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for the Obstetrician/Gynecologist
Vol. 32, No. 22 Published November 15, 1997 MDs Find Midwives Offer High Standard of Care BY SHEILA STAVISH San Francisco Bureau ........ VA N C 0 U V E R -- When ob.gyns. at Rochester (N.Y) General Hospital were told 8 years ago that midwives were going to be incorporated into the obstetric service, there was much grim talk among the physicians about deterioration of quality care and loss of status. Now, ob.gyns. and midwives at the hospital are collaborating harmoniously, learning from each other, and sharing pride in the hospital's record of excellent outcomes with lower rates of intervention than that of similar community hospitals in their area. The instructive pariah-to-partner tale was told by Dr. Jeanne E. Grove at the annual meeting of District 11 of the American College of Obstetricians and Gynecologists. A senior attending ob.gyn. at Rochester General Hospital, she is currently president of the hospital's medical and dental staff. During their first 4 years on staff, the midwife contingent was essentially marginzed. But in 1992, the University of Rochester stopped using the hospital as an ob-gyn. residency site, leaving 20 physicians to handle 2,300 deliveries a year with no house staff backup.
Into the gap stepped the midwives, whose work was a "delightful surprise" to Dr. Grove's colleagues. "Their fears proved to have no substance," she said. "The roles of physicians and midwives proved to be complementary, not competitive, adding value to patient care." Midwives began to assist with all deliveries, allowing the ob.gyns. to see their skills and appreciate their knowledge, Dr. Grove said. In turn, the physicians taught the midwives to do circumcisions and to serve as first assistant at cesarean sections. Simply exposing ob.gyns. to midwives ultimately led to what Dr. Grove called the best approach to obstetric care: "High touch with high tech." Since 1993-when the hospital instituted a new freestanding ob.gyn. residency program-midwives have provided 3060% of the coverage that would ordinarily fall to the physician house staff. Of the hospital's private patients, 24% are cared for by midwives. Residents are welcome to participate in midwife-managed deliveries, but they must follow the midwife style of practice. Currently, total deliveries by all providers in the hospital number almost 3,000 per year. Midwives are now providing prenatal care and managing term uncomplicated labor and spontaneous deliveries, including patients with protracted second-stage labor. Further, Dr. Grove said, midwives interview prospective residents, "to enlighten them about collaborative practice," and help mentor residents. Midwives also give grand round and didactic seminars to medical students and nurses.