Midwives Rock: Confessions of an OB/GYN Physician

midwifeI am an OB/GYN physician and…

I love midwives. In fact, I think MIDWIVES ROCK. Midwives deliver over 50% of the babies in our birth unit. When it comes to normal birth, they are the experts. Let me explain.

As OB/GYN physicians, we endure a very extreme four-year residency training program. We learn how to deliver babies in the most intense environments and difficult situations. We take care of very sick women while they are pregnant. We learn the art of intervention. We fix things. We come to the rescue. We save the day. We have many tools – vacuum, forceps, versions, cesarean. If things aren’t going well, we can make it better.

Midwives are different. In their training, they learn the art of normal physiologic birth and find pride in maximizing the patient experience in the birth process. They coach and labor support the patient when she wants to deliver without medication. They focus on education and wellness during the pregnancy. They offer options such as intermittent monitoring, birthing bars, labor hammocks and waterbirth. They also care for patients that end up with epidurals and c-sections and they provide support through that process.

So here’s the thing. Not all birth is fluffy with hearts, flowers and rainbows. Midwives know that and so do Doctors. Sometimes the shit literally hits the frickin’ fan… and that is where I come in. Though I am not always viewed as a superhero, the midwives do a great job of pumping me up before I even enter the room.

“She does the best c-section. Don’t worry, her incisions are tiny,” I’ll hear them tell the patient from outside the room.

“It’s okay. Dr. S. will come and see if a vacuum can’t give that babe a little help…”

So sweet. They are the best. This is the stuff I live for. I want a challenge. My training afforded me that. No offense, but normal birth isn’t really my thing. I have bigger fish to fry. There’s the patient with the ectopic pregnancy in the ER or the horribly sick pregnant patient in the ICU. All problems outside the scope of midwifery practice. All problems inherent to my training.

In a perfect world, we divide and conquer. We focus on the things we are good at and stratify. It’s a practice model I try to help my colleagues understand. We are experts in different things and we complement each other. Our patients can only benefit from our willingness to work together as a team and keep the lines of communication open.

Yesterday, while on-call, I had to attend to a bleeding patient in the postpartum ward. I left my laboring patient to the midwife on-call.

“I’m so sorry, can you catch her baby in case I am stuck downstairs?” I asked.

“Of course, be happy to,” the midwife replied.

I slipped downstairs and evaluated the bleeding patient. On my return, I watched the midwife perform the delivery on my patient. The lights were turned down. The bed was still intact and had not been broken down. She had my patient pushing on her side and the babe slowly eased out while the midwife coached her through the process. It was beautiful. I was so happy that my midwife partner could provide such a special experience for my patient while I was pulled to attend a more critical issue. I felt comfort leaving my patient in the midwife’s hands.

To my future patients… indulge in your mosaic tubs. Hang from your birthing hammocks. Open your pelvis with birthing yoga. Bring your doulas and your five-page birth plans…

Bring it. Were ready. We will love you for it. We want you to have the birth experience of a lifetime. MIDWIVES ROCK.

But remember, if the shit hits the fan. I’ll be there. Waiting in the wings. Ready.

Disclaimer: Medical stories are fictionalized.

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35 thoughts on “Midwives Rock: Confessions of an OB/GYN Physician

  1. I LOVE this post so much! I have never understood why so many doctors and midwives are at loggerheads with each other. When I did OBGYN for Internship recently, midwives were my saving grace. I was busy learning to do C-sections, and they made sure that I didn’t have to worry about the women delivering vaginally while I did so. And their gut feeling was impeccable. Sometimes they would let me catch a nap because they knew everything was going to be fine with an admission; other times they’d literally come fetch me wherever I was because they had a feeling – even before the CTG was done – that something was wrong.

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    1. So glad you enjoyed the blog. I am surprised that there is any friction in South Africa among OBs and Midwives as I was always under the impression that your country has a long history with midwifery care. Good to hear you appreciate them. They really can help us OBs along. Cheers!

      Liked by 1 person

    2. I appreciate the intention of the article and I think this model could be used in any practice that employs advanced practice nurses. I am, however, disturbed by the disclaimer below the article that states “medical stories fictional”. How much of the article is fiction?
      I think the addition of fiction diluted the message of colleaguialty that is so needed in the health care community. The “stories” were not needed to make the point. Real events like this happen every day.

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      1. Hi Phyllis, I guess what I meant to say is that the medical stories are “fictionalized” in the interest of protecting patient confidentiality, I did not want to use actual stories, but rather tweak a bit. Of course, there are many true stories to tell, but as providers, we have to be careful that a patient would not be able to identify themselves through those stories.

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  2. SImply awesome insight here by writer!!! We midwives are honored to work along side of our OB/GYN colleagues when we can all appreciate each other’s strengths! It is always our birthing families who benefit from such a team.

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  3. This is a fabulous Veiw into what I hope is most physicians brains. I am a midwife and I feel that your explanation of the differences yet the impecie collaboration is spot on. I love working with MD’s who value what we do. I for one do understand your training and feel blessed with your expertise when one of my precious mamma’s needs it. Thanks for a fabulous post that promotes what we as midwives do and how our collaboration works like a symphony when attitudes are in the right place for the patient’s care! You rock!

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  4. I’m also an OB/GYN and I love midwives. And my stories are real.
    Mother’s Day 2000. The midwife called and said, “GET HERE NOW!” I said, “Yes, ma’am” and drove like the proverbial bat out of hell. Patient was 8cm, bleeding profusely, but already in the operating room and everyone was ready.. Anesthesia came in wearing shorts. “Do you want me to change?”
    “Hell no, I want you to put her to sleep!”
    Found an 80% abruption. Baby needed a little resuscitation but did well.

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  5. I am a student midwife in New Zealand. We have the most amazing model of maternity care here. Women have their own Lead Maternity Carer – this is usually a midwife. They only ever have an OB when their is cause for referral outside ‘normal’. Even then midwives are trained and often more experienced in birthing malpresentstions. We save our OBs for instrumental intervention and the unwell women outside our scope of practice. I am so excited that I will be part of this women centred partnership in care model!! 😍

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  6. Fantastic post. I am a midwife in Canada and have friends in New Zealand (LOVE their system). We work well with our OB colleagues here but it can always be better. But this morning the situation highlighted exactly why we can work together for the best outcomes. My primip client, normal healthy woman with normal pregnancy came in at 4 cm and 2 hours later was fully and pushing; fetal heart rate always normal. Head was low, she was progressing well. Ten minutes later, the fhr was 75 and didn’t recover. Pressed the call bell, nurses came, OB came. Intrauterine resus, scalp clip, ?stat c/s (anesthetist at home …), ?vacuum, still no improvement of fhr. Mom pushed like stink with my voice (that she knew) in her ear, OB placed vacuum, respiratory therapist and NICU nurses in the room, baby born 20 minutes after first abnormal fh. After 30 seconds of stimulation, pink and crying. No resus, no nuchal cord, no obvious cause. Without that team though, no idea what the outcome would have been. Not all our OBs remain in hospital – so appreciate that this one does. So does my client and her baby, who are the ones that we always have to keep in mind.

    Liked by 1 person

      1. I’m so glad to hear you’re in my home state! I have a sad story to tell you. There was a wonderful thriving OB/GYN + Midwife practice run by a woman OB/GYN in my home town and the male OB/GYN’s in town effectively ran her out of business with complaints of “unsafe practices” meaning the use of midwives. I’m so thankful for this article to show how OB/GYN’s benefit from having midwives as part of their practice, but how patient care is improved greatly. I hope one day that a practice of a similar model will open so women can get such a high level of care again.

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  7. This was wonderful and how I love to practice, it should always be a team. I never want to practice without my OB back up! Renee Beninger CNM, FNP in Portland, Oregon

    Liked by 2 people

  8. I love this post! I think my favorite phrase is “my midwife partner”. As as advanced practice nurse I thank you for that! The term “mid-level providers” needs to go away.

    Liked by 1 person

  9. I completely support Nurse Midwifery, but I am very concerned about direct-entry midwives in the US who have much less education and training, who are doing home births, in which survivable complications become unsurvivable. They are not held accountable in the same way that CNMs and OBs are, but they are promoting themselves as being “at least as safe” as more qualified providers.

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    1. Some direct-entry midwives do not have adequate training–but some do. Laws vary state to state. In my state we are required to attend a 2-3 year program and perform rigorous clinicals (including some in-hospital births and work with backing physicians) before we can become licensed. We also are required to hold malpractice insurance. I agree that little to no training in the out of hospital birth midwife sector is scary and I hope as more states legalize midwifery (there are about 10-11 that aren’t), they adopt this style of training. Being an “expert in normal birth” is not enough, because birth doesn’t always go “normal”.

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  11. As a nurse-midwife, I appreciate what I read as the bottom line of this post: we have different roles, and it would be silly than to do anything else but complement each other for the sake of women. I’m right there with you.
    However, saying you have “bigger fish to fry” is, in my mind, part of the problem. Ectopic pregnancies and crash sections are “different” fish for sure, but are just that: different. Every event in a woman’s reproductive life is different, and I think we could all stand to use language (midwives included!) that recognizes our varying skill sets without ranking their importance. I for one never use the term “natural birth.” What does that even mean? Was your birth “unnatural” if you had a c-section? Ridiculous.
    Thank you for your post!

    Liked by 1 person

    1. Hello Darcy, thank you for your comments. Certainly meant no disrespect with “bigger fish to fry”, but gosh I just love that expression and it sort of gave me a chuckle to put it in there. Whether “bigger” or “different” is the appropriate term to use, I think the point I was trying to make is that we have different skill sets and we complement each other. Also, as physicians, we are trained to care for patients in more complex acuity conditions and the best use of our time is to collaborate and work within the boundaries of our scope of practice as a team. That’s really what we are in our practice setting – a phenomenal care team.

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  12. So nice to read this simple, straightforward take on how midwives and OBs can see each others’ expertise as complementary and work best together. Thanks!

    Liked by 1 person

  13. A really interesting article. As a Midwife in England, I know things are a bit different here. Midwives are the main carers of pregnant women antenatally, intrapartum and postpartum here. We only involve the Dr’s if there is a clinical need. I have such an enormous respect for my Dr colleagues and friends who are ALWAYS there when we need them. We also work as a team. They don’t intervene when they know they don’t need to, and we involve them when we know we need them! It’s interesting to read about how things are done by our counterparts across the ocean!

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    1. Hi Nicky-
      The outpouring of views and opinions on this matter is utterly refreshing. It is the way it should be. We have worked hard to create a model in our practice similar to that found in the UK, but alas we are living in a bit of a bubble here. My interpretation is that much of the issues stem from a lack of respect and clinical trust within the OB/GYN community (not all of it) and financial pressures/competition in the current environment. As we still have a “fee for service” reimbursement structure in the USA, midwives and docs often feel as though they are pitted against each other. I do feel the tide is turing in a new direction and am hopeful for more collaboration in the future! Thank you for your comments!

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  14. Midwife on call tonight reading your blog! Love this and thank you for the positivity. I adore my MD consultants and thank God for them when things get scarey. I’m blessed to work in a very collaberative practice. However I haven’t always worked with good support…some docs feel threatened by midwives, are just down right nasty to us or think of us as a malpractice risk. Would love your thoughts on how to change that culture.

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    1. Hi Jenn, thank you for your comment. Yes, I have also observed that there is great variability in cohesiveness of function of collaborative practice. We are changing the culture, one practice at a time. Lots of eduction. Lots of conversations. We also ask the midwife providers to be patient as it takes time for physician providers to learn how to practice in such a different way. Not everyone will buy into the practice model, but most of the new physicians graduating from residency are very familiar and comfortable with this practice model. I think we will see the tide turn over the next 10-15 years.

      Regarding malpractice risk – there is variability across the country with respect to this issue and I realize it is quite touchy. Should the physicians carry any risk, it is probably best to have some sort of accountability for the midwife providers to communicate regularly with the physician providers. Often times physicians feel as though they are the last to know about something going south if they are only called on a consultation basis. In our practice, the midwife and physician providers share the patients on the unit and we can freely discuss the progress and report out care plans. There are no barriers to that communication and that is very important to us.

      Another important piece is to create a compensation model that drives the model of care and incentivizes the right behaviors.

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  15. In Afghanistan midwives are claiming that complete Maternal health is under their practice. Apart from Maternal health consultation none can restrict them from prescribing combination of:Metronidazole,Amoxicilline,Nystatin,Ciprofloxacin ,Enoxacin,Folic acid for the treatment of PID (Pelvic Inflammatory Disease) under the slogan of to Fight for the women Wright by international community

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    1. Thank you for your comment. I know there are variations in scope of practice for midwife providers in other countries, especially when there is a scarcity of health care providers. I think it is important to note that my experience and love for midwifery stems on the concepts of collaboration. Without mutual respect, accountability and expectations of using best practices, the collaboration between doctors and midwives can be quite dysfunctional.

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