I am curious as to why a CNM needs less than a 10th of the experience of an OB resident to attend breech births alone at home? Do you view the OB required minimums as being way too cautious?
How do you feel about CPMs attending breech births?
We were only required to do 3 as an intern--I know I got more because I knew I wanted to be an obstetrician and hung out on the labor floor a LOT--same as any family practitioner who may be going into rural medicine---just in case someone presented to the ER and working in a place with no OB services. We had a rural medicine program where residents would do 6 months of OB/surgery and were trained to do C. Sections, low forceps and vacuums and had to do at LEAST 6 breeches --most got more than that (we did over 4000 deliveries a year at just ONE hospital in the city I trained and we had 5 other hospitals so plenty of deliveries--at least they HAD some experience with obstetrics and with breeches. Of course, KNOWN breeches/twins etc were transferred to a tertiary facility--where believe it or not we did NOT section breeches routinely--we delivered well over 80% vaginally--we were largely trained by Irish and Scottish doctors. The OB family practice basically did low risk deliveries and did not do PLANNED breeches---but if someone came in early at least they had someone with SOME experience.
I realize that the tide is such that women will choose home birth---some for altruistic reasons and some --especially the UC group may be planning it more because we have a crappy health care system here that cripples our citizen's finances==but that is another post. I would just like to see some standardization of midwifery----that some number (and I don't know now what that number IS), of deliveries be supervised and signed off on before flying solo.
...and I guess I don't really understand what a CPM does..... I have worked with CNM's so know what they do. I have a little problem with the idea being that they attend normal low risk deliveries--and then the line of what constitutes low risk has been--from what I see here--virtually erased---HVAC, HVAC2, twins, breeches.-etc.
I have seen a couple of uterine ruptures and they are ALARMING---last one THIS year was a women who showed up with no prenatal care and 10 cm---actually had everybody there and thought we would get a vaginal birth---I have done VBAC2s in the past many times---but BOOM ------Absolute WATERFALL of blood---I would say 750 ml-----thankfully we got the baby out with crash section withing 4 mins. I have no doubts that both would have died at home---her blood loss was well over 1500ml and required VIGOROUS resuscitation. I could do without another rupture---my anal sphincter is aging and may not hold up to another!
How do I unsubscribe from this thread, since you deleted my comment and all... obviously my perspective is not wanted in this "open exchange of ideas" so stop sending me emails about it...
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