Friday, August 29, 2008

Why Midwifery?

Some people might wonder why we're using a midwife instead of a traditional OB/GYN. One reason is I'm not very traditional. I'm a simple person when it comes to health care. Other than managing my asthma which is fairly mild at this point in my life, I lead a healthy life (eat organic "whole foods" as much as possible, exercise frequently, don't smoke) and usually go to my primary care physician once a year. I rarely use over-the-counter and prescription medications (as needed for my asthma). A drug-free kind of child birth fits my model of health care and midwifery seems like a natural fit. I could go "natural" with an OB/GYN, but the traditional medical model is potentially a lot more intrusive than I want. "You could have complications so let's check on everything rather than seeing me as a normal pregnant person."

Having said all that, it has been fascinating working with the West End Women's Health Center because it seems like a compromise of traditional midwifery and traditional obsterics practices. Throughout June and July I read Ina May Gaskin's Guide to Childbirth which basically tells the story of midwifery. Ina May is famously known from the midwifery practice at The Farm in Summertown, TN. I heard about The Farm often as a child of the 70's & 80's because one of my mom's good friends was a resident and currently is a midwife/instructor in Knoxville, TN. I have always had a positive association with The Farm and its values/tenets of living in community.

However, I didn't know much more about midwifery and this book is very informative and confirms my beliefs about how I want my child birth experience to be. Even at my AMA (advanced maternal age) I am not interested in having many of the diagnostic tests performed and that has been somewhat in conflict with SOP (standard operating procedure) even at WEWHC which surprises me. These tests used to be done for a specific medically driven concern - older age of mother, family history of genetic disorder, or some other genuine reason. With technological and medical developments as well as fear of malpractice, it seems like these tests have become standard and expected for all rather than rare and only truly necessary for a few.

Pregnancy and child birth are a normal part of life; women have been having children for centuries with the assistance of midwives. Actually outside of the United States, midwifery is much more common - something like 90% of women in the world use a midwife, only 5-10% use a different model. In the US, it is the opposite - only about 5-10% of American women use a midwife and most of those are affiliated with a hospital. Ironically that reminds me of the issue of last names when a WOMAN gets married. About 8% of women retain her "maiden" last name or hyphenate - 92% change to her husband's (in a heterosexual model). Once again I'm a non-traditionalist!

There is the convenience of insurance connected with using the WEWHC versus giving birth at The Farm or at home. It is still significantly cheaper to give birth using a midwife, even at the hospital - so I'm told by the WEWHC office manager. However, these lab tests cost money (someone pays for it) as well as being intrusive, possibly painful and potentially harmful to the fetus in addition to any emotional and mental anguish depending on the results.

At the end of my most recent visit to the midwife (not Soheyl again), she mentioned that at my next visit (28 weeks) I would have the test done for gestational diabetes. I said that I wasn't going to do the test and she looked up, seemingly surprised and said "not at all." I didn't understand that comment because I thought you have it or you don't. I said "not at all." Then she said she'd leave a note for my primary midwife who would prepare something for me to sign stating that I was declining the test. Interestingly enough it wasn't presented as a possible test to take and here's some information about why or why not to do it. It was presented as a standard test to have done.

I've read about the test - I don't have any of the symptoms. I haven't had fast weight gain, I don't eat much processed foods, I exercise, I don't have a family history of diabetes, and I eat because I'm hungry. Also I don't want to drink some sugary gunk, wait for an hour for them to take some blood and see if my blood sugar is high. That isn't natural!

I am happy with the WEWHC in general. When I asked the midwife about Labor & Delivery at Vanderbilt - can you move around, what kind of fetal monitoring is used, can you eat & drink, what about bath/showers, limits on labor time before induction, how do they feel about a birth plan, having people at the delivery, etc. - I received pleasing and comforting answers. The number of C-sections performed is low and there isn't pressure to get an epidural; it sounds like a more relaxed attitude about natural child birth which I would expect with midwifery.