Tuesday, January 27, 2004

A Midwife Appointment

A Midwife Appointment
Stacey Greenberg

I recently had a conversation about midwives, well one of many, with my brother (by bond, not blood) who is a med student. This conversation made me realize that a lot of people have no idea what an appointment at a midwife’s office is like, although almost everyone knows what a visit to the doctor’s office entails. So for those of you who have never been, this is what it is like. (I’m speaking from direct experience with the Home Birth Midwifery Service of Memphis.)

The following is an excerpt from HBMS’s Informed Choice Agreement:

Pregnancy, childbirth & breastfeeding are normal, natural states of mind and body for the healthy mother. The midwife offers assistance and guidance throughout the childbearing years as a counselor, birth attendant, and friend. She is a skilled specialist in attending normal births, giving care and advice to the mother in pregnancy, labor, and childbirth, and care for the mother and newborn following delivery. She should be able to detect abnormalities in mother or child and refer to or obtain medical aid. She maintains respect for the integrity of the birthing family and the naturally bestowed ability of a woman to give birth. Out of respect for the birthing process, the midwife believes that unnecessary interference is an unwise interruption of the body’s function. She carefully watches and guides, assisting the family in the way that is of their choosing, respecting the sacredness of the family and its rites of passage.

The Home Birth Midwifery Service of Memphis (HBMS) is located in the heart of Midtown in the First Congregational Church. First Congo is a pretty hip church, well, as hip as a church can be I suppose. (First Congo houses a free trade gift shop, a cooperative living space, a digital film-makers forum, and an AIDS activist center among other things.) HBMS’s office consists of a really large room with sofas, chairs, and a desk; a small examining room; a clothes closet; and a waiting/reading/tv/play area. The office is decorated with lots and lots of photos of past clients and babies, fertility goddesses, and toys. The furniture isn’t fancy, but it is comfortable. The feeling is of being in more of a living room than an office. The exam room is especially cool because it has a big, colorful vagina on the ceiling to look at while having your belly measured and a sign next to the scale that says, “Gaining weight is good.”

Midwife appointments usually last an hour, sometimes more. The midwives see patients on Tuesday and Thursday afternoons. Usually, there are two midwives present and an apprentice. Occasionally one has the good fortune of seeing all four midwives and both apprentices. (I believe they alternate days and then have one week per month when they are all in the office.) The appointment is usually kicked off with warm greetings, hugs, and the handing over of the “pee basket.” The pee basket contains urine test strips to measure glucose, protein, and other levels in the urine. The mother takes the basket to the bathroom and compares her pee strip to the colors on the container. If all looks good, she throws the strip away and reports her results to the midwives. In the event that the colors don’t correspond exactly, the pee strip can be paraded into the office for an expert eye.)

The next order of business is to talk about how the woman is feeling, both physically and mentally. The midwives are very attentive and offer advice on a range of subjects. (i.e. how to handle the stress of a former miscarriage, an impending visit from in-laws, work, sex, you name it.) Pregnant women are also asked to keep a record of what they are eating so the midwives can see if all nutritional needs are being met. I have had them recommend herbal teas, high iron foods, and good quality prenatal vitamins. The midwives also take the woman’s blood pressure and ask about symptoms such as swelling, nausea, heartburn, etc. Once this is complete, the mother is asked to lie on the exam table so her uterus can be measured. The midwives use their hands to feel for the top of the pubic bone and the top of the uterus. (The distance between the two should roughly correspond to the number of weeks the mother has been pregnant.) They also use their hands to feel if the baby is growing from visit to visit. If the woman is more than 12 weeks along the midwives can also use a Doppler or a fetascope to listen for the baby’s heartbeat. If the mother is nearing the end of her pregnancy, the midwives can often tell the position of the baby by feeling the woman’s belly with their hands. Finally, the woman is weighed.

Once all the numbers have been recorded, there’s another period of hanging out and talking. The mother or her husband/partner may have questions or just want to chit chat. Future appointments and payments are also made at this time. The mother will see the midwives every four weeks until 30 weeks, then every two weeks until 36, then once a week until delivery. At 36 weeks the midwives will conduct the appointment in the woman’s home. This is also usually the first time that they do a vaginal exam. (Patients are required to see a backup doctor for an initial visitation. The backup doctor will do an ultrasound if the mother so desires. Lab work can either be done by the doctor or the midwives.) The current fee for a homebirth is $2400. Some insurance covers the cost of homebirth, some doesn’t. My insurance covers it as an out of network provider, paying 70% after a $300 deductible. The midwives also do sliding scale for people lacking the financial means to cover the full cost. The $2400 includes all prenatal care, including three childbirth classes, delivery (and clean up!), and post partum care.

I believe that midwives offer exceptional prenatal care. I have been more than pleased with the service I have received and would highly recommend a homebirth to anyone willing and able. Of course, if you live outside of Memphis, you can also get midwifery care in a birth center environment if homebirth is not for you. In addition, many lay midwives offer doula services and childbirth education to women choosing to birth in the hospital.

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