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Is it normal for OB to ask NO prenatal questions? - Page 4

post #61 of 73
Midwives themselves seem to define their profession in a way that's consistent with the holistic approach described by many posters on this thread:

http://cfmidwifery.org/mmoc/define.aspx
Quote:
The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

* Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
* Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
* Minimizing technological interventions
* Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
http://www.mymidwife.org/index.cfm?id=3 (the consumer arm of http://www.acnm.org/)
Quote:
the philosophy of nurse-midwifery care "focuses on the needs of the individual and family for physical care, emotional and social support and active involvement of significant others according to cultural values and personal preferences."

Midwives listen to women, and always provide the information you need to make informed and educated decisions about your healthcare.
post #62 of 73
Quote:
Originally Posted by Individuation View Post
-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.
I can certainly see where you are coming from. Certain questions are just considered good manners, like how are you feeling to day or how was your weekend. I used to design customer service models and customers rated an interaction more delightful if there was a personal connection with the service provider. So while asking a person how they feel about their third birth might be a tad invasive asking someone other personal overall feel good questions are generally considered appropriate and in many cases are expected.
post #63 of 73
Quote:
Originally Posted by Saffron Frog View Post
My new OB is also very good about prenatal care...we've spent at least 25-30 minutes discussing things after all the routine care is out of the way at each of my appointments-including my first appointment with her when I went for my yearly, before I was pregnant-and what nutritional/lifestyle changes would be best before even actually being pregnant. Plus, she has 2 children, and had natural childbirth with both. For an OB, I think she's awesome.
Change this to a he and she (obviously HE didn't have a natural childbirth) and that's the practice I went to. They were awesome.
post #64 of 73
Quote:
Originally Posted by Individuation View Post
Ok, for the record:

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.
I agree that the lack of community is a major problem in our society today and is key to this conversation.

I think originally the midwives were more of a specialist who came in with her bag of tricks and the women around the pregnant mom (grandma, mom, sister, etc) took care of the major "doula" type support and the prenatal wisdom, so I think there is truth to this ideal that you look for in a mw.

My mw in Japan was very intuitive and very hands-off and she was great! She did about 300 births a year (with assistants) and she was just wise. She didn't talk much or ask a lot of questions but she was there if I needed her.

But I do think that the MWs (the good ones at least) are much more appropriate for our modern day needs. We do not have the community, like you say, or the experience of being at many births before it is our turn (most of us don't at least), so we kind of need that hand-holding.

Like you, Individuation, I was brought up in a "hippy" environment so all of these things were more just normal to me but I still enjoyed talking to my MW (the American one with dd#2) about all sorts of things. It is my hope that a MW will have enough experience and intuition to know when it is appropriate to delve and when it is not necessary or it is unwanted.

I think with any sort of care-giver there will be those we click with and those we don't. It can't be helped.

At this point I am more concerned that MOST people in the US don't even know they have a choice of going to a mw!! And that the standard of care MOST people are used to with OBs is really atrocious!!
post #65 of 73
Quote:
Originally Posted by Kitten View Post
I saw OBs for part of my first pregnancy. They obviously wanted to be in and out and seemed annoyed when I asked questions. I switched to the midwife practice and never got that impression with them.

I later got copies of my medical records to decide for myself whether homebirth was an option for me. I noticed that the OBs had noted on my chart, in rather large and angry-looking letters, "Patient had MANY questions" (emphasis theirs).

Geez, how dare I ask questions.

Makes me wonder exactly why they felt they had to make a specific note about this. From the tone of the rest of the entry, they did not feel my questions were a good thing.

LOL. That's code for "difficult patient" didn't ya know? When I was in the hospital with my first, my sis tried to help me avoid a csection. The notes said "twin sister had csection and is imposing her views on the patient" Ha.
post #66 of 73
Quote:
"Patient had MANY questions"
How dare you care about your health and the health of your baby and the health of your future pregnancies. What are you? A doctor?

Dr. Mendelsohn used to say that doctors would say condescendlingly to women patients, "Don't worry about that, DEAR!",
post #67 of 73
I had the reverse happen in my case. I started with a CNM with my oldest, and she acted like it was a pain to talk to me or do anything at all, and looked irritated whenever I asked a question. After 2 appointments I switched to an OB practice and they took their time asking questions about how I was doing and feeling, were open with me, and would casually chat a minute or two with me to see if there was anything that I was uncomfortable asking. Of course, the CNM was with a free clinic for lower income families, while the OB wasn't, so she saw a lot of druggie moms and welfare moochers and 14yo kids pregnant.............. And when I went into labor ith the oldest I found out that hile the OB practice rocked on prenatal care and making me feel important and special, their bedside manners really sucked...........

My current OB doesn't ask many questions about how I'm doing, usually just "how you feeling? How's baby's moving? Any problems? Any questions or conerns?" but he told me that he'd be like that because this is my fourth kid and he expects that I probably know what to look for by now. *shrug* And for the most part, he's right, I've mentioned things to him that felt off and he would follow up, digging deeper with more questions and doing any tests that may provide insight, but sometimes I feel like he may be a little too reliant on my being an "experienced" momma by now with this being the fourth baby. But he's awesome for delivery, and that's where it matters most to me. (I need to make a note to mention my recent swelling and such to him on Wednesday, I've had a few oddball symptoms come and go that could be a sign of something more and I think I should mention it, I just have that feeling)
post #68 of 73
That's how my old ob was. In fact I would hesitate to say he spent more than one minute with me at each appt. And if I had a question he wave his hand and say "don't worry" then he'd leave.
post #69 of 73
Quote:
Originally Posted by RachelGS View Post
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.
You know, I like the sentiment, but I'm wondering why is it only low-risk women who should have this option? Pregnancy and birth are still, "whole-woman, family-making events," when you're high-risk.

When I was a "high-risk" pregnant woman, I had a team of specialists probing incessantly for medical issues and making me insane, and a midwife providing actual pregnancy care. It was not a typical arrangement, but I think it -- or something like it -- should be. My MW was the only HCP involved in the whole thing who seemed to realize that I wasn't just having a pregnancy, I was having a baby.
post #70 of 73
Quote:
Originally Posted by Lady Lilya View Post
Then her entire nutritional advice was "3 meals a day plus 2 snacks, and drink lots of water."
In six pregnancies (two miscarried), the only nutritional advice I've ever had was "just make sure you take a prenatal - you can't get adequate nutrition from diet alone, anyway". That's from two different family physicians and one OB. (Okay - I lie - my original FP said my diet sounded good enough, but a prenatal "couldn't hurt" - the others never addressed diet/nutrition at all.)

My OB care has been with respect to "high risk" (post section) pregnancies, but it hasn't been very informative. When I got my medical records, I found the letter to my FP (I saw the OB by referral) with ds2 called me a "challenging" patient...with dd, the same OB called me a "very pleasant" patient. The only difference? I had more education, brought in research to back up what I'd learned and knew what I wanted. Both times, I was going for a VBAC.
post #71 of 73
SB,

I came to the first appointment with a detailed list of supplements I was taking already. I explained that I didn't want to take a prenatal because of the things in it I know I didn't need. (My iron is always high, and if I take vitC I get overdose reactions.) I asked her if there was anything I should add. They told me flouride! Not wanting to give them my anti-fluoride shpeel, I pulled out my book that lists which foods have which nutrients, read outloud what has fluoride, and told them I eat plenty of those. That satisfied them.
post #72 of 73
Quote:
Originally Posted by Lady Lilya View Post
she told me that my baby would end up brain damaged and only be able to get a job in McDonalds.
WHAT?!?!?!?!?!
post #73 of 73
Quote:
Originally Posted by ~pi View Post
You know, I like the sentiment, but I'm wondering why is it only low-risk women who should have this option? Pregnancy and birth are still, "whole-woman, family-making events," when you're high-risk.
Good point. I don't think it's that high-risk women aren't entitled to full-woman care, though-- just that it's not necessarily the job of an obstetrician to provide it. By definition, obstetrics is a surgical specialty. The job training is about managing major medical events and surgery. I think an arrangement like the one you describe is ideal. OBs SHOULD be checking in to be sure you're doing okay, emotionally speaking, and to facilitate an appropriate referral if you're not. But they're not trained in the whole-woman stuff and it's not a part of their model of care in the way that it is a part of the midwifery model of care.
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