I had my third prenatal appointment today at 23 weeks, three days. Here are some of the things which make me thoroughly enchanted by – not merely confident in – my midwife and her assistant. I think it’s important to have some kind of personal rapport with, or at least genuinely like, any kind of caregiver, especially a health care provider, since it’s easier to talk about personal things when you already, well, talk about personal things. I think there’s a significant qualitative difference in trusting your care to someone based solely on their education and experience, and trusting your care to someone based on not only their education and experience but also because you know that person actually cares about you in return, not just as a patient to manage or fix but as a person to comfort.
1. Transparency. For example, I do my own urine tests. They taught me the procedure, and I match the 15 or whatever different colored squares on the strip with the different colors on the test strip bottle. They taught me what the results mean, and we can discuss them for as long as I like, spurred by concern over a strange color or just rampant curiosity about theoretical results. I appreciate that my, ahem, “sample” isn’t merely whisked away, and I am later informed that “everything is normal” or “everything is normal except for X, which means now we want to do Y.” Riding that kind of train means I have no agency and am forced to follow the doctor who leads me by the hand down roads I don’t know anything about besides the pellets of information he’s feeding me along the way. I have a high pH balance, and now we’re going down the road towards fixing a bacterial infection or carbohydrate starvation? Why? Did you know that I had strawberry lemonade about 45 minutes before coming to this appointment, and that’s why my pH is wacky? Oh, you never asked, and I never would have known to tell you because all you’re looking for are problems to solve.
2. Unnecessary procedures are not treated as necessary. I had a blood draw done at my first appointment in order to do a full blood panel workup. I’ve never had one done before, and it would yield all kinds of useful information, so I consented. Now, I absolutely abhor needles. If I had already known that my blood was generally ok from having a blood panel done before, I probably would not have consented to it. Afterwards I told everybody who mentioned anything pregnancy related to me that I got leeched, and how well it went due to the assistant getting me on a soapbox about university policies and my midwife being the sweetest needle-wielder ever, even though I hate needles. To a man (well, except one who’s never been pregnant and who isn’t in a medically-related field) they all laughed and told me to get used to it because it would happen at every appointment. Well, no, it doesn’t, because it’s not necessary. I chose to get poked for the panel and today I chose to get poked at my next appointment for the glucose test, which I could have also refused. These needles have clear purposes with useful results and I am on board with wanting to see those results. Did I need to get my blood drawn at my second appointment, or at this one? No. There would have been no useful result. So why would something like that be routine instead of done when it actually has a reason for being done? Same for cervical checks. I have never had one and, God willing, I never will. Unless there’s a cervix-related issue going on, it’s pointless to do a cervical check because it says nothing of value. First, this makes my anxiety go WAY down. Years ago when my mom found out that I hate needles, she said I’d have to toughen up because if I ever got pregnant, I’d have to deal with needles all the time. That made me dread ever getting pregnant. If I were having a standard OB-managed hospital birth, she’d be right. Fortunately for me, I’m low-risk and am going a route with someone who knows that some routines should not be routine. Second, insurance (and technically us too, but we don’t have to pay copays for most things because there’s some fancy pool of cash that does it for us – no, I can’t remember what it’s called) doesn’t have to shell out as much money for things that really don’t need to happen. Third, it lets me know that there’s more critical thinking in general going on as well as awareness and response to the individual circumstances of the woman involved.
3. She listens to my entire long-winded questions and vague areas of inquiry including my description of the scenario leading up to it and all my attempts to answer the question myself and the results I got from that, and on and on, and she not only answers the central question, but also addresses everything else I bring up. She listens to ME and covers everything important to ME, instead of just listening long enough to catch a buzzword here and there in order to answer the question that she decides I should have asked. My husband has, for reasons unbeknownst to me, become very concerned over the possibility that we might be having twins. So I rambled about how can you tell and when can you tell and what would happen if we were going to have twins and what I can do to put his mind at ease until then, and how I really don’t think we’re having twins this time because of XYZ but on the other hand my grandma on one side had twins and my uncle on the other side had twins so it’s in the family… blah blah blah. She listened to all of it, figured out how important each aspect of this was to me, and we talked about all the facets I had brought up in order of importance. She never rushed me and she never turned it into a monologue. We already knew that my husband would be coming along to my next appointment because of the blood draw, and it would be around the right time to be reasonably sure about whether this belly contains twins or not anyway, so she offered to do the necessary prodding and dopplering involved that day so that he would be right there when it was done and would know the results firsthand. She DIDN’T just say, “Well go get a visual ultrasound if he’s so concerned about it” because she knows I don’t want one unless I have to get it (due to weird bleeding or whatnot). And then she regaled me with all the times that she’s found twins, how, and when – once as early as 12 and a half weeks.
4. She appreciates that I do my own research. I’ve read stories from dozens of women who said their doctor and/or nurse brushed them off or belittled them for daring to question the doctor’s procedures, diagnoses, and treatments based on the woman’s personal research. When I had run out of questions to ask before we were even halfway done with the allotted appointment time, I told them a funny thing that happened to me right before I came over that involved shopping for nursing bras. At one point I mentioned that I needed something for the interim “even though I know that technically you’re not supposed to buy your nursing bra until one month or so before you’re due so that you’re reasonably closest to your postpartum size…” and my midwife turned to her assistant and said with cheerful sarcasm, “You know one thing about Leah is that she never ever does her research, and she just walks in here not knowing the first thing…” We all laughed and I felt validated. Knowing as much as I can about things greatly helps me feel secure that even if I don’t know everything, I can ask intelligent questions, understand the answers, and know enough to recognize that we’re going in the right direction and when something might be veering off. For example, if I developed a taste for chewing on plastic bottle caps, if I didn’t know any better I might just chalk it up to some weird pregnancy quirk, because everybody knows that women go all sorts of sideways when they’re pregnant, and never tell my midwife about it. Instead, I know there’s a condition called pica where people are driven to eat things which are not food. This is a problem – some women are driven to eat laundry detergent powder, for heaven’s sake. If I started having cravings for non-food stuff, first and foremost I would know that something is wrong. Second, I’d know not to do it and to bring it up at the next appointment if not earlier. It also works in reverse, and keeps me from worrying about things that are totally normal and treatable at home, like an occasional UTI. I’m not frantically calling her up crying, “IT BURRRRRRRRRRNS!” I just drink way more water and cranberry juice if I can get it, and make sure to stick close to the bathroom for a couple of days.
5. She quoted Star Wars to me. Sigh… I think I’m in love.