Any reputable NICU will have and hire Neonatal Nurse Practitioners (NNP's). The level III NICU I worked at for many years, utilized NNP's to follow the most critical and long term neonates. They provided great continuity of care (as opposed to pediatric residents), and were very skilled in critical care procedures such as intubations, UAC/UVC placement,chest tube insertions etc. The only other example of nurse practitioners I have dealt with personally is certified nurse midwives. I recommend CNM's to any woman with an uncomplicated pregnancy.
"I recommend CNM's to any woman with an uncomplicated pregnancy."
This is one of the silliest things I've ever read. It's like saying if you are a safe driver you won't need car insurance. Or even if (s)he is really nice, I don't need to use a condom. Any one can catch a baby, including the inanimate vehicle the woman is driving in enroute to the hospital. OB complications are not restricted to easily identifiable factors. There are also emergent complications which the Midwife is not trained to deal with. Only OB/GYN's are trained to deal with all complications. To be willing to invest 9+ months of your body, time and energy into a fetus and then at the end take the risk with some one who is not capable of handling all the complications is pure stupidity.
Midwives are on par with poor choices like not vaccinating your child or smoking.
No way would I have my newborn managed by an NP in the NICU. Sorry. Certainly not for a chest tube or intubation. I would barely trust a senior peds resident under direct supervision of a NICU attending. That stated, NP's do have a role in uncomplicated admissions (simple pneumonia,UTI) and simple consults (ortho medical management in a non-complex patients) as long as there is hospitalist MD/DO backup. I disagree with BM/GS. Nurse midwives play a very important role in uncomplicated pregnancies as long as there is OB backup. High risk preganancy is another story A practicing doc
Bad medicine is woefully ignorant of what Certified Nurse Midwives do. In the state I work in the midwives are covered and partnered with an OB/Gyne group. The midwives have better outcomes (higher birth weights, less admissions to NICU etc) than their MD peers (yes, peers). They also have extremely low C/S rates. Your bias is not based on fact, but on ignorance. Birth is normal! Anonymous is correct that midwives have a very important role in low risk pregnancies. Caring for a "high-risk pregnancy" would be against their advance nurse practice acts anyway. I'm bummed on your views on NNP's however (is this from personal experience?). I will be forwarding BM/GS comments to some birthing blogs. It should give Happy some good traffic!
It is being done. I have a friend who is an ARNP that works at an ICU in a San Fransisco academic medical center (sorry can't remember which one). She basically acts in the role of a senior resident managing patient care on nights when the residents don't have call. From what I hear the program is considered a success and the residents don't feel pressured to violate work hours.
The midwives have better outcomes (higher birth weights, less admissions to NICU etc) than their MD peers (yes, peers). They also have extremely low C/S rates. Your bias is not based on fact, but on ignorance. Birth is normal!
I agree that the conception of birth as some sort of pathologic state is wrong. OB/GYN:fetus::ERdoc:adult, not primary:adult.
I am surprised at the doctors who blog against MLPs based on their superior training and yet don't seem to think to use stats to back up their arguments. Haven't seen one yet on several MD blogs. If MD training is a necessity, the outcomes for MLP managed patients would clearly be worse and this information must be somewhere.
But speaking of numbers, are those CNM outcomes controlled for the relatively higher number of uncomplicated pregnancies treated by CNMs?
If the CNMs have better Outcomes what are the OB/GYNs doin Birthin Babies???? Most of em probably rather be doin GYN procedures anyways... Evidence Based Medicine is the Future!!!
Didn't Gomer Pyle deliver a Baby in one episode???
Nurse midwives work in collaboration with ObGyns just like L&D nurses. There is always an ObGyn at a moments notice for any abnormalities or C sections. The bulk of the midwives training is focused on recognizing these abnormalities so that they can wake up the ObGyn doc to do the section, or vacuum. It is one of the most successful collaborations in medicine both for the docs and for the patients
Agreed Chris, I posted about this MLP bashing on my blog a while ago. So far, not one physician has produced an ounce of credible data to back up their concerns. It's kinda sad actually. I work at an ED where there are only PA's working, it is solely staffed by PA's. We have physician backup, but no one present. We also had the highest patient satisfaction scores in the ENTIRE COUNTRY last year. Now, I am not ignorant enough to believe that this is solely because of PA staffing, but it is an interesting fact. As one of our attendings at Mayo said. "You know, I'd rather have an experienced EM PA out there that knows his way around a trauma or code, than some family practitioner moonlighting there, who likely hasn't intubated someone in years."
So what did women do before there were OB/GYN doctors to slit them and drug them? Was the human race in jeopardy until you all were trained to save us all?
You and all other narrow-minded doctors are the reason I gave birth at home. I'll take my chances with a midwife, thank you.
Any reputable NICU will have and hire Neonatal Nurse Practitioners (NNP's). The level III NICU I worked at for many years, utilized NNP's to follow the most critical and long term neonates. They provided great continuity of care (as opposed to pediatric residents), and were very skilled in critical care procedures such as intubations, UAC/UVC placement,chest tube insertions etc. The only other example of nurse practitioners I have dealt with personally is certified nurse midwives. I recommend CNM's to any woman with an uncomplicated pregnancy.
ReplyDelete"I recommend CNM's to any woman with an uncomplicated pregnancy."
ReplyDeleteThis is one of the silliest things I've ever read. It's like saying if you are a safe driver you won't need car insurance. Or even if (s)he is really nice, I don't need to use a condom. Any one can catch a baby, including the inanimate vehicle the woman is driving in enroute to the hospital. OB complications are not restricted to easily identifiable factors. There are also emergent complications which the Midwife is not trained to deal with. Only OB/GYN's are trained to deal with all complications. To be willing to invest 9+ months of your body, time and energy into a fetus and then at the end take the risk with some one who is not capable of handling all the complications is pure stupidity.
Midwives are on par with poor choices like not vaccinating your child or smoking.
No way would I have my newborn managed by an NP in the NICU. Sorry. Certainly not for a chest tube or intubation. I would barely trust a senior peds resident under direct supervision of a NICU attending. That stated, NP's do have a role in uncomplicated admissions (simple pneumonia,UTI) and simple consults (ortho medical management in a non-complex patients) as long as there is hospitalist MD/DO backup. I disagree with BM/GS. Nurse midwives play a very important role in uncomplicated pregnancies as long as there is OB backup. High risk preganancy is another story
ReplyDeleteA practicing doc
Bad medicine is woefully ignorant of what Certified Nurse Midwives do. In the state I work in the midwives are covered and partnered with an OB/Gyne group. The midwives have better outcomes (higher birth weights, less admissions to NICU etc) than their MD peers (yes, peers). They also have extremely low C/S rates. Your bias is not based on fact, but on ignorance. Birth is normal! Anonymous is correct that midwives have a very important role in low risk pregnancies. Caring for a "high-risk pregnancy" would be against their advance nurse practice acts anyway. I'm bummed on your views on NNP's however (is this from personal experience?). I will be forwarding BM/GS comments to some birthing blogs. It should give Happy some good traffic!
ReplyDeleteNot peers. Not at all. By the way, the only way to truly determine if a pregnancy is high or low risk is to look back after it's over.
ReplyDeleteWhen (stuff) goes wrong, you wanna be in the hands of that mean doctor.
It is being done. I have a friend who is an ARNP that works at an ICU in a San Fransisco academic medical center (sorry can't remember which one). She basically acts in the role of a senior resident managing patient care on nights when the residents don't have call. From what I hear the program is considered a success and the residents don't feel pressured to violate work hours.
ReplyDeleteThe midwives have better outcomes (higher birth weights, less admissions to NICU etc) than their MD peers (yes, peers). They also have extremely low C/S rates. Your bias is not based on fact, but on ignorance. Birth is normal!
ReplyDeleteI agree that the conception of birth as some sort of pathologic state is wrong. OB/GYN:fetus::ERdoc:adult, not primary:adult.
I am surprised at the doctors who blog against MLPs based on their superior training and yet don't seem to think to use stats to back up their arguments. Haven't seen one yet on several MD blogs. If MD training is a necessity, the outcomes for MLP managed patients would clearly be worse and this information must be somewhere.
But speaking of numbers, are those CNM outcomes controlled for the relatively higher number of uncomplicated pregnancies treated by CNMs?
If the CNMs have better Outcomes what are the OB/GYNs doin Birthin Babies???? Most of em probably rather be doin GYN procedures anyways... Evidence Based Medicine is the Future!!!
ReplyDeleteDidn't Gomer Pyle deliver a Baby in one episode???
No, that was Andy Griffith
Nurse midwives work in collaboration with ObGyns just like L&D nurses. There is always an ObGyn at a moments notice for any abnormalities or C sections. The bulk of the midwives training is focused on recognizing these abnormalities so that they can wake up the ObGyn doc to do the section, or vacuum. It is one of the most successful collaborations in medicine both for the docs and for the patients
ReplyDeleteAgreed Chris, I posted about this MLP bashing on my blog a while ago. So far, not one physician has produced an ounce of credible data to back up their concerns. It's kinda sad actually. I work at an ED where there are only PA's working, it is solely staffed by PA's. We have physician backup, but no one present. We also had the highest patient satisfaction scores in the ENTIRE COUNTRY last year. Now, I am not ignorant enough to believe that this is solely because of PA staffing, but it is an interesting fact. As one of our attendings at Mayo said. "You know, I'd rather have an experienced EM PA out there that knows his way around a trauma or code, than some family practitioner moonlighting there, who likely hasn't intubated someone in years."
ReplyDeleteSo what did women do before there were OB/GYN doctors to slit them and drug them? Was the human race in jeopardy until you all were trained to save us all?
ReplyDeleteYou and all other narrow-minded doctors are the reason I gave birth at home. I'll take my chances with a midwife, thank you.