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Re: Interspeciality differences in OB care low-risk womenFrom: Cheri Van Hoover (cherivh@waonline.com)Thu Apr 24 17:09:49 1997
Laurie Lovely wrote: > I don't find it surprising, however, that > patients who see midwives end up with less intervention--patients who > choose to see midwives often do so for just that reason. My last practice was at an HMO where CNMs triaged all patients entering the L&D unit, independently managed all low-risk women, and co-managed most complicated patients. We did not do any prenatal care (due to union issues with NPs, limited space for providers in clinic, and poor support for CNM inclusion by the MDs), so we met all of these women for the first time when they were in labor. These were not women choosing CNM care. They just happened to have that kind of insurance. Since the CNM covering L&D frequently was responsible for the management of many laboring women (up to 7 at times), the midwife did not provide continuous labor support. Nonetheless, our epidural anesthesia rate, C/S rate, and rate of other interventions was lower than it presently is, now that the midwifery service has been greatly reduced by the hospital. Discussions with RNs still working at the hospital lead me to believe that the management style (particularly at night) has changed substantially, contributing to the increased rate of interventions.
-- Cheri Van Hoover, CNM Midwifery Service at Stanford Palo Alto, CA
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