Thursday, June 25, 2009

OB vs. Midwife

So... my wife, Betsy, is pregnant--15 weeks now. We had our first appointment with an OB/GYN two or three weeks ago, but I didn't really write much about it because, honestly, we were really disappointed by the experience. I mean, the doctor herself seemed to be perfectly competent, but she was extremely rushed. First, we had to wait 45 minutes. Then, we were rushed, rushed, rushed through a series of questions that were obviously intended to find red flags. There being none, the doctor and her nurse clearly wanted to get through the exam as quickly as possible.

I've worked in hospitals.... I understand about practicing defensive medicine and playing the odds and all that, but excellent care goes beyond merely doing what's necessary. A telling example, after betsy was told to put her clothes back on, the doctor knocked and let herself into the exam room before Betsy was even finished dressing. the doctor wanted us out, but I managed to sneak in a question anyway, "Since Betsy is traveling, can you prescribe some medicines that will be safe for her to take if she gets sick? Like an antibiotic, or something?" the doctor was strangely stumped by this question and told us to ask our "family doctor." But as we had explained several times before, Betsy doesn't have a "family doctor"--she uses the University Health Clinic. And really, shouldn't the OB be the expert on what medicines are safe for a pregnant woman?

There were a lot of other things that went wrong with that visit--I'm only using one of several examples of things that did not impress me. Afterwards I felt like a cow that had been forced through a series of cutes in an elaborate meat packaging factory: disoriented, ignorant, and ultimately stunned!

So after that we decided to go with a midwife. The doctor at the University Health Clinic never explained to Betsy that midwives work as an alternative to OB's in the Ontario Health system. One or the other manages the case, not both. So it was only after meeting with the OB that we were told we had an option to choose a midwife as an alternative to conventional care.

There was a waiting period. But after about a week or two a midwife practice in downtown called us to set up an appointment. We went. My... why a difference! To begin with, rather than meeting in the basement of the hospital, we went to a quaint house that felt like a home. There was air and light and even a library for clients to use. Toys kids and magazines for parents. Lots of baby pictures on the walls. The midwife's examining room/office was decorated in a warm and informal way. I noted two flutes hanging in a pouch on a door nob (when is the last time you saw music instruments in a clinic). the only medical equipment I could see was a stethoscope, blood pressure cuff, sharps container, and box of gloves. A flat futton-like bed with pillows was in the corner. It felt warm and comfortable. I'm sure there was more gear in the closet, but the room was obviously design to make us feel comfortable, not to make it easy for clinicians to access gear.

We spent a whole hour with the midwife just talking about how midwives work and what sort of options are available. They really try to focus the care around the paradigm of women making informed decisions for themselves. Their role is to be guides. When we asked about pain control, for example, they said that although drugs are available, they prefer to control pain with "knowledge." Practically speaking, that means being smart about using all kinds of techniques like massage, positions, herbal remedies, etc., etc., to control pain. Another telling detail, when Betsy does begin labour they will come to our home to help us determine when it's time to go to the hospital. And once Betsy comes back home they will continue to visit us there to help us transition into caring for an infant. The OB, on the other, emphatically emphasized that once the baby is out she's no longer in the picture. I'm really glad we are going this way. The whole hour talking about what kind of experience we want to have--imagine that!

After the midwife appointment I went over to the Toronto Islands for my Wednesday night race. The start was delayed due to low wind. We may have won the start, but the committee boat couldn't see us due to a hair-ball of boats blocking the view. In the end the course was shorted to just one windward leg. We finished 6th out of 8 boats racing in our class. The most exciting thing that happened was a boat almost colliding with us as we rounded the mark defining one end of the finish line. I had to fend aggressively to keep the boats apart.

Also today--did more errands in preparation for Betsy's trip to Athens. Hard to believe she's leaving on Saturday for two months away! There is much to do in the meantime.

Now I'm tired. Bed beckons...


1 comment:

Daniel Graves said...

We are big advocates of midwifery care. Both our kids were born with midwives in attendance (one born at the hospital and the other at home). We'd be happy to chat further if you'd like.