midwife in hospitals) is
    under no restrictions at all.  The consequence of this is that a
    doctor with no training at all in OB/GYN is preferred by the medical
    establishment to supervise a home birth over a non-doctor with the
    training needed for this.

				    Topher

    re .16, and I'm NOT being picky here...
    
    I am an EMT, I AM trained in and have delivered babieS!  The key word
    here is I ASSIST in the birth.  Let's face it, when a mom is going to
    give birth, she's going to give birth, and unless there is a
    complication requiring a C-section, about all I am ABLE to do is stand
    by and, as our training manuals put it, get ready to catch!
    
    We, as a unit, have had more deliveries on the bathroom floor.  Why? 
    because mom forgot her toothbrush, or hair dryer etc and went back to
    get it, and bingo, you've got a new life. 
    
    We have had people who have run into some sort of catch-22, and
    purposely waited too long to get to the hospital, and call us when they
    know delivery is immenent.  We transport mom and baby, the baby and mom
    are usually checked out, generally both are pronounced healthy, and
    sent home within a day or two.  Or the ones who fully believe they want
    a home-birth and simply panic when presented with an unassisted birth.
    (It's in the same category of those who choose to die at home and
    relatives panic when death is immenent) It's also one way of guaranteeing 
    that the baby will be in the room with you from admission to discharge,
    since babies born outside of a delivery room are considered "contaminated"
    (I've always hated that terminology!), and must be isolated from babies 
    born in a delivery room.
    
    So under the rule, am I doing something "illegal" by assisting a birth
    at home?
    
    Lyn

    I really don't know whether the rule applies to an EMT.  The idea is
    that a nurse should not do a doctor's work, however well qualified they
    are.  In U.S. medical culture (unlike virtually everywhere else in the
    world) all birth is viewed as being a medical crisis requiring the
    professional oversight of a doctor.

    Under normal conditions an RN (which is the only licensing rule I know
    about) or an EMT is not supposed to perform a tracheotomy without
    a doctor's supervision.  For them to do so would be to risk their
    license.  In an emergency an EMT (and I presume -- hope -- an RN) could
    perform an unsupervised tracheotomy without serious risk of losing
    their livlihood.

    The same would apply to assisting at a birth (home or elevator).  It
    would be irrational for the licensing authority to make rules against
    unsupervised birth assitance under emergency conditions (which doesn't
    mean they haven't made the rules, but they probably have an exception).

    The regulations for RN make explicit mention of assisting at births
    unsupervised, I don't know whether they do or not for EMTs.

    By the way, I didn't speak of "assisting in the birth" because I
    thought that might be confusing in this context.  Who actually assists
    and who is medically responsible and in authority are not necessarily
    the same person.  When a midwife works within a hospital or
    birthing-center context they are not.

>    Or the ones who fully believe they want
>    a home-birth and simply panic when presented with an unassisted birth.

    This confuses "home birth" with an "unassisted birth" they are not at
    all the same thing.  Assisted home births have a problem rate the same
    or lower than hospital births (even after selection effects -- e.g.,
    problem pregnancies are sent to the hospital by midwives -- are taken
    into account).

				    Topher

Colorado has reaffirmed (by committee vote, I believe) the current laws on
midwifery.  Some folks were trying to change it this year, to allow a woman to
choose a midwife if she wanted one. 

Currently, the law is something like:  
	you can give birth in a hospital with a doctor,
	you can give birth in your home all alone,
	but you *can't* choose to give birth with a midwife unless you are
		*also* using a doctor.

Most doctors won't even consider using midwives, and many doctors lobbied
against the change of the law.  They said that if midwives were allowed to
deliver babies then we would lose more lives.

      Carol

    
    The only way to buck the Doctors is to hit them where it hurts, the 
    pocketbook. Insist on seeing only OB/GYN that use midwives.
    
    

    
    Even in Canada (where doctors don't open their palms directly
    to the patients) Midwives are not recognized in the medical 
    profession and their services are not considered legit. 
    However, in most provinces at one time or another, there have
    been fights to get legal status. Same argument about mortality though.
    
    Monica