As I mentioned when I introduced myself, I am planning to have a midwife-attended home birth, rather than a hospital birth. I do, however, have a regular OB/GYN at my local clinic, and I went to see her about seven weeks into my pregnancy, hoping to build a rapport with her in the (relatively unlikely and highly undesirable) event that I would experience some sort of complication during home birth that would necessitate transfer to a hospital for medical intervention. I therefore have the unique and enlightening opportunity to compare the prenatal care provided at a clinic or hospital by a OB/GYN and the care provided by my midwifes. It is quite the stark contrast indeed.
While I was at the OB/GYN’s office for approximately 45 minutes, I only saw the OB/GYN for about 15. I was first seen by a (very kind and peppy) nurse who asked me a whole battery of health questions. She then went over a sheet of topics that she was required to discuss with me at my first prenatal visit. One of them was nutrition, which she glossed over by saying, “Eat whatever you feel like.” Really? It is a good thing for my unborn child that I am not craving Twinkies and Pepsi. Somewhere in the “things you should avoid” list I made a reference to listeria, and she was shocked by my knowledge. Apparently, at the doctor’s office, they do not expect women to be informed about or in charge of their pregnancies. She also asked me one question about exercise: do you work out? I responded by saying yes, about five hours per week. I attempted to continue by explaining exactly what sort of activity and asking if there were any more effective workouts I could do to make labor easier, but she interrupted with an “oh, that’s great” and continued on her list of questions.
After she left and I changed into the requisite hospital gown (no clothes on underneath, of course) the OB/GYN came in the room and promptly performed a pelvic exam. She asked no questions about my health, well-being, nutrition, or anything along those lines, but did tell me that I needed to get a flu shot. When I refused, she gave me a threatening lecture about how I could end up in the hospital or dead because of the flu virus. Never mind that I am a generally healthy and robust individual who has never had a single issue with the flu, that the flu shot is laced with formaldehyde and mercury (which we are supposed to avoid at all costs, especially during pregnancy – stay away from that fish!), and that the flu shot is not even guaranteed to protect against the flu. It is no more than the CDC’s best guess as to which strains are going to be most prevalent in the coming year; it might provide immunity against a couple of strains, but certainly not all of them. But in any case, I refused the flu shot and got a lecture and a scowl, as I was sitting with my legs spread, feet in stirrups, in a hospital gown. I am sure it is fairly easy to look down on somebody when they are in such a position, and I certainly did not feel like I was on equal footing with my doctor, or equally involved in my own and my baby’s care.
I visited my midwives for the first time about a week later, and the experience was infinitely more pleasant and helpful. Nick and I sat and talked with them for an entire hour, and I got to remain fully clothed for the entire visit. They began by answering all of the questions Nick had about the logistics of home birth, and all of my questions about what sorts of interventions they would or would not perform on my baby after birth. In terms of the flu shot, they emphasized that it was entirely my decision to get it or not to get it. In terms of possible procedures performed on the baby, they were willing to give us all of the information they had on vitamin K administration (oral and injected), antibiotic eye drops, cutting of the umbilical cord, weighing, and Apgar, and then allow us to make our own, informed, decision about if, when, and how we would like them to perform any of these interventions. I feel that as a parent I should be responsible for my child’s health, and an active and informed participant in the medical decision-making process, and (unlike my OB/GYN), my midwives certainly seem to agree with me.
During our hour with the midwives we also discussed pain-management (nonmedical, of course) during labor and childbirth preparation classes. This discussion was entirely lacking at the doctor’s office. We left with the names of several people in our area who are childbirth educators, as well as two books from their lending library concerning natural labor and delivery. The staff at the clinic gave me a folder full of information about their OB/GYN department, along with a sheet of nutritional recommendations that I found absolutely abhorrent (I will be discussing that sheet of paper tomorrow) and a book that I will also be discussing in the weeks to come. And believe me, it will not be a thumbs-up review.
What I took away from my first two prenatal visits is that midwife-supported pregnancy and birth is focused much more on prevention, on keeping women and babies in optimal health, and on giving women the tools, knowledge, and sense of power they need to make it through labor naturally. The medical model of prenatal care is exactly that: medical. There seems to be little focus on staying healthy, getting fit for labor, or being informed or knowledgeable, and much more of an emphasis on medical interventions. And there is a strong sense of disproval when a patient refuses medical intervention. I mentioned the word midwife (not even home birth – I did not dare), and I got a look of reproof for that even stronger than for refusing the flu vaccine. Even after only one visit to the OB/GYN, I can see why the more than one in three births in the United States is by c-section.