15 August 2011

Why We Chose Midwifery Care :: Part 3 of 3

And one last time, the disclaimer ...

When it comes to having selected a midwifery model of care for my pregnancies, I speak only from my own experience. I claim no expertise in the fields of midwifery or obstetrics, and make no claims to know what is best for each individual pregnant woman and her family. Recognizing that a variety of experiences and reasons inform a woman's choice of who will provide her with the best care, I have nothing against any person who chooses an obstetrical model of care for her pregnancy and birth. I believe every woman should choose the form of care which she is convinced will provide the best experience and outcomes for her and for her family. 

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Read Part 1
Read Part 2

Insanity: doing the same thing over and over again and expecting different results.
Albert Einstein

So. Assuming you've read the previous posts in this series, you may be thinking what I would probably be thinking at this point: that seeking out methods of health care outside the mainstream was and is a reaction against my prior experiences with modern medicine. That may be partly true, but there is much more that may be said about my reasons for choosing such alternative means of care now.

I related two experiences that stand out in terms of my relationship to the modern medical system, but it is important to note that they are not isolated. They are largely representative of what I came to be familiar with on a broader scale in subsequent visits. I found that I could roughly expect that the doctor would be running late, seem rushed, that I would have to repeat things I had already stated, or that things that I had said might be forgotten or dismissed as irrelevant. I came to expect that instead of a diagnosis and a treatment plan intended to achieve better health, I would get what was oftentimes a misplaced hypothesis that achieved no more than getting me to feel like a bit of a lab rat -- a body pumped full of pharmaceuticals that achieved nothing, or that were intended to mask the underlying cause. It appeared to me that the goal was not necessarily good health, but rather symptom management. The times when I did not feel like this were sadly and overwhelmingly the exception. 

Frustrated doesn't even begin to cover how I felt. The modern medical system -- for all the merits it may well possess -- failed me. Seven prescriptions, five doctors, two ER visits, two endoscopies, one CAT scan, and thousands of dollars later, and I was nowhere. But lest it be thought I'm coming down hard exclusively on doctors, it needs to be said that I recognize that they are operating within a system in which there are a number of factors at play that are out of their control, including but not limited to: insurance companies and their policies, hospital and/or clinic leadership and policies, pharmaceutical companies, federal regulations, and so on. I also recognize they are not the ones determining significant factors that directly impact my experience of the care I receive (e.g., how many patients they're scheduled to see in an hour, etc).

Seeking an alternative form a care came out of more than frustration and disappointment. When I was in good health and an infrequent participant in the medical system, I didn't have any problems with what I experienced. But being in and out of it on a very regular and frequent basis for a year revealed a host of weaknesses to me. The system as I experienced it was very broken, and I refused to believe that what I had experienced was the best that was available to me. So I went in search of system that would not only work, but that I could believe in.

When I did my research on some of the core premises of naturopathy, I found I agreed more with the foundational principles of this alternate form of care than I did in the more "modern" approach I had experienced. Naturopaths also abide by the promise to "first, do no harm" just like medical doctors do, but in addition to this there are five other principles that under gird the practice: the healing power of nature, discover and treat the cause -- not just the effect, treat the whole person, the physician is a teacher, and prevention is the best cure. I could add my Amen! to all of those.

Now, it should be said that when it comes to methods of treatment labeled as "alternative," or that otherwise veer from the norm of modern medicine, there are some utterly bizarre and questionable things out there -- things that, like many others who advocate the modern approach, I reject as forms of quackery. Those aren't at all the types of things I would support. For me, it really was finding a system that treats the whole person, that uses the gentlest and least invasive methods possible, and that produces the best overall results in my health (which for me, includes not losing my mind in the process). Midwifery, like naturopathy, is a method of care that meets those criteria in my assessment. In fact, the reasons I went to a naturopath and the reasons I'm now going to a midwife can be tied to just two root causes that go hand in hand, stemming from my previous experiences.

1. I want to use a method of care that is holistic (i.e., that treats the whole person) and effective, as well as a provider I can trust.
Though naturopathy is seen as an "alternative" form of medical care, it ended up being the most effective for me. For the cost of a few hundred dollars and over a period of just a few weeks, I got what thousands of dollars, multiple expensive tests (some of which were highly invasive, others of which involved ingesting copious amounts of nasty, thick liquids), and wasting months on end did not. In naturopathy, good health was presumed to be the norm and the ultimate goal. It was not just about getting rid of symptoms. In my naturopathic physician, I found someone who partnered with me in finding and addressing the root cause of whatever ailment it was that caused my health problems. I felt like he was on my team.

I see midwifery in a similar light. Instead of primarily being a medical event, pregnancy is seen as a healthy, normal part of life. Statistically speaking, pregnancy comes without significant complications for most women, meaning: most women don't require significant medical interventions. Fetal heart defects in my previous pregnancy excepted, I am one of those women. The pregnancy part is (relatively speaking) a breeze and my prior labor and delivery couldn't have been any more textbook. My OB in Washington noted that I had a body that was perfect for delivering babies naturally.

What's more, there tend to be significant differences in terms of the approach to care. Appointments with a midwife take more time. More than just the raw physical data is considered and discussed. In the hour we have together, we spend a lot of time talking not just about my overall physical health, (e.g., blood pressure, weight, baby's heartbeat, etc.) but also about how I am handling things emotionally. We talk about anything and everything impacting my overall well-being. When we had our first consultation with Kelli, the midwife we are seeing here in Florida, she told me: We will talk about your weight, your blood pressure, and your nutrition. We well do all the tests we need to and we will listen to the baby. But I also want to know about your heart and how you're feeling emotionally. She explained and affirmed what I already knew to be true: that these things as well as the others impacted one's pregnancy, labor, and delivery.

For me, this makes a substantial difference in terms of developing trust for the one providing my care. I am more relaxed even when the talk and procedures are medical in nature because my experience affirms that I am being seen and treated as a whole person. My pregnancy feels more like the beautiful, life-changing thing that it is instead of primarily being a medical event. I feel more at ease when I have the freedom to air whatever it is I'm feeling or thinking. The OB we saw in Washington for my pregnancy with Ewan was really great at accomplishing this same thing in the relatively short amount of time allotted for our visits together.

But we're in a very different place now, and I'm nearly halfway through this pregnancy. We know what kind of care we want, so seeking obstetric care is only a priority should something go awry.

Which brings me to my second point ...

2. My experiences at the doctor have led to a serious case of "white coat hypertension" and distrust.
Prior to dealing with my stomach issues five years ago, I had no problem going to the doctor. It didn't make me nervous in the least. I trusted my physicians implicitly and kept going back for my routine check-ups, or on the odd occasion that something didn't seem right.

The year that I spent dealing with my stomach issues changed all of that. I know there are good doctors out there -- great ones, even. I have seen some of them. But for the most part, I would have to describe the care I received over the course of that year as consistently mediocre. Not only were my health issues not resolved, I became frustrated and angry at how I was being treated, falling repeatedly through some fairly wide cracks and rifts in the system.

It is difficult to describe just how psychologically wearing this was on me. On top of being sick and exhausted, I wasn't getting the help I desperately needed and actively sought in order to get better. My quality of life was severely compromised. I felt dismissed and ignored, and there were many times I could tell that the guy with the stethoscope wasn't listening to me, but just ticking down the seconds until he could check me off his to-do list and get on to the next patient. I was pumped full of pharmaceuticals that weren't doing the job (and believe me, I said as much), but was instructed to keep taking them "just in case." Doctors that were working concurrently on my case routinely disagreed about the best approach to my care, and I got caught in the middle of the tug-of-war.

Since that year, I have absolutely hated going to the doctor, no matter the doctor and no matter the reason. I have no problem actually going when I know I need to go, whether it's for a routine check-up or I've got a medical issue that requires attention. But no matter how benign or routine the visit, I still become incredibly anxious.

Another result of this experience is that my capacity to trust doctors and the entire system of which they are a part eroded almost entirely. I am no longer willing to put up with the things I once patiently endured. Even when I know for sure I am seeing a good doctor and am able to reason with myself at length that I have no reason to be nervous (my OB from Washington being case in point), I will still get hypertensive. My heart will race, my blood pressure rise, and my breaths become short and shallow -- without fail (and all this before I even walk into the doctor's office).

maternity: on the farm {EXPLORED}
I like being pregnant. Really!

I love being pregnant. I have no idea how many times I'll get to do this again, and I want to enjoy every blessed minute of it, aching hips and all. I want to be relaxed, and I want to receive the best possible care from an experienced provider. I would rather look forward to my prenatal visits than dread them. It's not only better for me, but for the child who depends on me, too.

When it comes to labor and delivery, I want to have someone there who I trust, not only with her level of expertise, but also with her demonstrated understanding of the sanctity of the event. After all, she's playing a key role in one of the most intimate and transforming life events that a person can experience. The last thing I want is it being reduced to anything less in the process. Like any good midwife, we will have an emergency hospital backup in place before I ever go into labor just in case things don't go as planned (and with this particular midwife, we have the added advantage that she has several years prior experience as an EMT). But in the more likely event that we do not require that backup, I look forward to having my next child in an atmosphere where I feel safe and relaxed, with a person who (by that time) I know well and who understands not only just about pregnancy and birth, but what James and I want and need from her in one of the most important events of our lives.

I know midwives aren't for everyone, and I know they aren't perfect, either. Like doctors, I am sure there are some less than stellar examples of the profession out there. It also should be said that I know a lot of women -- many friends, in fact -- who are more comfortable having their babies with an OB in a hospital setting and who certainly don't have the white coat issues that I experience at doctor's visits. More power to them, I say! Who am I to have a problem with it?

But when it comes to me, to the tiny sliver of universe I occupy and to the choices that are mine, I find that if I don't absolutely need it, the modern medical approach is almost certainly not the best for me. It produces in me too much anxiety and frustration to be good for my overall health, things that are especially important to avoid in pregnancy. My current midwife comes from a varied background, several years experience, and hasn't lost any moms or babies in her many years of attending births. I'm not sacrificing good prenatal care for the sake of an experience. I'm getting all the same scans, tests, and blood work that I would get if I were seeing an OB.

The truth is, I just feel a whole lot better about how I'm receiving those things. Like any expectant mom, my heart is in this. I've been through too much already to compromise on what I want, what is most important to me, and on what I'm convinced my family needs. For my own well-being and the well-being of my baby, I want and need someone alongside us for the journey who gets this, who practices her profession in a way that not only reassures me that she knows our hearts, but that hers is in it with us, too.