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I am a certified licenced midwife who has attended out-of-hospital birth in the Portland Metro area for 26 years. My understanding has been that there are only two major hospitals with on site OB's 24/7 : OHSU and Emanuel.  Every place is different in protocol and response.  Some hospitals will not call the OB in until a nurse has first assessed the need.  In other cases, when we have requested a surgical team to be enroute immediately, the team was walking in the door at the same time we arrived.  These are the very rare moments where respect between doctor and midwife are crucial to outcome as well as the experience of the birthing family.

I can say that the majority of my experiences with transfer to physicians have been very positive. The best transfers of care occur when both midwife and receiving physician refuse to view one another as an adversary, but accept the other as a co-helper for the laboring mom. The excellent midwife prepares her clients prenatally to view the hospital as a positive place, there to help them if the need arises. She will communicate openly with hospital staff and not take a defensive posture. The excellent physician will ask the midwife for her insights and ideas on how to help the birthing family.  These wonderful doctors express empathy to the famiy, acknowledging that things didn't unfold as they had hoped. This respect assists the family in accepting needed medical interventions and generates a best outcome scenario both medically and emotionally. 

In my experience, those rare hospital transports that are truly horrific are usually not due to physician disagreement with care decisions made by the midwife, but to the fact a home birth was planned in the first place.  I have seen Doctors yell at parents, call them idiots, and actually cause serious medical harm, neglect patients, or refuse to provide care due to their anger and prejudice.  Midwives can be just as wrong when they delay timely transport due to hospital prejudice. Fortunately, most Doctors and midwives are professional enough not to let their strong opinions compromise good care.

If we truly care about the mothers and babies we serve, both physicians and midwives would develop working relationships where they view one another as allies and work together for optimal outcomes and experiences.

posted 4 years ago
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