This week begins National Midwifery Week, and both national and global midwives deserve this recognition for their incredible work.
Although obstetricians and midwives deliver babies, there are differences in our respective training, which I previously discussed in my book, The Smart Mother's Guide to a Better Pregnancy. There is also a rift between both professions that I hope will heal. I thought long and hard about this division and realize that the difference stems from priorities. Midwives focus on the experience of birth, while obstetricians concentrate on the outcomes related to childbirth. Both groups also want the ensure the well-being of an expectant mother.
While many states allow certified nurse-midwives to practice independently, all states encourage physician collaboration under emergent circumstances. These circumstances include complex cases and cases that exceed the scope of their training. Not all pregnancies are low-risk, and not all babies can be delivered vaginally.
Based on over three decades of clinical practice and two decades of obstetrical medical malpractice case reviews, this author recommends the following:
1. Identification of a referral source or collaborative physician for home birth deliveries before the onset of a patient's labor
2. Collaboration or obtain a second opinion for patient's with Category 2 fetal tracings lasting more than a maximum of 2 hours (preferably after one hour)
3. Do not assume that patients elevated blood pressures are due to pain during labor. Seek collaboration or a second opinion for all patients, which elevated blood pressures using AHA and ACOG criteria.
Careful planning and collaboration will not only reduce patient harm but will also save your professional license.
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