Is it normal for OB to ask NO prenatal questions? - Page 3

[tammyswanson]

You must have had my docs too! Since I started going, I've seen about 4 different ones, and a FNP too. I had pre term labor when I was about 26 weeks along, when I went for my next prenatal appt they didn't check my cervix or anything. Most of the time they just do what they do to you. I almost wonder why I go, I actually cancelled my last appt because I read all they do is palpate your uterus and see where the baby is at. I already know the position of him though. I think I'd rather have fewer questions than too many, like too many unnecessary ultrasounds, kwim?

BTW, when I was in ptl, I didn't even know I was. A few days before my appt, I had noticed some old blood, and wasn't even really going to mention it. The FNP (who was the only one who even gave me any info about anything or seemed interested at all) asked me if I had any questions, and I told her about the bloody show. She then checked me and saw I was dialated, then they hooked me up to the beepy monitors and saw I was having contractions already.

I usually wait about 45 minutes in the waiting room (how appropriately named), then they make me wait another in the exam room, then they rush in and I'm out of there in like 3 minutes or less. They don't even tell me what my BP is unless I ask...and I had hypertension as well.

[wifeandmom]

I was fortunate with all three pregnancies to have doctors who talked with me about a range of topics. With my first pg, I saw one of four perinatologists for each visit. I'd say I spent an average of 10-15 minutes minimum talking about general pg issues at each visit which was more than enough for me.

Second pg, I saw one of the above peris til 26 weeks when we moved, then had a fabulous OB at our new location that I just cannot say enough good stuff about. She never came across as intrusive or patronizing, yet asked enough to get a clear picture of what was going on.

Third pg was my only pg outside of military health care and it was a dream. He would give a routine sounding speech that was appropriate to whatever stage of pg I was at, but then was just very laid back and asked questions and gave me ample opportunity to ask questions as well. His nurse was phenomenal as well.

[hubris]

Originally Posted by Individuation

a midwife who felt she was entitled to ask "various questions about my life"? *shudder*

Well, I didn't want to go into specifics, but anything she has asked has been pregnancy-related and not intrusive. I'm just impressed that she seems thoughtful about my health as a whole person, not just as a perineum, uterus, and fetus with some other random flesh attached. I recently found out the sex of my baby - he will be my third son - and she asked how I felt about having a third son. She asked because she has known women who were devastated by not having a baby of a different gender. I'm fine, excited about boy #3, but talking about it was nice, and I'm very happy that she is asking women these questions. What if I were somebody who really were having trouble with that? I would want her to pick up on it and help in whatever way might be appropriate.

What I was trying to express is that a HB MW is a lot more in touch with the fact that a pregnant mother is a PERSON. I really enjoy my MW appts. She has interesting information to share with me, and I appreciate that she truly seems to care about my health beyond just a fetal heartbeat.

Originally Posted by Individuation

Seriously, though, OBs may stop being so controlling and paternalistic when women stop needing to have their hands held and their hair stroked throughout their pregnancies.

Wow, that seems like a harsh way to view pregnant women. I don't think women who appreciate a holistic caregiver with good bedside manner are needy or behaving in an infantile manner at all.

Yes, I'm hiring my MW for her birth expertise, but because she will be with me during my labor and I know how important environment is to labor and birth, I'm all for building rapport with her, and I think it's great that her expertise in pregnancy, labor, and birth has helped her to build a knowledge base that guides what kinds of advice she might give me (mine to take or to ignore) and what kinds of questions she asks, based on her experience with other pregnant women (mine to answer or not).


I stand by my original assertion that it's irresponsible for any practitioner not to ask questions about his/her client's emotional welfare. Some women might not realize that they can bring these topics up on their own. Some might not know that things they're experiencing are pregnancy-related. It would be nice if all women were knowledgeable and comfortable enough to know just what questions to ask and when, but the fact is that a physician or midwife cannot assume that the woman in front of them is that knowledgeable and comfortable. As the expert, it's their duty to make sure that their client is healthy and informed.

...and FWIW, healthy women who are getting their needs met sometimes do have questions about emotional health. I'm a very physically and emotionally healthy mother with a very normal pregnancy. I'm experiencing pregnancy-related mood swings. Totally normal, and I know that. I have ample social support, a DH who understands what I'm experiencing and is an active dad to our two children - but I still don't *like* feeling like a raging bitch, and as such, I wanted to ask my midwife if she knew of anything I could do that I hadn't already tried. To me, that's just good use of a resource.

If a woman doesn't *want* to make use of a resource, that's fine, but I do think that caregivers need to make sure that their clients know what resources are available. One way they can do this is by offering advice and asking questions.

[Beppie]

[QUOTE=hubris;8674559]
I don't think women who appreciate a holistic caregiver with good bedside manner are needy or behaving in an infantile manner at all.

I stand by my original assertion that it's irresponsible for any practitioner not to ask questions about his/her client's emotional welfare.
QUOTE]

I agree with this 100%. Additionally, it really bothers me that my doctor, who does none of these things & asks no questions, then sends a bill for an outrageous amount of $$$. So I'm paying him for basically no services, just the 2 minutes he spends in the room with me and the stress that his lack of care causes me?

After my experience with that OB, I appreciate even more the holistic care that my homebirth midwife provides. I've only been pregnant once before; whereas she has helped many women through pregnancy and birth. Regardless of my book-knowledge, there is a lot I can learn from her experiences; that is why I'd like a provider who has a holistic approach. There is always more to learn.

[RachelGS]

I think the difference is in the RECOGNITION that pregnancy and birth are not simply medical events. They are whole-woman, family-making events, and as such, they have components that are physical and emotional and spiritual. Obstetrics as a high-risk surgical specialty tends to deal only with the physical. Appropriate care for low-risk women should include the acknowledgement and interest in the other areas of a woman's experience that are being affected by her pregnancy and birth. Now, how much each woman feels the need to go into that is a wildly individual thing. But not to have it as part of care leaves out a whole lot of the whole woman.

[redhen]

I saw an OB for the first (and only) time during my pregnancy at 22 weeks (I also saw a CNM once prior to that at 18 weeks and had an ultrasound around 23). That is exactly how my visit went and totally solidified my choice to UP the rest of the pregnancy and have a UC.

[applejuice]

Originally Posted by wifeandmom

I was fortunate with all three pregnancies to have doctors who talked with me about a range of topics. With my first pg, I saw one of four perinatologists for each visit. I'd say I spent an average of 10-15 minutes minimum talking about general pg issues at each visit which was more than enough for me.

Second pg, I saw one of the above peris til 26 weeks when we moved, then had a fabulous OB at our new location that I just cannot say enough good stuff about. She never came across as intrusive or patronizing, yet asked enough to get a clear picture of what was going on.

Third pg was my only pg outside of military health care and it was a dream. He would give a routine sounding speech that was appropriate to whatever stage of pg I was at, but then was just very laid back and asked questions and gave me ample opportunity to ask questions as well. His nurse was phenomenal as well.

I am glad you found good care within the medical profession of obstetrics.

Do you think the fact that your DH is also a medical professional worked in your favor also?

[lyttlewon]

Originally Posted by RachelGS

I think the difference is in the RECOGNITION that pregnancy and birth are not simply medical events. They are whole-woman, family-making events, and as such, they have components that are physical and emotional and spiritual. Obstetrics as a high-risk surgical specialty tends to deal only with the physical. Appropriate care for low-risk women should include the acknowledgement and interest in the other areas of a woman's experience that are being affected by her pregnancy and birth. Now, how much each woman feels the need to go into that is a wildly individual thing. But not to have it as part of care leaves out a whole lot of the whole woman.

That was very well said!

[georgia]

Originally Posted by RachelGS

I think the difference is in the RECOGNITION that pregnancy and birth are not simply medical events. They are whole-woman, family-making events, and as such, they have components that are physical and emotional and spiritual. Obstetrics as a high-risk surgical specialty tends to deal only with the physical. Appropriate care for low-risk women should include the acknowledgement and interest in the other areas of a woman's experience that are being affected by her pregnancy and birth. Now, how much each woman feels the need to go into that is a wildly individual thing. But not to have it as part of care leaves out a whole lot of the whole woman.

ITA

[Individuation]

Ok, for the record:

1) I think a lot of the previous posters here have described situations with OBs that would not make me happy at all. Controlling OBs who wouldn't ask/answer questions, and so forth. And I agree that this is not a good thing.

2) Some of the previous posters have described an opposite extreme where doctors/midwives have asked what I consider to be very invasive questions. If someone asked me how I felt about having a third son, I would be very put off. That's almost exactly the sort of thing I was talking about. Other invasive, inappropriate lines of questioning would, to me, include:

-asking about my relationship with my husband.

-asking about my relationship with my other children, or my other children's projected relationship with the new baby, or any such things.

-getting really, really involved in exactly what I eat and when I eat it, as opposed to offering good nutrition advice and being open to questions. This is a big one with midwives. A lot of them "discovered" nutrition and natural health as adults and have the zeal of the converted. I was raised by a hippie mom--growing up, I didn't know anyone who didn't know what probiotics were, or who drank soda. I eat a very balanced, whole-food, near-vegetarian diet, with a few frivolous foods in moderation (things like the occasional bag of Terra chips or latte), which is what I say to any healthcare practicioner. Doctors say "great!" Midwives feel entitled to ask for a whole diet plan ("and what did you eat yesterday? and have you tried blue-green algae?") My MW now doesn't do this. In fact, here's a really good example of not being invasive:

MW: Any nutrition concerns?
Me: How worried should I be about protein intake? All I want to eat are fruits and raw vegetables.
MW: (tells me roughly how much protein I ought to be getting)
Me: OK, I think I need to get more protein.
MW: Do you want me to go through some protein options that vegetarian moms have found helpful?
Me: Actually, I think I'll just eat a bit more meat for the duration of the pregnancy. We have a good organic farmer's market where I can get meat, and I have the safe fish list.

-That seatbelt thing a PP brought up? I'd be annoyed by it. I wouldn't be annoyed by an info sheet on seatbelt safety while pregnant, given to me with the initial paperwork (if you do initial paperwork). There's a big different between offering info and telling an adult that you need to know how they're buckling their seatbelt.

-I'd be really annoyed by excessive questioning about anything not related to my MIDWIFERY care, but to other aspects of my medical care. I let a midwife know my health issues at the initial interview, it is then up to her if she chooses to take me on as a client. However, I see her as a specialist, not a holistic practicioner, and I do NOT appreciate her taking on the role of my internist, my neurologist, or my psychiatrist.
Again, that said, I want to make sure she has the info she needs. I called my MW before my last major MS-evaluation/neurologist appointment just to see if she had any questions she'd like me to pass on to my neurologist regarding the birth. OTOH, the first MW I saw had major opinions about which MS medication I took, and kept asking me if I had researched "curing" my MS with a gluten-free diet. This was unprofessional and put me off completely.

-This is a personal thing, but I don't like emotional questions from strangers. I really, really hate being asked how I'm feeling. In everyday life, I've learned to accept the question from friends as an expression of friendship, like "I care how you're doing." When my DH asks, I actually do a "systems check" and report back on my emotional status. But when a midwife (or doctor) asks, it just gets on my nerves.

One last thing, and then I'm done ramblng.

I didn't mean to call pregnant women who want attention and questioning "infantile," although I can see how I came off that way. I think that women these days are very divorced from a community of other women who could have supported them and shared stories with them during pregnancy, and they are often forced to rely on a partner who may or may not be very supportive or (in the case of MDC moms) family who have radically different ideas about birth and parenting. Not fun. In all this isolation, I can see a real need for the birth practicioner to take on some of the role that in other times might have been taken on by other women in the community.

However, I worry that pregnant women in general have become very infantilized by US birth culture, and I think it's a dangerous thing to allow. If it's all right for practicioners to ask us about our marriages and to give an accounting of every food we eat, then I don't see how we can complain that they're trying to control our births when they talk about "letting" us go overdue...it's part and parcel of the same attitude.

[Individuation]

Originally Posted by RachelGS

I think the difference is in the RECOGNITION that pregnancy and birth are not simply medical events. They are whole-woman, family-making events, and as such, they have components that are physical and emotional and spiritual. Obstetrics as a high-risk surgical specialty tends to deal only with the physical. Appropriate care for low-risk women should include the acknowledgement and interest in the other areas of a woman's experience that are being affected by her pregnancy and birth. Now, how much each woman feels the need to go into that is a wildly individual thing. But not to have it as part of care leaves out a whole lot of the whole woman.

If my "emotional and spiritual" aspects were considered legitimate areas for a birth practitioner to explore, I'd be a lot more tempted to UC . Pregnancy and birth may not be simply medical events, but I do not expect my medical practitioner to address the non-medical areas of them. (edited to ask, does that last sentence make ANY grammatical sense?)

[BetsyS]

Originally Posted by Individuation

-I'd be really annoyed by excessive questioning about anything not related to my MIDWIFERY care, but to other aspects of my medical care. I let a midwife know my health issues at the initial interview, it is then up to her if she chooses to take me on as a client. However, I see her as a specialist, not a holistic practicioner, and I do NOT appreciate her taking on the role of my internist, my neurologist, or my psychiatrist.

First, let me say that I'm happy you have found a provider that you like and can work with.

However, I do think that midwifery care is its own beast, and you're not really understanding it. Midwives LIKE that they provide care for the WHOLE woman, which includes much, much, much more than a perineum and a fetal heart beat. Even CNMs. I remember in midwifery school, when we learned to do prenatal visits, one of the things in the huge learning curve was to remember to ask about their sex life in, oh, around the 20th week or so. There was a big push by the ACNM a few years back to make sure that we asked every single pregnant mama if she was safe at home and in her relationships. Between being a nurse and a midwife, I've asked that question hundreds of times, with only one "unsafe" answer. And, it was worth annoying all those other women to get help for that one unsafe woman. I'm sorry if you don't agree. But, it didn't hurt those women to ask the questions, just was annoying.

Most women do NOT bring up all their concerns. Or they operate under false assumptions. Women range wildly in their educations about pregnancy/birth/newborns. A huge, huge part of midwifery care is education, as well as caring for the WHOLE woman.

For me as a patient, if someone is going to check my cervix, I'm already comfortable enough with them to let them know that I'm doing okay emotionally. Or not.

[RachelGS]

Originally Posted by Individuation

If my "emotional and spiritual" aspects were considered legitimate areas for a birth practitioner to explore, I'd be a lot more tempted to UC . Pregnancy and birth may not be simply medical events, but I do not expect my medical practitioner to address the non-medical areas of them. (edited to ask, does that last sentence make ANY grammatical sense?)

Ah. Well, you see, that's where we differ. I don't think of a midwife as just a "medical" provider, because I don't think of birth as a medical procedure.

You can feel free not to participate in any of those kinds of discussions with your provider, but I absolutely think they're appropriate. If we had more attention to the emotional side of the perinatal experience, we'd have a lot less PPD, for one thing. We'd also have more women recognizing that there's more to having a baby than the physical part of it, and maybe insisting on being treated as people rather than just as (problematic) vaginas.

[Individuation]

Originally Posted by BetsyS

First, let me say that I'm happy you have found a provider that you like and can work with.

However, I do think that midwifery care is its own beast, and you're not really understanding it. Midwives LIKE that they provide care for the WHOLE woman, which includes much, much, much more than a perineum and a fetal heart beat. Even CNMs. I remember in midwifery school, when we learned to do prenatal visits, one of the things in the huge learning curve was to remember to ask about their sex life in, oh, around the 20th week or so. There was a big push by the ACNM a few years back to make sure that we asked every single pregnant mama if she was safe at home and in her relationships. Between being a nurse and a midwife, I've asked that question hundreds of times, with only one "unsafe" answer. And, it was worth annoying all those other women to get help for that one unsafe woman. I'm sorry if you don't agree. But, it didn't hurt those women to ask the questions, just was annoying.

Most women do NOT bring up all their concerns. Or they operate under false assumptions. Women range wildly in their educations about pregnancy/birth/newborns. A huge, huge part of midwifery care is education, as well as caring for the WHOLE woman.

For me as a patient, if someone is going to check my cervix, I'm already comfortable enough with them to let them know that I'm doing okay emotionally. Or not.

Well, first of all, I would like to point out that most if not all medical practicioners do ask an abuse-screening question or two... and that's fine. Probably a good thing. That's hardly new or limited to midwifery.

However, the rest of your post gives me pause.

A midwife is a specialized practitioner of a medical service--or, if you choose to define birth as "not a medical event," then she is a provider of a specialized service. She is not a educator, nor is she a general practitioner. If women feel that they cannot get appropriate care from their doctors and choose to seek it from their midwives, that is certainly the woman's prerogative. If they are able to find it, so much the better. However, I'm extremely disturbed at the idea that the standard of care in midwifery would be one in which the midwife's self-defined role was both so broad and so vague.

Genuine question: I'm also curious why you would need an emotional relationship with someone who was checking your cervix. Is it because you specifically mention a cervical check? Would you feel the same about a blood pressure or heart check--you wouldn't want one from someone you weren't comfortable talking with about your feelings? I mention this because it seems like another weird blurring of boundaries... the need for "closeness" with someone because the medical procedure involves checking the sexual organs. If that was meant to be a joke, then I apologize. If not, then yes I would find it a strange point of view to hold, and it would be a red flag for me if a midwife said it.

[RachelGS]

But you're still not getting what midwifery IS. What midwives do, by definition of the field, is so much more than checking vitals. It's not a rogue midwife being bizarrely personal-- it's a midwife following her training and the accepted standards of her field. If that's not okay with you, midwifery is not for you.

[Individuation]

Originally Posted by RachelGS

But you're still not getting what midwifery IS. What midwives do, by definition of the field, is so much more than checking vitals. It's not a rogue midwife being bizarrely personal-- it's a midwife following her training and the accepted standards of her field. If that's not okay with you, midwifery is not for you.

And as I mentioned, if yours was the standard definition, I'd probably be UC'ing with OB shadow care...

Thankfully, most of the midwives I've met aren't practicing according to these "accepted standards" yet.

[BetsyS]

Well, since you asked...

It is my opinion that medical care is very personal. I would like for someone to know me beyond "the brunette in room 3" before they do anything I deem invasive. I don't necessarily see taking my blood pressure as invasive, but checking a cervix certainly is. So, invasive is where I draw the line. And, they don't need to be my best friend, either. Just a wee bit of a professional relationship. It's the same reason I don't go to a provider that meets patients dressed in a gown (or naked) the first time. The first meeting is fully clothed. It's a simple thing, but it makes me happy.

And, for the other point, I see a midwife as a primary care provider, similar to a family practitioner. Maybe not for all women, maybe not for their lifespan, but certainly during pregnancy. I don't see my midwife as a specialist that I'm going to see to just deal with "female" stuff. I see her as more rounded than that.

And, like I said, if that's not what you desire, good for you for knowing that. I'm glad you found someone that you could connect (or not) with. I think that is very important. I connected with my midwife. Loved her, in fact. I had specific things I wanted from her, which she provided. That's all anyone can ask.

[RachelGS]

Originally Posted by Individuation

And as I mentioned, if yours was the standard definition, I'd probably be UC'ing with OB shadow care...

Thankfully, most of the midwives I've met aren't practicing according to these "accepted standards" yet.

It's not my definition. I wrote my dissertation about midwifery. It's what I came across again and again and again in both national and international literature about what the midwifery philosophy entails.

But it's not for everyone.

[~Megan~]

Sounds like my OB.

pee in a cup, blood pressure, feel fundus, tell about upcoming tests then we leave.

My midwife appointments included a lot more emotional and physical issues discussion.

[katt]

that was very close to my sister's experience. She got a little bit more then in and out, but not much.