Readers of this blog (and many others) often express a belief that under trained “mid-level providers” are equivalent to board certified physicians. If this law is allowed to go into effect, some unfortunate families will pay the ultimate price for their state’s legislative naivety…
In June, Gov. Matt Blunt signed into law a bill to make health insurance more affordable for the state’s citizens. The law includes a provision granting certified professional midwives the right to practice independently.
Related posts:
- Midwives and primary care
- Maine’s universal health plan a failure
- Idiocy in Missouri
- AMA working for reform that benefits patients and physicians
- Should a doctor be board-certified?
- Top 12 Trends for Physicians in 2008
- "No beginning physician could afford to cover the liability risks of today, alone"
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More physicians filing frivolous lawsuits. Great.
A nice embarassment for the legislators, of whom more than 90% are lawyers. They claim that they voted for the bill without understanding the meaning of certain words in the text, like ‘tocological’. Using an arcane word guarantees a reasonable legal challenge because interpreting its meaning as used in the 2007 bill could be quite difficult since no one actively uses that word today. It is a bit like using the word cunt today and claiming that you intend only that it be taken by the listener as a proper medical term (in 19th century medical texts) to denote the external female genitals.
The representative who introduced the bill is known for his chicanery, and this effort to get midwifery passed is the culmination of years of effort on his part to do so. Interestingly, it seems that from a representative perspective he is failing to ‘represent’ as his constituency does not seem on aggregate to favor this. He has also voted against his own constituency on other matters.
I would think that upon being duped the state house and senate would repeal the midwife law that they were duped into passing out of principle, then allow such a measure to move foreward on its own merits using plain modern language.
90% of the Missouri legislature are lawyers? Do the facts ever enter into your assessments?
Here’s the House of Reps website, educate yourself from there:
http://www.house.mo.gov/default.aspx?info=/bills071/member/memmail.htm
We all look forward to the multiplication of bad bady lawsuits.
Clinicians trying to stifle competition yet again. The “its for the patients” pabulum is wearing thin. Clinicians are abandoning patients left and right for simple financial motivations and now they are fighting to keep others from providing healthcare services in order to keep their hegemony intact.
Whether midwife births are any more or less dangerous than physician attended births has been studies. All studies of which I am aware indicate OVERWHELMINGLY that midwife attended births are BETTER for the mother in terms of invasive procedures and likelihood of C-sections and episiotemies.
Furthermore, while nice, randomized studies are impossible in this country, decent prospective studies show equivalent, or near equivalent, infant mortality rates for midwives and physicians.
http://jech.bmj.com/cgi/content/abstract/52/5/310
In fact, some studies suggest midwifery LOWERS neonatal mortality rates.
See above and
http://www.nber.org/confer/2005/hcs05/miller.pdf
Kevin’s knee jerk reaction is typical of the doctor monopolist mentality. It’s killing babies and moms –or at least causing a lot of unneccessary cutting and druggin– and really should stop.
“All studies of which I am aware indicate OVERWHELMINGLY that midwife attended births are BETTER for the mother in terms of invasive procedures and likelihood of C-sections and episiotemies.”
Which of course means better outcomes right??
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This same process is behind a lot of legislation that favors specific provider groups. One powerful legislator whose has been bought, and the rest wheeling and dealing their way through the day without reading or paying attention to the bills.
That is why psychologist prescribing (they aren’t even medical professionals for crying out loud, they are social studies majors!) is reality only in the two most corrupt states in the union with the most corrupt legislatures: Louisiana and New Mexico.
uhhh . . . where are all you evidence based medicine advocates? as was cited in the above-post, there is NO evidence that outcomes are worse for midwifes–to the contrary, they seem better. Why would anyone who isn’t an evil, greedy doctor be against the law?
Re: psychologists. If they prescribe for depression, who cares? It’s arguably not a medical condition. Doctors really have no understanding of its neurological mechanics–and not surprisingly, anti-depressives have enormous placebo effects. It’s all black box–and it should be a game all can play.
tricyclic antidepressants have a whole host of side effects based on their chemical properties, and interactions with lots of other commonly prescribed meds.
psychologists prescribing such drugs (or ANY drugs) is ridiculous.
“Doctors really have no understanding of its neurological mechanics” – by that logic ALL drugs should be over-the-counter – is that what you’re advocating???
As far as I know, the use of cesarean section in the US is now above the 30 %-mark (correct me if I’m wrong).
That fact alone speaks volumes about the average American obstetrician’s lack of reasonable abilities within his field.
A C-section rate that high is far beyond the WHO’s level that constitutes “good practice”.
So that makes it time to leave the field of childbirth to others, doesn’t it? If you can’t perform competentyly yourselves, why not let others have a chance?
Most of these posts demonstrate how a little bit of knowledge can be a very dangerous thing.
As a physician, it brings me no joy to supervise mid-levels. When the shit hits the fan, it’s my ass on the line. In our current legal environment, I may as well just see the patients myself.
That being said, if a mid-level, by law, can “be tried as adults” so to speak…do their own thing, carry their own libility, and share in the misery of lawsuits and “ultimate responsibility” (especially when something goes wrong)…
…I say, let ‘em taste our pain.
amen poster 1:07 –
In fact, for the minute-clinics that the undereducated masses are screaming for, the mid-levels doling out antibiotics & viagra should NOT have supervision by an MD off-site, and should bear the full responsibility of treating their patients, especially when the treat that “cold” with a z-pak when it was really a CHF or COPD exacerbation.
“In fact, some studies suggest midwifery LOWERS neonatal mortality rates.”
Yeah, okay. Midwives have better outcomes than OB’s. Does anyone in their freaking mind believe this garbage???
How many midwife deliveries have these dingbats actually attended where the thing goies HORRIBLY wrong and the doctor must step in? I HAVE I HAVE!!! And I’m sure there aren’t ANY Wwhere an OB said “Please Midwife, help meeeeee!!!”
To those whi crave all these superior midwife outcomes, please, do all OB’s afavor and NEVER DARKEN THEIR DOORSTEP!!! They won’t miss you, believe me.
Of course, most Americans have snese and wouldn’t choose such a thing.
Hey, Mike, thy name is confirmation basis. Look at the numbers. Do what doctors so rarely do–look at the evidence?
Undoubtedly, midwives go to doctors when there’re complications. As they should. And, no doubt, it’s a stressful challenge . . . uh . . . but that’s your job and why you get the big bucks.
However, for the vast majority of normal cases, cutting-happy doctors, with their drugs and unnecessary procedures, may not be the best choice.
If you were really concerned about women’s health, you’d accept this.
Going back to the ORIGINAL point of the post, as a CNM (certified nurse-midwife) I have to say I am glad this law is being contested. Most reliable midwives (nurse-midwives AND Certified Professional midwives) that I know PREFER to have a backup physician, a person whom they can trust to refer higher risk patients to or discuss them with.
I am not naive or an idiot; I am well aware that many midwives consider MD’s to be the worst evil in the medical world, or that the midwife can do things as well or better as an MD. (and yes, I have heard them talk). But I also believe that many times, Obstetrics has gotten too much like an illness and too little like a normal event.
I had high risk pregnancies and used an OB. I have cared for many women and had wonderful, safe deliveries and many women who ended up needing medical interventions for one reason or another.
I really believe that midwives and physicians can work together and tricks like this one are wrong.
One last thing: I have read many of the debates regarding MD vs midwife, home birth vs hospital. If you look at many European countries where women DO deliver at home, with a midwife, you see that many do just fine. However, here in the US we don’t have the infrastructure to do that safely. You can’t compare those apples and oranges.
Many midwives have great statistics. However, if you compare them to a MD ONLY COMPARING SIMILAR PATIENTS (drop all the high risk patients the MD has), I think most doctors would show the same great statistics.
Why doesn’t anyone bother to look at the studies?
http://jech.bmj.com/cgi/content/abstract/52/5/310
http://www.nber.org/confer/2005/hcs05/miller.pdf
Comparing apples-to-apples (normal pregnancies presenting no complications) midwives have equivalent outcomes without as much cutting and other invasive procedures?
As our friend from the North, Dr. Quisling-Hamsen, Oh, I mean Isberg, points out–U.S. obstetrics is the stray datapoint, way out of international norms as far as invasive procedures.
There are risks to going to a midwife; there are risks to going to a doctor. No one knows which is better. People should be able to chose; that’s what this law did. That’s good–and doctors are dastardly to oppose it.
The obvious point missed over the outcome studies is the complicated pregnancy is transferred to a real obstetrician, and the OB/GYN statistically inherits the bad outcome.
Anon 6:17, fdont confuse them with facts or obviosu statistical points. These guys just believe whatever they want to believe.
Kevin has already posted a wealth of articles about why C section rates are up.. hello, anybody say “John Edwards”??
And to the midwife who posted… if you take the VAST MAJORITY of pregnancies, and hand them to midwives, then where in the world do you think you can procure a vast number o OB’s from??? What would we need them for. But oops, if there’s ashortage, I guess we’ll just have to suck it up.
Why doesn’t anyone come to their senses about this midlevel stuff already?
to: let em taste our pain:
You are right on the money! Midwives probably have a unfair advantage when it comes to malpractice insurance because the physicians backing them up probably take the heat most of the time for bad outcomes, I would suspect. So as you say, if they can now practice without supervision, their malpractice rates would likely go up, thus leveling the playing field a little.
If you could really say, (for the sake of argument) let them die in labor, or somehow be able to hand off the duty to someone else, I’m not taking on the patient’s care, I suppose the malpractice rates would go up.
In reality, the obstetricians are FORCED to take on the patients as a condition of medical staff appointment.
So the midwife with the complication turns over the patient to the hospital, and the unlicky obstetrician on duty that day inherits the risk.
Having seen many such cases over the years, the midwife always skates off responsibility. The patient has been fed the anti-doctor line, to even be in the doctor’s care is sort of an insult to them, the midwife does not see any responsibility.
And heck, I’m in primary care. And even I’ve seen this. The other thing with mid-levels is the request for “co-management” and “collaboration” which really means when there’s trouble, the response is “I’m just the nurse” and the search is on for a doctor to take the blame.
yet another reason for boarded obstetricians (ie. MDs) to stop delivering babies & practice GYN only; and to be able to divorce oneself from the hospital and their requirements for unreimbursed on-call duties, etc.
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