Well, that blind date was a disaster!

25 Jan 2012 1 Comment

by Heather in Pregnancy, Uncategorized Tags: midwife, Pregnancy

Had a blind date yesterday with a new midwife and it was a disaster.  Yep, no love connection there at all, not even a little bit.  As I mentioned a week and a half ago, I learned that the midwives that I really want to work with after we move aren’t in network for my insurance and we have no out-of-network benefits.  So I was in the position of trying to find a new midwife or midwives to work with.  Unfortunately, since I don’t know much about the midwives in my new state it was kind of like going on a blind date.  Don’t know anything about your date except that they meet the minimum requirements, being a midwife.  There was some cause for trepidation early on because they are in an integrated practice with 7 OBs. 7 OBs vs. 4 midwives… hmm, wonder who’s going to influence the culture of the practice more?

I won’t rehash the whole visit.  Suffice to say that the midwife was nice enough but the negatives or causes for concern far outweighed the positives.  Here are a few of the things that caused concern for me:

• A nurse did my initial intake, including reviewing paperwork, taking my blood pressure, and listening to the baby’s heartbeat via doppler.  To be honest, she’s the one that I liked best at that practice.  She was genial and supportive.  However, I am used to everything being done by the midwife so I was a little thrown by working with the RN first.  Kinda felt like a regular MD’s office rather than a midwifery practice.
• When the midwife came in she was wearing a white coat.  I haven’t met that many midwives but I’ve never met a midwife that wore a white coat.  To me, it’s one of the symbols of the “I am the professional, you are the patient” power dynamic that is antithetical to midwifery care.  It may not be a problem during prenatal care but that approach is what can lead to women being pressured into interventions that they don’t want and don’t believe are necessary while in the middle of labor.  The midwives I’ve worked with have all met with me wearing business casual or casual clothes, except during the delivery of course, then it was scrubs.  That feels to me more representative of the “We’re in this together.  Let’s work together to support your body while it does when it was meant to do” philosophy, which is what I was looking for.
• The midwife explained that she was going to do a pap smear.  When I questioned her about doing it during pregnancy when I’ve had one within the last year, she assured me it was standard practice and then started the physical.  During the pre-pap conversation I mentioned that I didn’t have much breast tenderness now since (1) my son stopped nursing and (2) the first trimester is over.  She completed the rest of the exam and then said something along the lines of, “I didn’t realize that you’re already pregnant.  You’re right; we won’t do a pap now.”  Um, I’m 25 weeks.  It’s in the chart AND I’m showing.  *Loses points for inattentiveness to important details.*
• Once the physical exam was over, she left the room so I could dress, saying that she’d be back to answer all my questions.  She did come back to answer my questions but I got the distinct impression that she had somewhere more important to be.  Her answers were short and dismissive and she didn’t really make eye contact.  When I shared my concern that my first child being big would predispose a new care provider to moving to c-section too quickly she said, “Oh, that shouldn’t be a problem.  You have a proven pelvis.”  Proven pelvis.  Hate that phrase and, to me, it is pretty telling.  If you believe in a woman’s innate ability to birth a child given the right support then all pelvises are proven until shown otherwise AND there are a relatively low number of women who will need intervention for reasons related to their pelvis.  (I should qualify this by saying that this is true for women who have had adequate nutrition over the course of their lives.  It can be far more difficult for women whose own growth is stunted or delayed due to malnutrition to birth a child vaginally without intervention or significant damage.)  That was probably the biggest red flag of all for me.

On my way home I was asking myself things like… If I ended up with a c-section would I trust that the folks in this practice had exhausted every possible option to help me have a vaginal birth instead?  How likely would I be to hear things like “failure to progress” and “let’s talk about medication” during labor if I stayed with this practice?  If something went wrong with the birth, how would I feel about my decision to stay with this practice?  I was practically in tears as I compared the experience I’d just had with the one I had with the midwives that I wanted to work with.  I was waffling back and forth between feeling like I should stay with them because they are covered by my insurance and feeling like I should do whatever I could to get back to the folks I wanted to be with.

I was still processing this when my husband got home from work.  In a few short minutes he threw my own logic back at me (“trust and the birthing process”… ya gotta have trust) and all of a sudden it was clear as day that I couldn’t stay with that practice.  The reality is that if I stayed with this practice and wasn’t able to have the kind of birth I hope for, I wouldn’t be able to trust that they’d done everything they could to help me have the birth I want.  I’d always question whether their decisions were influenced by their proximity to OBs, questions of liability, whether they’d started seeing birth as a medical process rather than a natural, normal thing that most women’s bodies can do with relatively little interference.

Last night I scrambled through our health insurance’s website and found the local midwives that do accept our insurance.  Much to my delight, I discovered that there is a small, independent birth center in PA that is only 30 minutes from our new home AND they take our insurance.  I called to ask some questions and had a much, much, much more positive experience on the phone than I did with the midwife/OB practice.  I have an initial intake appointment with them next week and am very optimistic that I may have found our next care providers.  Stay tuned!