Saturday, July 26, 2008

Spoiled forever?

Not having to cook for the whole summer isn't the only thing spoiling me these days. I'm wondering if I'll ever have such a good experience (so far) with a midwife again.

I remember reading Shannan's blog during her pregnancy and hearing her rave about her midwifery care. I had a midwife with Miriam, but the kinds of positive things that Shannan had to say about her experience didn't really jive with mine. I was mostly thankful for my midwife because I believe that if I had been under an OB's care, I would have had a C-section. For that alone, I was counting my blessings.

So now I'm happy to be able to say for myself that everything she said about midwifery care being an empowering, positive experience is true. I firmly believe that women should choose the kind of prenatal caregiver that will be best for them, whether it be an OB or a midwife. There are both kinds - terrible and wonderful - of each out there, and what matters is that you find the best match for your situation.

What I've experienced transferring from a midwife in Tucson to a midwife in Middlebury is the perfect example of that concept. You really can't make blanket statements like "midwives are better than OBs" because, as I said, there is so much variation within each method.

To give you an idea of what I'm talking about, here is what a typical visit to the midwife in Tucson was like: Arrive ten minutes early, wait up to 70 minutes to be shown to a room (that was my longest wait; I think my shortest was more like 30 minutes), wait an additional 10 minutes to see the midwife after the nurse has done the weight and blood pressure check, chat with the midwife for no more than five minutes or so, do any exams that need to be done, and see you later. I leave feeling like I've just wasted two hours of my day to basically have my weight written down on a chart.

A visit to the midwife in Vergennes (a few towns over), on the other hand, looks more like this: Arrive 10 - 30 minutes early, depending on the bus schedule; pee in a cup and take my weight on my own while I wait; be seen on time or even early, depending on the midwife's schedule; chat with the midwife about whatever for what so far has been as long as I want. I imagine there is a time limit, but we haven't found it yet. Move into a different room to do any exams that need to be done, and see you later. I leave feeling confident, hopeful, and happy.

To be fair, I know there must be so many background circumstances at work here that I don't understand. Things like budgeting, funding, staff availability, size of population served, length of practice, etc. all contribute to the differences in experience listed above. But on the face of it, I realize now that I was not satisfied with the level of care I was receiving in Tucson. I felt unloved, unappreciated, and un-listened to - just another patient whose name they could never remember. In a medical sense, of course, I felt that I was in perfectly capable hands, and until seeing a midwife in Middlebury, I had been telling myself that that's all that matters.

So now I fear I'm spoiled forever as far as prenatal care goes because now I know what it can really be like. I've seen midwifery care's full potential and it would be hard to go back.

What were your experiences with prenatal care, whether it was with an OB or a midwife?


Sarah Rose Evans said...

I had the "let's talk for as long as you have questions" sort of midwives, and better yet, they made house visits the entire duration of my pregnancy.

Liz Johnson said...

I had the rushed, impersonal, snotty experience with my 4 midwives in Indiana (shockingly, because it was a small practice with very few patients). I saw a practice of 6 midwives with Connor and while I loved them, I did sort of feel like just another woman being pushed through the baby factory. The OB that they worked with was actually the most personable of the bunch. This last time, I saw a practice of 2 midwives and 2 OB's (and I stayed mostly with one midwife, who also delivered Nathan), and it was the most amazing experience, much like you described. Empowering, hopeful, and wonderful. I think you're right - I prefer the midwifery model of care as a philosophy, but an OB or a midwife can embrace that... and my last midwife was the closest to my ideal experience.

Lark said...

I have only done OBs and my one in Tucson was lame, but my OB here in Vegas was great - a male OB/GYN. Can I tell you how much I love having a male OB? Its nice to have the steady male calming the unsteady, hormonal pregnant me. But yes, I did wait a long time sometimes. He was quite personal and helpful and I loved his philosophies.
But, don't let me get started on the current medical situation in America...having a husband in the field has really opened my eyes to what a mess it is. Contrary to popular belief, these doctors really get the raw end of the deal. So lets say it costs $100 to deliver your baby, but insurance says, no...I'll just pay you (doctor) $50. Its like going to the grocery store and the checker says it costs $50. And you say, no..I'll just pay you $20. Its a mess - there are so many people with their hands in the pot that its a mess. There are several other issues that are making me fume...I should blog about it!
Anyway, sorry for the loooong comment :)
Good luck with delivery. I'm glad you are having a positive experience so far!

Lindsay said...

Somehow, we always move during my pregnancies, so I have never really had one doctor/midwive take care of all my prenatal and delivery business. I saw two different OB's with my first, and then a totally new doctor deliverd the baby because my doctor was out of town. With my second, I started seeing an OB, but most of my other visits in that office were with midwives. Then my OB was there to deliver. I'm keeping the trend alive, as I have seen two different OB's again because of moves. Luckily, I have had really easy pregnancies and deliveries, so the lack of getting to know one particular OB/Midwife has not been a problem. So far, with 3 pregancies and 8 caregivers, I have yet to have a big problem with any of them. (But I also have not had a super great experience either.) Hope things continue to go well for you!

Suzanne Bubnash said...

Midwives were not known in the 70s & 80s and we managed to move between each child, so my OB experience is varied. I thought I liked my first OB--Dr. Judd--but the wait time was 1-3 hours. There was way less respect for patient's time then, and this guy was always in a hurry, although he did answer all my questions. He had way too many patients. But his partner delivered my baby and I liked him way better after all. I suspect that Judd would have rushed through that difficult delivery, perhaps causing more problems later. Would have used the partner for the second child except we moved.

The next two OBs were average. One of those got me through a rare tumor & just happened to be the only one in town who had experience with that type.

Only my last two were delivered by the same OB, a guy who is like a big teddy bear. I still go to him for annuals 16 years after my last baby. He has become a friend. The night Teresa was born he was not on-call but came anyway. So just as with midwives, there's the wonderful, the average, and the mediocre. Women should switch immediately, even in mid-pregnancy, if they don't care for the provider.

Heather said...

After spending 4 months in labor delivery and mother baby following nurses around and watching dr.'s and midwives perform, I noticed major differences between the two. A lot of the nurses I talked to would wait until the last possible second to call the doctor in because the Dr.'s are typically so impatient, they will do whatever it takes to get the baby out quickly. Which means either an episiotomy or c-section. However, most of the midwives I witnessed didn't know much more than I (and the regular RN's) about delivering a baby. They only go to 2 more years of school than me. After talking to charge nurses and various staff members of the labor delivery unit, I discovered that OB's are generally a safer bet because of their greater knowledge and their ability to deal with complications if they arise.

Aimee said...

I am sorry that your first midwifery experience was less than wonderful. I was really lucky that I found an amazing group of women who took fantastic care of me the last 2.5 months of my pregnancy, hour long appt. each time, empowering, and they taught me a ton about labor and delivery. In Colorado I do go to a group of OB/gyn's and they are amazing as well. I also have a Doctor midwife in Vienna (not an OB though). She is awesome. In Vienna, the only time an OB comes into delivery is when there are complications in the pregnancy/delivery. When I left Austria she wished me a "non-medical" delivery, meaning no c-section or epidural. I got my wish, and next time I would consider delivering in Vienna with her or even at home with one of my midwives who now lives in MT. While I love my doctors, the midwifery model is definitely the one I prefer for me.
Good luck! I wish you an empowering "non-medical" delivery.

Nattie said...

Bridget, you're always so diplomatic. My OB in San Francisco was AWESOME. The jury's still out on my midwife here...

Lilianne and Jason Wright said...

While I don't know Lark - her comments ring very true and very real for me as well! Healthcare in America is broken and the docs do really get the raw end of the deal most of the time.

In any case, I have a female OB/GYN and I absolutely LOVE her. The only times i had to wait for her were the times that she was at the hospital with one of her patients who was giving birth - which made me feel good that she'd be there for me when I went into labor. She always took the time with me, never ever made me feel rushed, always took time to answer all my questions, ask me about things, etc. She was more on the conservative side of things and I always felt like I was important to her.

Still to this day, even when I'm not pregnant anymore, she's called me twice to make sure that I was doing okay and then took another appointment to discuss family planning with me and what me and Jason wanted to do. To put it plainly, I will miss our frequent visits because I really like her - not only as my doctor, but as a friend.

Bridget said...

Heather, I don't doubt what you've observed, but I think there are many, many midwives out there who are extremely experienced - if not formally book-educated - in matters of childbirth. I think that for whatever reason, there is still a huge misconception out there that midwives are somehow less qualified to be delivering babies.

"Qualified" is a tricky word to use because yes, they do go to school for a shorter period of time, but can "qualified" really be measured by years spent paying tuition to an institute of higher education? My opinion on this subject is informed by these books in particular, in case anyone is interested in learning more about the difference between midwives and OBs (I've read others but these were the best):

-A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812


-Baby Catcher

Also, just to be clear, I had an OB in Syria and he was awesome. So I have had good experiences on both sides.

Bridget said...

Oh, also, I do take issue with claiming that OBs are automatically safer because they are better trained to deal with complications if they arise. The idea of midwifery care is to deal with complications before they arise; or, rather, to deal with them before labor begins. In cases where such complications cannot be resolved by a midwife, of course it is safer to transfer to an OB (and a good midwife would never disagree).

A Midwife's Tale partially addresses this conventional wisdom by comparing mortality rates between when midwives were primarily responsible for delivering babies and when male doctors took over the practice (albeit in the 18th century). Similarly, in all the hundreds of home (!) births attended by the midwife who wrote Baby Catcher, if I remember correctly, only two had to be transferred at the last desperate minute to the hospital due to unforeseen circumstances.

Shannan said...

Wow - thanks for linking me and sorry I'm late for the party.

I think you hit the nail on the head that you can't make a blanket statement that applies to everyone just because of the name: i.e. all midwives are wonderful because it certainly does vary. Like you I moved from a larger city (Seattle suburb) to a small town (Silverton, OR) and I found the midwives in the small town to be more real, more personable, definately a short wait time and just a better overall experience. 2 OBs and 3 midwives. Sometimes I felt even shocked or slightly embarassed that they gave me so much of their time because I wasn't used to it.

And truly, if you do your research and/or reading you'll see that midwives are actually "safer" than OBs and usually have less incidence of C-sections and need for higher interventions. With my midwife birth, the baby had the cord wrapped around his neck as he came out and she just said, "Okay, stop for a minute" (unwrapped the cord carefully and efficiently) and then, "Okay you can push again".


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