Midwives now doing annual exams at my OBGYN office?

[Lisa75]

I hope this is the right board to post this. And first, I do not mean to insult or undermine anyone who may be a midwife or part of this profession.

I have gone to an OBGYN practice for many years now. I love it so much that I travel over an hour every year for the appointment. My annual is coming up and I received a call from the practice that my doctor was no longer there (she had a baby and quit working). They offered to re-book my appointment with a physician assistant. I was fine with that. But they then tried to move me from October (time for the annual exam) to March .

They called back and offered the original appointment but would I be willing to be seen by one of the midwives? I was just a little taken back by this. I had not heard of this in a regular practice. I am just not informed about this and wanted to get some opinions. Is this common now? Is a midwife a nurse as well?

I really am not sure. I just turned 35. DH and I are trying to conceive for the first time and have been for about one year now. It seems to me like I probably need a doctor on board. I asked them to go ahead and book the exam but please assign a new doctor to me as well.

This is a really good practice. It's nice, the doctors were great. The office is really nice. It is also at the hospital I would use if we are fortunate enough to have a baby soon.

What do you guys think? Again, I probably just am missing that this is totally common place now and acceptable. And I am not here to insult anyone's profession. I just want to learn for my own sake and decision making. Just hadn't heard it before.

My guess is they have had to cut back like many other places and maybe are just having doctors deal with actual pregnancies and births. Would the midwife be able to assess possible reproductive issues as well?

I look forward to hearing what everyone knows and/or thinks on this topic.

Thanks, ladies!

 

[Mermaid02]

CNM- Certified Nurse Midwife. They do annuals at my doctors office! I figure if they can deliver a baby, they can do a pap and breast exam!

 

[barkley]

just want to suggest that if you have insurance you check with them to see if they will cover treatments or procedures from midwifes.

my insurance will deny certain identical procedures/tests (like a pap) if it's done by a p.a. instead of the actual doctor. back in the 90's when i had my kids i used a midwife employed by my ob/gyn's office, and the insurance would only cover it because she was also a p.a..

 

[kelleyrn2000]

This is pretty common in my area. I did see an OB for most of my pregnancy visits, but my first few visits were with a wonderful midwife who really helped me get through those first few months, and worked closely with the dr's to make sure I got the medications I needed. There was one instance she left the room to consult with the OB in the office before I left to decide on treatment. I felt very confident in her care. Later I was followed by my OB for the pg and delivery (my choice, but I could have chosen the midwife as well).

There are also nurse practitioners who do alot of the routine annual visits, but that is personal preference. I prefer to see my OB, since that is usually the only time I see a dr during the year. But many people like the fact that nurse practitioners and midwives generally have a little more time to spend with each patient. I think it's a matter of personal preference, but most are typically very competent to handle routine visits.

 

[marlynnp]

Is this a Certified Nurse Midwife? Then I would be completely fine with it. They are completely qualified to perform annuals.

When you are pregnant (or if you have problems conceiving) you will also have appointments with a Dr. when necessary. I had this type of 'combined' care over ten years ago.

 

[Lisa75]

Thank you for all the replies. I knew where to go to get a good idea of this. I think it just hasn't been common in this area and I didn't realize. That is a good point about the insurance. I will check to make sure our BC/BS covers this. I take for granted that the office knows your insurance and what is covered, but good point! I am much more at ease now.

 

[disney1990]

Thank you for all the replies. I knew where to go to get a good idea of this. I think it just hasn't been common in this area and I didn't realize. That is a good point about the insurance. I will check to make sure our BC/BS covers this. I take for granted that the office knows your insurance and what is covered, but good point! I am much more at ease now.

Most insurance companies in situations like this make payment to the Doctor's office, so it doesn't matter who you see at the particular practice.

 

[erincon23]

When I was pregnant with my first child, I interviewed a couple of drs that had been suggested by friends. I went to see one doctor, who I knew worked with two midwives (in Illinois, midwives are required to be in practice with doctors and actually in the hospital during any delivery, although the midwife could deliver the baby -- I know in some other states they can practice independently). This doctor told me that while I would see him probably twice during my pregnancy, I would be much happier with the midwife for regular visits, because, in his words, he "had the personality of a doorknob." That's who I went with! I did see the midwife for most of my visits, although I ended up being very glad that the doctor was required to be in the hospital during delivery, because I had to have an emergency c-section.

I changed practices after that child (doctor was VERY far away), and loved the new OB/GYN, but in the last few years started to see the physician's assistants in their office -- I think they're terrific. They seem to have more time and interest for their patients, and unless I really have a specific, complicated issue, they have enough knowledge to deal with my regular problems. I wouldn't hesitate to see a P.A. or a midwife especially if I was pregnant (unless there were complications, of course). Midwives have quite a bit of additional training, have to be licensed and take exams, etc. I think you'll be pleasantly surprised.

 

[castleview]

I had a midwife for an OBGYN exam and she was terrific. She spent far more time than the doctor would have and she was extremely informative.

I'm not sure if this is the trend, but it seems like many offices are having their midwives, nurse practitioners, and physician's assistants doing routine care and leaving the emergency situations and research to the doctors. I'm ok with this since I've found that if a doctor isn't young, there's a good chance they are burnt out or bored with routine care.

 

[barkley]

Most insurance companies in situations like this make payment to the Doctor's office, so it doesn't matter who you see at the particular practice.

i would still check to make sure.

i've got a ppo plan, so unless i go to a preferred provider i have to both meet my deductable and pay a much larger share of cost. the issue we have been seeing much more in the last year or 2 is with the economy, while an a medical group might be listed as a preferred provider with our insurance, everyone working within that medical group is not nesc. working FOR that medical group (read-private contractor with the group) so unless they have personaly contracted with our insurance company to be a preferred provider we are out of luck.

it's to a point, that unless dh, the kids, or i have an appointment with our specific doctor that we know is covered, we have to research it before the appointment. that's a huge issue when it's an issue that requires a same day (walk in) or what our group calls "urgent care" (no appointment, walk in after 4 p.m. or during their limited sat/sun hours) because the group rotates all the doctors and p.a.'s (they each have so many days/hours each month that they are slotted into having no appointments and being the go-to person to see these in-coming patients).

i remember when i was trying to get pregnant with my second child, b/c of issues i had with the first pregnancy i spent months locating an obgyn group that was not only covered, but had all their staff as employees and were therefore covered (this was back in the 90's, and at least where we lived-midwives were often private contractors who worked for several doctors and might only be in a particular practice's physical location once or twice a week).

 

[mickeyboat]

I always see a CNM (for 13 years - through the births of both my children, two pregnancy losses, and my gyn care for 10 years), and I have been very happy. They don't hesitate to being in a doctor if they need to, and have always spent a lot of time at my exams and care about the whole me, not just part of me.

 

[cm8]

I hope this is the right board to post this. And first, I do not mean to insult or undermine anyone who may be a midwife or part of this profession.

I have gone to an OBGYN practice for many years now. I love it so much that I travel over an hour every year for the appointment. My annual is coming up and I received a call from the practice that my doctor was no longer there (she had a baby and quit working). They offered to re-book my appointment with a physician assistant. I was fine with that. But they then tried to move me from October (time for the annual exam) to March .

They called back and offered the original appointment but would I be willing to be seen by one of the midwives? I was just a little taken back by this. I had not heard of this in a regular practice. I am just not informed about this and wanted to get some opinions. Is this common now? Is a midwife a nurse as well?

I really am not sure. I just turned 35. DH and I are trying to conceive for the first time and have been for about one year now. It seems to me like I probably need a doctor on board. I asked them to go ahead and book the exam but please assign a new doctor to me as well.

This is a really good practice. It's nice, the doctors were great. The office is really nice. It is also at the hospital I would use if we are fortunate enough to have a baby soon.

What do you guys think? Again, I probably just am missing that this is totally common place now and acceptable. And I am not here to insult anyone's profession. I just want to learn for my own sake and decision making. Just hadn't heard it before.

My guess is they have had to cut back like many other places and maybe are just having doctors deal with actual pregnancies and births. Would the midwife be able to assess possible reproductive issues as well?

I look forward to hearing what everyone knows and/or thinks on this topic.

Thanks, ladies!

Midwives are just as capable of administering an GYN exam. I can understand that due to your situation with trying to conceive, you may want to bring that to the attention of your practice and I am sure that they can fit you in with someone else. Good luck with trying to conceive

Lot's of baby dust coming your way

 

[MariDisney]

I have had all my GYN care with midwives for about 10 years now. I MUCH prefer seeing the midwife to the doctor. She takes a ton of time and also makes some recommendations about alternative treatments. In the times I've need the care of a doctor she has been swift to make sure that happened and I never felt like a midwife has been involved in something beyond her scope of expertise.

 

[Pea-n-Me]

This is not my area of practice, so I can't say for certain, but here are my thoughts:

I would venture to guess that the "midwife" they referred to is actually a Certified Nurse Midwife but that there is some confusion over the semantics of names, even within the area of service itself and people answering phones, etc. A CNM will likely have the same level of training as a Physician's Assistant (PA), i.e. at least a Master's Degree, and an advanced practice license, although the CNM in all likelihood spent many years working as a Labor and Delivery nurse before completing additional training to become a CNM. I think that in other areas, NPs are called NPs, but in OB/GYN they're called "midwives" (when in fact they're CNMs).

Some people like seeing NPs because they are educated and licensed to treat medical issues, but come at it from the perspective of a nurse, which is generally a very humanistic/holistic perspective which takes into consideration a person's responses to their illness and/or medical experience. Of course this is generally speaking, but in a nutshell, if you don't mind seeing a PA then you shouldn't mind seeing an NP/CNM either.

As for your trying to become pregnant at age 35 for the first time, for that reason alone I'd probably prefer to see a physician but also develop a relationship with the PA/CNM/NP on his or her team as well. At 35 you don't wait the usual "year" that younger people wait, it's more like six months, and even then your caregiver may want to begin some basic testing and such to start. At some point if there's trouble, you should keep a low threshold for consulting a Reproductive Endocrinologist, who's the person to see if you're unable to conceive. ETA just noticed it's already a year. Book an MD to start and take it from there.

Hope this clarifies a little, and good luck.

A certified-nurse midwife needs to obtain a nursing degree as a registered nurse prior to entrance in any program. Job experience as an R.N. is also necessary before the rigors of nurse-midwifery education begins. Once that is completed another couple years is required and usually a masters degree as well before being able to take state boards to become a C.N.M.

A lay midwife, also called direct-entry midwife in some places, typically does not have a nursing degree and acquires training through an apprenticeship with another midwife. How long it takes to become a lay midwife depends on how many births are available for attendance and if any formal textbook learning is needed.

Lay midwives do mostly homebirths though some are able to work in free-standing birth centers. The ideology behind homebirth is a non-interventive approach so someone with no medical training is the preferred route to go. Which is why I doubt your OB/GYN practice is using "midwives" for routine care. It would be illegal.

http://www.essortment.com/all/practisingmidwi_rask.htm

 

[Mary•Poppins]

Hmmm ....

Just want to say, if you have ANY reservations, consult a doctor. I was seeing the midwife in our practice after she delivered my last son. I was very comfortable with her and thought the world of her. So, I requested her for my yearly exams.

Anyway, a few years back, I kept coming back with abnormal pap smears. After a few appointments about this, she suggested a very invasive procedure (that would be done by one of the doctors in the practice). On the day I was to have the procedure, the nurse had me get ready for the procedure, and I waited, and waited and waited for the doctor. About a 1/2 our later, the doctor came in and told me that he DID NOT recommend the procedure. He wanted to wait because many times the type of results I had on my pap smear would clear up. So, I did not have the procedure done and immediately had a second opinion. My new doctor said the same thing as the doctor in the first practice.

After that, I feel more comfortable having a doctor exam and attend to my needs. And I truly LOVED my midwife, but I felt she just didn't have all of the schooling and knowledge that a doctor possesses.

Just my 2c.

 

[KiKi Mouse]

I have a lot more respect for midwives than many doctors.
I was cared for by a midwife for two babies, and two losses. The standard of care was fantastic.
Anything not within their realm is sent to a doctor. For example after DD#2 I had an abnormal pap. I was sent to the colposcopy (sp?) clinic.
I don't have time at the moment to sing all the praise but I can tell you that you are in goods hands and shouldn't worry.
As for TTC the midwife should be able to refer you to a specialist. I went that route and have DD#3 on my lap right now.

and baby dust to you

 

[My2Cinderellas]

Rules for midwives vary from state to state. Some states allow midwives who have just completed a midwifery program, most require they be RN's before completing a midwifery program. ARNP (nurse practitioner) is a different program than CNM (certified nurse midwife).

I would be very comfortable seeing a midwife for an annual exam, and if this is the group you want to deliver your children in the future, it's important to stay active in that practice. There is a popular OB/GYN group in my area where the doctors are not taking new patients, but the ARNP's and midwives are - so the only way to get the docs to take you as an OB patient is to see one of the ARNP's or midwives for routine yearly care before getting pregnant.

I had high risk pregnancies - I was not allowed to see the ARNP's in my practice for pregnancy checks, but now that I'm done having kids I see one of the ARNP's for yearly checkups. She is actually more thorough in her exams, and takes more time with me than any of the docs in the practice ever did.

 

[mickeyboat]

I'm back and remembering that my midwife actually was the one who gave me the referral to the RE. We discussed TTC at my annual appointment, and I told her I knew I needed to call the RE. About a week later the RE's office called me to schedule an appointment. She was amazing!

 

[PaulaSue]

I LOVE our midwive at my OBGYN. I have been going to her as much as possible (some preggo appts had to be with a MD for us, etc) for over 12 years. She can do everything a MD can do here and even write scrips. ( I was lucky enough that she caught my last DD, 7 years ago)

 

[golfgal]

I've used a CNM for over 20 years. They are great, spend a lot of time with you and have as much OB training as an MD (don't really have the "rest" of the medical training). They also usually have a lot of hands on experience because they are RN's before they can become a nurse-midwife.