Thursday, April 30, 2009

Differences Between Physician and Midwife - My Personal Reflections

I'm 30 weeks along in my pregnancy and doing well. This is my fifth baby, but it is a new experience for me because I am planning my first home birth and working with a midwife for the first time.

I had a prenatal checkup yesterday, and with each visit I am increasingly amazed at the difference in care I'm receiving from my midwife compared to what I've experienced with my obstetrician. At each prenatal visit, my midwife does the urinalysis, checks my blood pressure, weight, measurement, baby's heart rate, etc. She does all of the clinical things that my obstetrician (or his nurse) would do at a prenatal checkup. But she does much more than that.

Visits with my obstetrician generally lasted no longer than 10-15 minutes at the most. The majority of the visit was used for the clinical work I mentioned above, with a few minutes to talk with the doctor. My midwife reserves about an hour for each appointment. Very little of that is taken up by clinical procedures. The majority of the visit is spent talking. There is so much that a pregnant woman goes through. From my personal experience, I feel that the obstetric approach addresses mainly the physical changes in an expectant mother, and the midwifery approach looks at the woman as a whole and tries to address all concerns; including physical, emotional and mental.

My midwife asks questions that I don't remember my physician ever asking (in 4 previous pregnancies). She asks me about my diet, what I had for breakfast, lunch, and dinner the past day. She asks about my family, how my husband and kids are doing and how we are getting along. She gives me nutritional advice to help with my concerns about iron levels, getting enough good nutrition to help me feel better and have more energy. I feel that my midwife really cares about me personally, and that deep sense of care is reflected in the way she talks with me and conducts each prenatal visit.

I have a good obstetrician. He has always taken care of me, answered my questions and addressed all of my clinical needs. I've never had a complaint about him. The difference in care with my midwife is more emotionally fulfilling for me. I can talk with my midwife about anything, but when I go to a physician I tend to keep the questions on a purely clinical or medical level. I also have the comfort of knowing I can call my midwife at any time, with any concern, and she will answer the phone and answer all of my questions.

I'll put it in a nutshell: with my midwife I know that all of my clinical and medical needs are being taken care of as they would be with a physician, but I also have the added security of feeling emotionally and mentally supported as well.

My midwife only attends home births as a midwife. She has 15 years of experience as a direct entry midwife. She is also a doula and attends hospital births in that role, so she is familiar with all different birth settings. I am comfortable with her because I know that her views on childbirth match my own, and I feel completely supported in my plans for a home birth. Our prenatal visits are in her home, which is beautiful and comfortable.

Midwives differ according to their certification, training, office set-up and more. Certified Nurse Midwives only attend hospital births and most often work under the supervision of a physician in an office. In general, CNM's are more clinically focused and may not be able to schedule a long appointment for open discussion, depending on the office procedures and how busy they are. If you are looking for a prenatal care provider, please see my earlier post: Choosing a Prenatal Caregiver: Doctor or Midwife? Please also consider putting together a list of questions and concerns to use in interviewing caregivers and considering your options.

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