Monday, June 30, 2014

Nurse-Midwives and Physicians: The Team Approach Is a Win-Win

By E’Louise Ondash, RN

There was a time when C-sections were reserved for mostly emergency situations, but today, 1 in 3 pregnant women undergo a C-section to deliver their babies--a 60 percent rise since 1996. This, according to a report from the Congress of Obstetricians and Gynecologists.

The World Health Organization (WHO) recommends that the C-section rate for any nation not exceed 15 percent.

A cesarean section, or C-section, is often the delivery-method-of-choice for the busy woman who works outside the home, a trend that has escalated as more women enter the workforce. But experts say the health of mother and child can be in jeopardy with the unnecessary surgery.

A new San Francisco Bay Area program aims to encourage women to let nature take its course and to reduce the C-section rate in the area by half. It pairs nurse-midwives with physicians, who will always be available for backup in case of an emergency, according to a recent story in the San Jose Mercury News.

"The philosophy is to trust the body's ability to do that process, and we are the overseer," explained Lin Lee, RN, CNM, in an interview with the newspaper. Lee will direct the program, called Bay Area Maternity, with two physicians.

The program is funded by the Lucina Maternity Foundation, so named for the Roman goddess of childbirth who was believed to keep women in labor safe.  Seed money for the foundation totaling $1 million was donated by two big names in Silicon Valley--Anne Wojcicki, CEO of biotech start-up 23andMe, and Angela Buenning Filo, wife of Yahoo co-founder David Filo. Lee was midwife for both women.

The foundation also will fund a second center at Santa Clara County’s Valley Medical Center. The county is located at the southern end of the San Francisco Bay Area and includes Silicon Valley.

Creating nurse-midwife and physician teams is not new. The idea has been around for some time, and there are practices all over the country; some have up to 10 or 12 midwives and as many doctors working together.

But there are still places where professional rivalries between physicians and these advanced practice nurses exist, as well as divisions in philosophy. These differences can generate tensions and "turf wars," which end up putting patients on the losing side.

It doesn’t have to be that way, according to the American College of Nurse-Midwives, which favors teaming nurse-midwives and doctors.

"Having midwives working in collaboration with physicians, where everyone is using their appropriate skills and the appropriate time, is better for the mother and baby--and is more cost-effective," said Tina Johnson, CNM, MS, director of professional practice and health policy at ACNM, in an interview.

Pairing nurses and physicians in other areas of practice like gerontology and pediatrics can not only be cost effective but result in a higher level of care. The complexity of today’s health care demands a team approach if we are to continue to deliver quality care.

Do you work in an area that pairs nurses and physicians or implements the team care philosophy? Do you think the team approach improves the quality of care?

Tell us about it.

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