One thing I love (love LOVE!) about the midwifery model of care is the continuity of care and presence that the midwife has with her clients. Prenatal appointments always last 45 to 90 minutes. The midwife is the one who takes you back, does all the initial readings, answering of questions, and more “professional” tests herself. She is with you throughout the entire birth, from when labor gets going until a few hours (at least) after the baby is born. She will let that time take as long as it takes, no intervening to hurry things along, but she also knows when to go to interventions.
Compare that to an OB/hospital birth. Prenatal appointments may last 45 minutes…but only about 5 minutes of that (maybe 10 if you’re lucky) are with your actual OB. Much of the rest of the time you’re waiting, filling out paperwork, or an assistant is asking you questions and doing procedures. The assistant takes you back and does all the initial readings. OBs are often frustrated that you have questions that expand the length of your appointment, and I know women who have even been told, “Well your questions took so long now we have no time to do any of the normal checks for this appointment.” The OB ducks in to do the professional tests, then ducks back out and sends results or follow-up info back in with the assistant. At the birth you are attended mainly by L&D nurses, who are likely to rotate throughout your stay. No one has ultimate responsibility for your care, it’s easy to pass the buck if something confusing happens. And it can be hard to notice long-term patterns, since there is no one with you long-term. The OB shows up just at the end to catch the baby…and not uncommonly you are told to wait for the OB to show up so they can catch. The other time the OB might show up is to try to get you more on their schedule, so you can deliver before their shift is over or it gets too late at night, by advising additional procedures.
This is so different. So wildly different. I know some don’t understand my desire to have a midwife over an OB. This is one of the many reasons. Social Anxiety Disorder, people. I will have a hard enough time relaxing in front of one person I trust enough to make good progress through labor (because yes, being scared, nervous or anxious can stop or slow labor), constantly changing nurses and whatever OB is on call at the time is not my cup ‘o’ tea. Especially when I don’t trust them to let me be me..possibly outside of the “average” progression or procedure of labor but still perfectly safe. I have had too many doctors not accept that I am the way I am and just try to “fix” me against my will, I don’t need to go through that at birth, too.
But my thoughts here were more than just birth.
I recently made the connection between this attitude in obstetrics and this attitude of all of modern medicine.
Recently I found a new doctor (recommended by a friend). I’ve only seen her once, but I thought she was fabulous. She talked to me for 45 minutes, really getting a history. She was happy to explain why she recommended everything, answering all of my questions without making me feel guilty for taking up her time. She recommended, and I got, 3 vaccines, but I felt pretty OK taking her recommendations, because she was happy to explain her reasoning behind them and every time she had a good, concrete reason.
Now I have to go back to get the follow up vaccine (since it’s a multi-shot series for one of them).
I called yesterday to make my appointment (because I am anal retentive and I wanted it scheduled waaaaaaay ahead of time so I don’t forget and then have to wait one extra day for an appointment but when I got the first one it was too waaaaay early to schedule the second). Since I first saw the doctor, and she seemed so happy to answer my questions, I had started a list of follow-up questions that I had been thinking of. I was so disheartened by past bad doctors I hadn’t made a big list before the first appointment (plus I had that one big issue on my mind), so I was excited for this next one when I could ask all those little things I’d been wondering about for early pregnancy and TTC.
As I scheduled the appointment, the scheduler let me know, “So if this is just for a vaccine you won’t see the doctor, this will just be an appointment with her assistant.”
It makes sense, given the modern medical model. The assistant pulls me back. She does all the basic intake tests. She delivers the vaccines. So why would the doctor even need to come in?
Except that I want to see my primary care provider. Because that’s who I go to the office to see. I want her to do my care. All of it. Start to finish.
I hadn’t realized how much this fragmented model of care kind of got under my skin. Not a lot. But a little.
The endless repetitive paperwork.
The re-answering the questions for the assistant.
The re-re-answering the questions for the doctor.
The doctors’ time just feels like it’s too precious to be spent with patients. You need your blood pressure read? Eh, someone less skilled could handle that. You need a prescription? Eh, I’ll send it back in with the nurse, if you have (any or further) questions you can ask the pharmacist. You’re coming in to get a vaccination? Eh, the assistant can handle everything there.
I’m pretty sure I’m paying the same price for the office visit, doctor or no doctor showing up (though maybe not). So why can’t she just stop by to look everything over quickly before giving me the shot?
I mean, heck, even the vets want to see my dog before just giving him shots.
I want continuous models of care to become common. So I don’t feel like I’m wasting the time of professional who I hired to provide a service by asking her to provide that service in depth. I just want to see her regularly. And, maybe more importantly, have her see me.
Not a big deal. Just feels kinda off. Something else for me to think about.