Pregnancy and Health Gadgets

Blood Pressure Monitor

 I love gadgets, and when I can get gadgets that help with my family's health, it's even more fun!

My midwife recommended I get an automatic blood pressure monitor. I have a cuff and stethoscope and I'm comfortable taking my blood pressure with that, but she felt the automatic monitor might be easier and more accurate. It was like Christmas to get one and bring it home.

Traditional
Blood Pressure Cuff

She also suggested that I get my own doppler to listen to fetal heart tones. I already have a fetoscope that I haven't been able to use yet, because I'm not far enough along yet. A fetoscope can be used starting around 18-20 weeks, and I'm really looking forward to trying mine out. I love that the fetoscope doesn't use electricity or sound waves like the doppler, but I think a doppler would still be fun to have, especially since I plan on becoming a midwife and would like to have one for my future practice. I'm not sure how much I'd use a doppler versus a fetoscope, but I'd like to get some practice with both, especially the fetoscope since it takes some skill, or at least a trained ear, to use.

Doppler

Fetoscope

I don't have a history of blood pressure problems or other pregnancy complications, but I'm getting these things as part of my plan to take charge of my prenatal health. As I talked with my midwife about these things yesterday she also suggested that I bring home the file she started for me, and use that to track my prenatal health. She asked me to bring the file to each of the five prenatal visits and she said:

"You're responsible, which is really true for everyone, but they don't always take that responsibility."

And that statement pretty much sums it up for me.

15 Weeks - Prenatal Visit and Plans

Midwife Ina May Gaskin at a prenatal visit.

I keep meaning to blog about my first prenatal visit, and it turns out I have more than that to talk about. Things are coming together, and I'm very excited.

I'll start about prenatal care.

I intentionally waited to schedule my first prenatal visit. Because of my two miscarriages I didn't want to try to find a heart rate at any point when being able to find one would be questionable. For instance, at 10 weeks with a doppler it's possible to get fetal heart tones, but it doesn't always happen. I didn't want to set my hopes up for something that might not work out even if things were still fine. If I hadn't been able to hear a heart beat at that point, it would have only caused more questions and doubts about the viability of my pregnancy, and I couldn't deal with any doubt. I was focusing on the positive and moving forward without fear. There were other factors in choosing to put off my first prenatal visit, but it was mostly that I felt things were OK and I didn't feel a need to have an official visit. I was already consulting with my midwife over the phone, and she had already helped me with some of my needs by offering advice, information, and alternatives I might not have considered myself. That shifted in my 14th week. Out of the blue I felt it was time to call my midwife and schedule a prenatal visit, so I did.

I took all my kids with me to Sherri's house, thinking they'd be happy to play there and that they could all gather around to hear the heart beat when it was time. Not so much. My toddler had just woken from a short nap and was grumpy. The other kids were fine, but the toddler refused to calm down. We didn't know where his pacifier was - I thought we'd left it at home - and he was MAD. Sherri and I were trying to start the prenatal visit and he just screamed at me. About halfway through the visit he found a Spiderman mask, and from that moment on he was Spiderman and he was happy. Phew! I had to laugh when Sherri's 5 year-old (her youngest) who owned the mask kept asking for it back and telling me how "crazy" my toddler was. Yes, welcome to my life.

On to the more important things. My weight was good, and exactly where I knew it was. I had bought a scale when I was thinking I'd have an unassisted pregnancy, so I'd been watching my weight. My blood pressure was nice and low (108/69 - normal for me), and the urinalysis was perfect! When I was pregnant with my youngest I had problems spilling ketones in my urine, meaning I wasn't getting enough nutrition, probably because I was still trying to breastfeed my fourth child at the time and it was such a struggle to meet my body's demands. My midwife counseled me endlessly during that pregnancy about eating more and eating healthier. I was so glad to have avoided that whole conversation this time!

She was able to find the baby's heart rate immediately, and it was 158 beats per minute.

Ina May Gaskin checking FHT with a fetoscope.

I don't remember everything we talked about. She asked if I was taking my nutritional supplements (yes) and how I was feeling. When I told her that I was still fatigued she asked about my sleep schedule and suggested more naps and going to bed earlier. 

Sherri was about to wrap things up and I said "Oh yeah, one more thing!" I told her about how I'd originally wanted to plan an unassisted birth for this baby, and how my husband hadn't felt comfortable about that and we'd decided to hire her again. I explained my reasons for wanting a UC and she listened and promised me that she would be as hands off as I want her to be. At the end of the visit she reminded me of her fees and asked me to talk with my husband and figure out how we would be able to pay her. I told her we would and thanked her, and we scheduled the next visit in 4 weeks. Then I gathered my kids and cleaned up the mess they'd made, and we went home.

I was happy about how the visit had gone, with the exception of the angry toddler. I was grateful for my midwife's support and felt very reassured that all was well with both me and the baby.

And here's where there's more.

About a week after the prenatal visit Sherri called me. She said she'd been thinking about what I told her about wanting an unassisted birth, and about our financial situation. She's a dear friend to us, and she knows our circumstances and has always been willing to work with us. She told me she thought that part of my motivation for wanting a UC was because of finances. She was right, but I had been afraid to admit that to myself until she pointed it out. She agreed that I have a lot of knowledge and understanding about pregnancy and birth and understood that I felt comfortable moving forward without outside support. She also pointed out that at my home birth there was a lot happening behind the scenes that I wasn't aware of. I had thought about that before and realized it was wonderful to just focus and be in labor la la land without worrying about setting up, cleaning up, and all the nitty gritty.

Sherri then offered an alternative plan.

She had talked with one of her midwife assistants and had made arrangements for this assistant to work with her in giving me 5 prenatal visits through my pregnancy, attend the birth, and provide one postpartum visit. They would also provide phone consultation throughout the pregnancy. She offered me this for a significantly lower cost than what my midwife normally charges.

The visits would be at the assistant midwife's home, which is closer to my home and a shorter drive than to Sherri's house. They would expect me to be responsible for my own prenatal care between visits, including tracking my own blood pressure and doing my own urinalysis. I was already comfortable with that, because I'd been considering doing it all myself to begin with. She suggested I get an automatic blood pressure cuff that would take the reading for me, since she wasn't sure if taking my own blood pressure would be accurate. She also told me where I could order the urinalysis strips from, and suggested I could also get my own doppler to use for fetal heart tones. She also asked that I commit to come to her monthly forum throughout the pregnancy, which was something I really enjoyed last time and was already planning on doing.

I'm very happy about this plan. I feel it shows trust in me to tune in to my body's needs and stay healthy and take care of myself, with minimal visits to the midwives themselves. I feel it's a really good compromise between an unassisted pregnancy and one with the full 13 prenatal visits that are typical. I feel very comfortable doing most of my prenatal care myself, and I love the idea of having my midwife and one of her assistants available as consultants. I feel this is a good way of utilizing them as valuable resources but not depending on them for everything. I'm really glad I spoke up and told my midwife about my desire to be unassisted, and that she really listened and seriously considered my wishes and my needs. It also takes some financial strain off by offering us a more affordable alternative.

How the United States Ranks

There are precious few situations in life where the cheaper alternative is also the better alternative – and maternity care is one. If we eradicated the unjustified obstetric monopoly in the United States, with its extreme medicalization of birth, and replace it with a humanized maternity care, we can vastly improve the care of women and babies, lower death rates for both women and babies, and save vast sums of money at the same time. A few facts:

• Percentage of gross national product spent on health care:
  

1966: 6 percent
1992: 12 percent

• Percentage by which U.S. health care expenditures exceed those of:
  

Canada: 40 percent
Germany: 90 percent
Japan: 100 percent

• The twenty-two countries with lower infant mortality rates than the U.S.: Japan, Sweden, Canada, Singapore, Hong Kong, Netherlands, France, Ireland, Germany, Denmark, Norway, Scotland, Australia, Northern Ireland, Spain, England and Wales, Belgium, Austria, Italy.
• Percentage of countries with lower infant mortality rates than the US that provide universal prenatal care: 100 percent
• Percentage of US women who receive little or no prenatal care: 25 percent
• Chances that a woman with little or no prenatal care will give birth to a low-weight baby(less than 5.5lbs) or premature baby(less than 37wks): 1 in 2
• Factor most closely associated with infant death: low birth weight
• Percentage of infant deaths link to low birth weight: 60 percent
• Average cost of long-term care(through age 35) for a low-birth-weight baby: $50,5588
• Average cost of long-term care (through age 35) for a baby of average birth weight: $20,003
• Cost of newborn intensive care for one infant: $20,00 to $100,00
• Cost of prenatal care for thirty women: $20,000 to $100,000
• Percentage of births attended principally by midwives (CNM’s and CPM’s): United States: 10 percent; European Nations: 75 percent
• Percentage of countries with lower infant mortality rates than the US in which midwives are principal birth attendants: 100 percent
• Average cost of a midwife-attendant birth in the US: $1,200
• Average cost of a physician-attended vaginal birth in the US: $4,200
• Health care cost savings obtainable by using midwifery care for 75 percent of pregnancies in the US: $8.5 BILLION per year
• Cost per year of using routine electronic fetal monitoring during every childbirth: $750 million
• Number of well-constructed scientific studies in which routine electronic fetal monitoring (EFM) during every birth has been proven more effective than the simple stethoscope to monitor the fetal heart: zero
• Health care cost savings obtainable by eliminating the routine use of electronic fetal monitoring in every birth: $675 per year
• US C-section rate: 1965: 5 percent, 2004: 29.1 percent, 2007: 33.3 percent
• Cesarean section rate targeted by the World Health Organization (WHO) and the US Department of Health and Human Services (HHS): 12 percent
• The eighteen industrialized nations and states with lower C-section rates than the US: Czech Republic, Japan, Hungary, Netherlands, England and Wales, New Zealand, Switzerland, Norway, Spain, Sweden, Greece, Portugal, Italy, Denmark, Scotland, Bavaria, Australia, Canada.
• Percentage of women in the US with C-sections who undergo repeat c-sections today: 91 percent
• Ratio of women dying from C-section to women dying from vaginal birth: 4 to 1
• Average cost of a C-section birth: $7,826
• Health care cost savings obtainable by bringing the US C-section rare into compliance with recommendation from WHO and the federal Department of Health and Human Services: $1.5 billion a year
  

Source: Born in the USA by Marsden Wagner,M.D. , 2006

Reducing Infant Mortality

Newborn Mortality (Death) Rate

The United States is one of the only developed nations that continues to have worse infant mortality rates every year. We see more newborn death in the U.S. than every other country in the world that has adopted mother-friendly and baby-friendly birth and post-natal practices.

The video below is very good. It explores the causes of and solutions for infant death. Please take the time to watch it.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

My Baby is Coming Soon! My Feelings and Preparations.

My baby's due date is approaching soon. I have two due dates; one based on the first day of my last menstrual period, and the other is based on an ultrasound that was done at 20 weeks gestation. The ultrasound date is 11 days later than the other, and I know that estimated due dates are not always accurate, so we are awaiting the arrival of our baby whenever he decides it's time to come. My obstetrician also admitted to me that ultrasound dates aren't very accurate at 20 weeks, and if we had done an ultrasound earlier, say around 9 weeks, it would have been much more accurate. When someone asks me when the baby is due, I just say "sometime in July". I get some pretty funny looks from them when I don't give an exact date, but I'd rather not focus on a specific day and get myself worked up about it.

My first baby was born 2 days past the due date. My last 3 babies were each born 4 days before the due date. If the pattern holds true with this baby, then I will have a new baby in less than a week! I'm not focusing on that however, and I'm happy to wait until the baby is ready.

We are busily preparing ourselves for his arrival, and we're very excited to be so close to welcoming a new child into our family. We have still been unpacking from our move a few months ago, and we only have a few boxes left to go through. It feels good to be organizing our home and staying busy. I'm especially excited that we're also preparing our home to have the birth take place here. I feel great peace about my decision to birth at home, and I feel ready for the birth.

My midwife gave me a birth kit that she put together with some essentials, such as chux pads (the absorbent pads used in hospitals to catch all the fluids and yucky stuff from the birth - I never knew before that you can buy them from the local store!), latex gloves, cord clamp, herbs for sits baths (for healing after the birth), suction catheter (just in case), gauze pads for cord care after the birth, and more. She told me that most births don't require everything in the kit, but it's better to have more than you need than not enough.

She also gave me a list of things to have on hand for the birth, including: feminine hygiene pads, diapers, towels, wash cloths, sheets, shower curtains (to use under the top bedsheet and under the birthing tub), garbage bags, paper towels, wipes, ice and bowl, crock pot (to hold and keep warm compresses) baby clothes, birth food for mom and everyone who will be there, lots of juice, and ingredients for her wonderful cayenne drink (which she uses to reduce bleeding). Anything else that may be needed for the birth will be brought by the midwife and her attendants, including the birthing tub.

My midwife has several attendants training under her, and I've met tham all. I don't have a specific preference of which attendants come to the birth, so we decided that when the time comes she will call them all and see who is available to come. We could have 2 or more attendants along with our midwife, and I feel good about that, knowing I'll have lots of support along with my husband (who is a wonderful support for me during labor and birth).

My husband has been more involved in preparing the house for this baby, and I think it's because the baby will be born here. I know that he's looking forward to not having to drive to and from the hospital. We're also glad that I won't be separated from the kids for 2 or more days like I was when I gave birth in the hospital. Our youngest is only 18 months old, and I know she'll be happier having me home rather than away from her for such a long time. I feel happy knowing that I will be able to control the atmosphere at the birth, and have all the comforts of home close at hand, and be away from the hustle and chaos of the hospital. I'm really excited about laboring and possibly delivering the baby in the tub (which no hospital in my state will allow), and not feeling like I'm under pressure to perform according to hospital protocol.

When talking about home birth, many people ask about the possibility of something going wrong. Many are afraid of the "what ifs" of birth, and worry that they should be in the hospital "just in case". I have not had any fear about these things. I feel comfortable knowing that 95% of pregnancies and births are low-risk and require no intervention. I've had excellent prenatal care from my midwife throughout the pregnancy, and have not had any complications so far. I will also be surrounded by a team including my midwife (who has 15 years experience with home birth) and her attendants, and they will support me and watch for any possible complications. They know how to handle many surprises at home, and if something more serious were to happen, they would know when a transfer to the hospital may be needed.

All in all, this pregnancy has been wonderful and I'm a little sad for it to be ending, but more overwhelmingly excited to be welcoming a new beautiful baby into our family and home. My family is the most important thing in my life, and I would not trade this life for anything else!

The Rights of Childbearing Women

I always talk about how important it is to educate yourself about your options and your rights. This will hopefully clarify what those rights and some options are. I ran across this blog by Doula Momma that lists 20 rights of childbearing women.

This article originally appeared on The Childbirth Connection. Please refer to their article for a list of resources and if you want more information.

"The Rights of Childbearing Women
This statement outlines a set of basic maternity rights that Childbirth Connection has identified and promotes for all childbearing women. It applies widely accepted human rights to the specific situation of maternity care. Although most of these rights are granted to women in the United States by law, many women do not have knowledge of their maternity rights.

Fundamental Problems with Maternity Care in the United States
This statement was developed in response to serious and continuing problems with maternity care in the United States, including:

• The United States is the only wealthy industrialized nation that does not guarantee access to essential health care for all pregnant women and infants. Many women, especially those with low incomes, lack access to adequate maternity care.
• A large body of scientific research shows that many widely used maternity care practices that involve risk and discomfort are of no benefit to low-risk women and infants. On the other hand, some practices that clearly offer important benefits are not widely available in U.S. hospitals.
• Many women do not receive adequate information about benefits and risks of specific procedures, drugs, tests, and treatments, or about alternatives.
• Childbearing women frequently are not aware of their legal right to make health care choices on behalf of themselves and their babies, and do not exercise this right.
  

We must ensure that all childbearing women have access to information and care that is based on the best scientific evidence now available, and that they understand and have opportunities to exercise their right to make health care decisions. Women whose rights are violated need access to legal or other recourse to address their grievances.

The Rights of Childbearing Women
* At this time in the United States, childbearing women are legally entitled to those rights.
** The legal system would probably uphold those rights.

1. Every woman has the right to health care before, during and after pregnancy and childbirth.
2. Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks.* Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.
3. Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all.
4. Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.*
5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care.* (Only second sentence is a legal right.)
6. Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.*
7. Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.*
8. Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby.** She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health.
9. Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.* She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.
10. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.* (Please note that this established legal right has been challenged in a number of recent cases.)
11. Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.*
12. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.*
13. Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.*
14. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.**
15. Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.**
16. Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.*
17. Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.*
18. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.**
19. Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.**
20. Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.**
    

1999, 2006 Childbirth Connection

AMA Resolution Would Seek to Label “Ungrateful” Patients as "Non-Compliant"

I just came across this article regarding a proposed AMA medical billing change that could affect expectant parents' rights to take charge of their prenatal care by jeopardizing their ability to get insurance coverage or seek other care givers by labeling them as "non-complaint". Under this proposed change, I could be labeled as non-compliant by my obstetrician's office simply for not subscribing to the suggested routine of prenatal visits (because I've been doing those with my midwife instead) and choosing not to participate in certain prenatal tests and screens. I would hate for my personal choices in managing my prenatal care to impact my future care options. I've posted the article in its entirety.

Please go to the International Cesarean Awareness Network website to see what you can do to help affect a positive change. I've posted the ICAN article in its entirety:

AMA Resolution Would Seek to Label “Ungrateful” Patients Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)

The resolution complains:

“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
• Use of these labels fails to recognize patients as competent partners with physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers
  

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.

1. Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”
2. Evidence-Based Maternity Care: What It Is and What It Can Achieve
3. http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans

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.

Key Questions About Your Care

Key Questions About Your Care

by Penny Simkin, PT, CD (DONA)

Answers to the following questions will help you participate in your care responsibly and help you know what to expect.

When A Test is Suggested:

1. What is the reason for it? What problem are we looking for?
2. What will it tell us? How accurate or reliable are the results?
3. If the test detects a problem, what will happen next?
4. If the test does not detect a problem, what will happen next?
   

When A Treatment of Intervention is Suggested:

1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
2. Describe the treatment. How is it done? How likely is it to detect or solve the problem?
3. If it does not succeed, what are the next steps?
4. Are there risks or side-effects to the treatment?
5. Are there any alternatives (including waiting or doing nothing?)
6. Ask questions 2, 3, and 4 about any alternatives.

In an emergency it may be impossible to fully explore these questions. Your caregiver should tell you how serious and urgent a situation is.