About that midwife we're seeing...

Several people have asked me what is UP with this whole seeing a midwife thing.

As Chris told me early on, "It wouldn't be so weird if the word 'midwife' wasn't so...renaissance-sounding."  He's totally right. A midwife sounds like someone you fetch to your farm in the middle of the night, pay three silver coins to and hope she keeps your wife alive as well as the baby, so she can help work in the field next week. Harvest is a'comin!

But the modern truth is that nurse-midwives provide excellent care for women with uncomplicated pregnancies and refer out women WITH complications. They're thoroughly responsible, well-educated and licensed and they don't take silver coins for payment.  They take insurance and FSA accounts and they deliver in hospitals or medical centers as well as homes and birth centers.

They way we ended up with our midwife is a long story and I originally wasn't even going to tell it here because it's so ranty and angsty, but I think it's important.  I think a lot of women feel they don't have options when it comes to choosing care (OB or a super granola home birth and there's no in-between, which isn't true) and that they can't say no (sure you can!) and I think it results in a rash of bad care that has the wrong motivations behind it. The 2007 c-section rate in this country was 31.8% and that is too high. Ridiculously high, actually.

Look, it's no secret that healthcare in general is sort of MESSY in the United States. But the field of obstetrics is, to me, a particularly screwed up specialty.

***

I couldn't go see my old obstetrician because of a really ugly situation, that happened after Claire was born, with a good friend of mine. The obstetrician I had decided on, the one I had decided on WEEKS ago and was scheduled to see after our trip to Maui when I was 13 weeks, that practice is being sued by the state Attorney General for purchasing AND USING WITHOUT PATIENT CONSENT products not approved by the FDA.

They were buying IUDs from a Canadian pharmacy because they cost less. They didn't tell patients that before inserting them. IUDs from Canada are not FDA-approved. I could probably end up agreeing with them that Canadian IUDs are identical, but I cannot agree with their opinion that they are above the law. I don't care that the FDA are stupid sometimes, they are the law and you obey the law. Period. The woman who spoke on behalf of the practice (the clinic's President!) was defiant and showed absolutely no remorse. The tone was definitely, "I'd do it again."

Well. Well, well, well. What else are you doing that's illegal? How else are you trying to make more money off of patients and their insurance, illegally? If you have such little disregard for the law and such little respect for your patients that you don't even inform them that you're putting unapproved and, in fact, illegal items into their bodies, then wow. Just, WOW. I cannot be a patient at this practice.

I focused on female DOs after that and found two that looked promising. I called the one with a website because I figured that was at least a step in the right direction towards the kind of doctor I want. (That should have been telling, right?)

When I called, the nurse sort of gave me a tone about how I was 14 weeks and hadn't seen an official OB yet (though I had seen another physican, but not an OB, which I guess isn't good enough). Then she tried to sort of shame me because of the timing. Why haven't I seen someone before now? Well, I've been busy. "You've been.........busy." And I could tell she thought I was some sort of crack addict who doesn't care about her baby enough to get proper prenatal care. But the fact is, I know that I haven't missed any key windows for testing and all I've missed out on as far as they're concerned are two billing cycles. And I knew that my due date was accurate so really, there was NOTHING to be done prior to now. Remember, this job is largely JUST OBSERVING.

She told me that I'd missed the mark for the visit to the perinatologist (in a very "tsk tsk" way). I interrupted her and said, "I'm declining the nuchal screen; I know what it is." When she started up again about other testing I interrupted again and told her that I was declining the quad panel as well. I could feel her judging me through the phone and I hated it. I hated being treated like I'm an idiot or that I'm not very smart at all or even like I don't have an internet connection and access to those asinine "Your pregnancy this week!" and "Your baby is the size of a kiwi!" emails. I even told her that it was my second pregnancy, which I was hoping would bring SOME sort of street cred to me as a patient.

I knew that it wasn't personal, that she was reading her script and parroting what she's been told and trained to say but that's exactly what was killing me: it seems like nobody I encounter in this profession's administration can think for themselves. Instead of saying that I missed a deadline she should let the doctor discuss that with me. Not everyone wants that test, you moron! It felt like she wanted me to have those tests so they could scoop up the billings. If your insurance pays for it, why not? UGH. (Why did we decline those tests?  Because they have a high false-positive rate and they weren't going to tell us anything that would lead us to termination. Why bother?)

I hated knowing that I would have to go to this appointment and have a conversation that starts out with,

I am looking for a physician that enthusiastically agrees that the Cesarean rate in the United States is astronomically high.

I am looking for a physician that will report to me her personal rate and back it up, proudly and happily, with documentation.

I am looking for a physician that will treat me like I'm an intelligent person.

I am looking for a physician that respects my time.

I am looking for a physician that does not practice litigious medicine.

I am looking for a physician that will not try to schedule my birth for when it's convenient for HER.

I came to the really frustrating realization that I'm not going to find it. There is no physician like this. I will have to play the stupid game and over-advocate for myself and just thinking about it was exhausting.

What is boils down to for me is this is not patient-centered care. This is monetary-centered care, designed to get as much as they can, as legally as they can, while minimizing the risk of litigation at all costs (including the cost of what's best for the patient). It's all on the doctor's terms with almost no allowance being given to the patient. We wait 30 minutes after our appointments are supposed to start before a doctor traipses in without an apology, they want us to pay for the delivery up-front, they won't give us our records for free unless they're sending them to another doctor (which makes absolutely no sense). It's ridiculous and the ultimate power struggle that preys on our worst nightmares and I wanted nothing to do with it.

I hate it! HATE IT! It filled me with indescribable rage that I had to play this hokey game and run around town to find someone halfway normal to do a job that is largely JUST OBSERVING. As someone smart once asked me, "Do you go to the hospital and pay this much money to do ALL THE WORK YOURSELF for any other procedure? No, you do not."  The same person also told me that the premise of "there's something wrong with you that we need to treat" is equally infuriating.  There's nothing wrong with me! I don't need fixing! There is a very high probability that my body is going to do this JUST RIGHT all on its own, without any help.

I hated having to waste so much of my time and energy and mental agility trying to second guess everything from "Why am I still waiting after twenty minutes?" to "No, I will not allow you to pre-bill me for services you will not perform until next APRIL."

What really bothers me is that they do not understand that this is a CUSTOMER SERVICE business. If they were trying to earn me as a client none of this hootenanny would happen in the first place. You don't treat new business like she's stupid. Do you think I'm going to walk in here and just hand over $10,000 worth of new business to you without you EARNING it? Really?? You think can treat your customers like morons and they'll just take it?? The relationship is not peer to peer as it should be, it's more like teacher-student and that's wrong. It's just WRONG.

A CPA never makes you feel guilty about what you choose to do with your money. A CPA doesn't pressure you into doing something becuase it's convenient for him (such as, making sure to write that IRA contribution check before Thursday at 4 because he's going out of town and it would really be easier to send it in with all the others). But this is exactly what an OB does.

An OB judges you and pressures you in a way that nobody else you PAY for their professional services does. A professional is supposed to offer their educated, licensed-by-the-state opinion and let you make a decision. But I find that OBs often use fear (the baby's going to die/have birth defects/you'll die) to get what they want (convenience and inflated billings) and this infuriates me.

There's even a small, highly feminist part of me that is mad at all of the women in America who do walk in with their fat slice of business (pregnancy and childbirth is often the most expensive medical event in a woman's lifetime!) and take this kind of treatment and just HAND OVER the money and insurance card without a second thought. It's that behavior that allows the specialty to be so one-sided in the United States. If every woman was as demanding about her care I wouldn't be in this one-sided argument where I seem to be the only person who speaks up about my time being wasted or being horrified about convenience as a primary objective. I'm not wrong to want to be treated well.

What it really came down to for me is that I feel like I've been pretty well traumatized with the whole obstetrician thing from the doctor who delivered Claire being involved in the situation with my friend, to the other doctor I had all picked out being sued by the state Attorney General. It left me at 15 weeks pregnant with no OB or nurse-midwife through no fault of my own and because I can't ever get an appointment same-week at ANY office, I have to wait two weeks to meet a new doctor and I just...I just couldn't seem to win.

And then when I was walking into Walmart one day, being all rage-y and pissy and cranky about being taken advantage of against my will and being forced to submit to this ridiculous system of false health care, it hit me: I want a midwife. What I want is a midwife that shares my point of view. I want someone I don't have to fight with. I want someone who views my care as holistically as I do.

I did a simple search for a nurse-midwife covered by my insurance and I found one that I love. But I will tell you about her later because dudes, I'm lucky if anyone is still actually reading this 1,900-word post.  GOOD NIGHT.

Comments

[Vanessa]

Read it all. :) Totally agree.

I left my first OB because she kept harassing me about my weight gain. Wanted to do an extra ultrasound to "make sure this baby wasn't getting too big". She even went so far as to ask what I had eaten the day before and when I mentioned 2 pieces of See's Candy she said "Well, there you go. If you admit to 2 pieces you probably ate the box." Um...new doctor thanks.

I gained 35 pounds thank you very much.

[lindsay]

Wow. Shocked at what Vanessa wrote and totally nodded my head about what you said about billing cycles. It's these kinds of posts that make me think that of all things I want my kids to have, confidence and a voice are seriously near the top of the list.

Very interested to hear more.

[Holly]

I switched OBs at 30 weeks because while my doc was "on staff" at the University department where I work (so I thought he'd be more 'cool' with me), he made the comment of "You're doing so well, you make me look good!". Yah. You are not doing ANYTHING, bucko. And by the way, something tells me you're not down with the Bradley Method, and when I deny induction and whatnot in 10 weeks, it's not going to be pretty.

The OB that cared for me the last 10 weeks and his partner that delivered me, were awesome. I actually think I'd go with his partner next time, young Indian woman, who was totally easy going and calm while my delivery nurses were freakazoids.

[Raven]

Awesome post and so very, very true. If I had it to do over again, I would change so many things. My OB/GYN for Sprog was awful. I called her the dragon lady. She made me cry many times. She was militant about weight gain (kinda like Vanessa's dr up there) but went so far as to tell me I could only gain 20lbs total. Um. I was 15 lbs under when I started but that apparently wasn't important to her. When I started to deviate from her plan, it was all doom and gloom and how I was going to gain 100lbs that I would never be able to lose.

I gained 37lbs. I had him on a Tuesday and had already lost 22lbs by that Friday.

[DCZia]

I read every word! Hear, HEAR! Yes. Just YES. I had very nice, professional OBs that I liked, but switched to a midwife at around 25-ish weeks during my pregnancy, because I just wanted a different model of care. I am tremendously disturbed by how well-educated women do almost nothing to inform themselves about their birth options, and just accept what OBs tell them as the norm - testing, epidurals, lying on your back in a bed during labor, absurd time limits on birth designed for administrative convenience, and not for the well being of the mother and baby. Thanks for this spin on what we should ALL be expecting from our caregivers.

[A'Dell]

Vanessa! I cannot BELIEVE that your OB said that to you about the Sees candy!! (YUM. SEEEEEES). You should have just given her a face and calmly said, You know what? Youre fired. I dont pay people to talk to me that way.

[Jennie]

I'm just glad you found someone you love and you're happy with the outcome. You're certainly reminding me to take my time with things and not rush to find a solution.

(I did/do love my specific doctor and I don't think I could speak more highly of the way she handled my TTC period/pregnancy/labor & delivery but even with ALL THAT SAID, I'd have a hard time returning to that practice (as you know) and if we ever do get pregnant again, I know I'll explore this path you've talked about, definitely.)

[Vanessa]

She was fired. I just wished I had been more vocal in her office and let her know just what I thought.

We kept leaving her office unhappy and I would ask Brent,"You heard her right? Am I overreacting or did she call me fat?" and he would say I hadn't overreacted. But, then we just kept thinking well, maybe she's mean, but if she's good in delivery we'll deal. SO, one day I asked my Bradley coach if she had ever heard of her and what she was like in the delivery room. She said that one of her former students said while she was in labor she kept telling her to stop being so loud she was scaring other people and trying to push pain meds.

Awful. Just awful.

My new OB was great. Did have a C Section because footling breech, but he tried to turn her. Also, the nurses weren't going to let me leave the hospital for 4 nights because of procedure. He came by and I asked him if I could leave early. He said, "4 nights? Are they crazy? You're healing just fine. The nurses don't make the decisions I do. When do you want to leave?" When I left one of the nurses said she could tell I was "one of those Bradley people" and wondered why I didn't just have a home birth. ????? Yes, nursing and limited meds make me crazy!

Anyway, all this to say lots of OBs suck.

[Maggie]

I had two really excellent doctors (a family practice and an OB) and whenever I read what the internet has to say about birth-as-business I feel incredibly lucky!

Also, as you already know, I want to be you when I grow up.

[Elizabeth]

I read every word and I love you and you are so right and this was SO my experience (the second time) and I appreciate you SO MUCH for questioning it and finding another way because it was horrible and I am NEVER going back to that way again.

[Holly]

I really loved this A'Dell. Even though I don't have kids yet, my maniacal planning brain is already thinking about all of these things as we approach that stage and one of the things that I keep coming back to is -- HOLY HELL, HOW AM I GOING TO FIND A DOCTOR THAT WON'T OVERMEDICALIZE AND FREAK ME OUT? I agree with everything you have said, and I'm really excited to hear more about your experience. Really.

[Erin G]

I read every word. I love that you took the time to write it (hilariously, btw, even through your rage it's funny) when it's so much of what I think as well... but frankly am too exhausted to even try to write. I start thinking about everything I hate about the medical system and it just zaps the mental energy out of me and shoots my nerves.

But this is well-articulated and I loved reading it.

If I wasn't so enamored with the damned epidural, I'd be using a midwife too.

[Home Sweet Sarah]

I read it! (Because it was AWESOME, thank you!)

Quite honestly, I haven't had a particularly pro-active approach to my OB care, I think because I'm relatively pleased with my office. I meet with a nurse-practitioner midwife who I LOVE, but only because when given the option between meeting with her or my regular GYN, I picked the nicer person.

Unfortunately she's in-office only and doesn't do births, but I guess we'll cross that bridge when we get there.

But until then (and in between now and then) you've given me a lot to think about, so thank you again!

[HereWeGoAJen]

I had a mediocre practice last time. My main problem with them was that they believed that I was stupid and uneducated (we had a six day discrepancy between when they said my due date was and when I said my due date was, my body does not actually behave according to their little wheel thing). But I understood why they thought I was stupid and uneducated because of the demographic where their office was located. I was probably one of the only patients they had who understands how that wheel works.

But, next time, if there is a next time, I'd like a little better, now that we've moved and I have a few more options (I hope I have more options anyway, I haven't checked yet, but it couldn't be worse). I don't know that I would be comfortable with a midwife, but I don't know that I won't either. I am looking forward to hearing more about your experience.

I am going to switch practices next time though if I have to have another argument about their stupid wheel. (Me: "First of all, I don't have a 28 day cycle. And even if I did, how are you inputting a start date of something that occurred on a Monday and coming up with 40 weeks later happening on a Thursday? And does that wheel have leap year included on it?")

[Elsha]

I really wanted a midwife when I was switching doctors with my second pregnancy. I figured that would be the best way to get a VBAC. I found out that there are two midwife groups here (relatively small town Colorado)-- one my insurance doesn't cover (having just been laid off, out of pocket wasn't an option) and one doesn't do VBACS. At all. I was pretty surprised about that.

Fortunately the midwife I had a consult with (at no-VBACS practice) referred me to an OB practice here in town where all the doctors do VBACS. And as it turned out, my OB was great. She didn't blink when I came in for the first time at 20 weeks. She didn't recommend a whole bunch of tests. She didn't worry when it looked like was borderline for gestational diabetes. She didn't put on any pressure about my Christmas eve due date. I will definitely be going back next time.

[Belly Girl]

I'm so bummed that I didn't read something like this before I had my babies. I had really good experiences with both of them - except feeling quite a bit of pressure to induce once I was at 40 weeks ("much higher risk of c-section", she said several times, preying on my fears). I can't wait to hear more about your midwife!