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Re: Dr. Sanchez-Ramos & CNM's From: Ari Gold (arig@getnet.com) Wed Feb 18 12:34:52 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's" Previous message: R. Daniel Braun, M.D.: "Re: female circumcision" In reply to: Luis Sanchez-Ramos: "Re: female circumcision" Next in thread: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's" Reply: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's" At 10:34 AM 2/18/98 -0600, you wrote: >There is no need for me to share my experiences with you. I feel very >confident with my surgical skills and feel that I could handle most >problems or complications referred by you or other midwives. >Yes, many practices in the U.S.A. are hiring midwives instead of >OB/GYNs. This of course is for purely ecnomical reasons. While this is perhaps true in some practices, in many it is not the case. In fact, many nurse midwives spend more time with their clients both prenatally and in labor than OB's typcally do, and do not engage in the lucrative surgeries that OB's do, therefore not being as "cost effective". Many practices still choose to hire CNM's though, because they have increased patient satisfaction, lower ceserean rates with matched populations, higher rates for VBAC's, decreased rates of other interventions, lower rates of suit for malpractice, etc. (I have original references available for all of these claims if anyone is interested) However, >occasionally midwives do not recognize their limitations and attempt to >manage high risk patients such as the one you have described. I feel >that it is inappropriate for nurse-midwives to be taking care of high >risk patients. That is my personal opinion. I am glad you have clarified that this is your personal opinion, because it is clearly unsupported by clinical data, which demonstrate excellent outcomes with nurse-midwifery care, even among high risk populations, where patients are managed collaboratively. I am not in private >practice, I practice in an academic environment and have had up to 5 >midwives who take care of low risk patients. I am not certain what you mean when you say that you have had up to 5 midwives, I hope it means you worked together in a clinical practice. Respectfully, Ingrid Gold, CNM arig@getnet.com >Luis Sanchez-Ramos, MD > >At Wed, 18 Feb 1998, Deborah J. Wage wrote: >> >>I don't think that I solicited any advise from you as to how we manage >>and/or co-manage our patients. We have many high-risk patients and the >>midwives are part of their care at various levels. There is an aspect of >>normal with every pregnant woman. My back-up, who happen to be >>perinatologists, insist that I continue to be an integral part of each >>and every woman's care while they deal with the areas that they have >>expertise in. Never do they assume total management, the FNP/CNM or FP >>always remains the primary care manager. The concept of >>interdispliplinary management is one that is finding favor in many >>institutions and clinics across the US. >> >>Now, would you now like to share your vast experience with the question >>at hand? You have asserted that the average OB/GYN would have more >>experience than an FP or midwife so I am assuming you possess a wealth of >>knowledge (unless you are not 'average' ) >> >>Deborah Wage, FNP,CNM >> >>Luis Sanchez-Ramos wrote: >> >>> At Tue, 17 Feb 1998, Deborah J. Wage wrote: >>> >"We have 3 women due next month with infibulation >>> >and would like some advise on what to do." >>> > >>> >We refers to 2 OB/GYNs, 2 FPs, 2 dual certified FNP/CNMs. >>> >>> I'm glad you're not on your own. Make sure the OB/GYNs take carte of >>> the high risk patients. >>> >>> Luis Sanchez-Ramos, MD > Next message: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's" Previous message: R. Daniel Braun, M.D.: "Re: female circumcision" In reply to: Luis Sanchez-Ramos: "Re: female circumcision" Next in thread: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's" Reply: Luis Sanchez-Ramos: "Re: Dr. Sanchez-Ramos & CNM's"

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