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<p>I mentioned in another thread that I have a bone to pick with my midwife and I'm composing a letter to her. I'd like to get your thoughts on it, overall I feel strongly about this but I don't want to seem out in left field either. If you have thoughts or suggestions, I'm open. Names have been changed to protect blah blah blah...</p>
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<p>thanks in advance!</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">Dear (midwife and midwifery staff),</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">It has come to my attention through personal experience and the shared experience of other women who have received care through your midwifery practice that there is a significant problem that needs addressing.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">While significant, this issue is simple – it can be rectified with very little effort on your part – perhaps an hour of work in the end, and I wholeheartedly believe it will improve the patient experience of every woman within your care.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">It's the issue of prenatal care information and consent.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I know without even asking that your existence as a whole is largely based on the premise of offering women alternatives, options, and freedom in their childbirth. This happens through the sharing of ideas and information and giving women empowerment in their birthing decisions that is often stripped from them in other birthing environments.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">Why then does this ideology start at the threshold of labor and delivery, and not 8 months prior when a woman typically enters your care?</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">In the period of one calendar year, I am the 4<sup>th</sup> member of my immediate family to use your birthing expertise and facilities, and the second generation within the family to avail myself of (midwifes name) midwifery services. This is quite possibly an unprecedented occurrence for your practice. It also is possibly a unique position of observation of your standard care procedures, protocols, and so forth.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">The consensus between myself and the 3 other family members previously mentioned is that the prenatal care – ie. The monthly, bi-monthly and weekly visits to your clinic – are lacking in basic communication between caregiver and patient. I feel uninformed by your staff of what to expect at any given visit, and since this is not my first birth, nor my first with a midwife, I have an advantage that my other family members (all first time mothers) cannot claim.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I expect when I go to any routine prenatal appointment to know what will be happening during that visit, what tests will be offered, administered and suggested, and what to expect in future visits. I should walk out of my very first appointment with at least a rudimentary understanding of what the next 8 months, birth, and post-partum care will look like. I know this is not an unreasonable expectation because it is the standard I have received at other freestanding birth centers and OB/GYN practices.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I find it unacceptable to arrive at an appointment and be told as my blood pressure is being checked that they will be drawing blood today – with no explanation of why, what for, or if it is an optional test that I have the right to waive if I so choose.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I find it unacceptable to leave an appointment having been told that my next appointment will include a 1 hr glucose test, but am not given any written information about the test or requirements for taking it along with protocols to remember a month in advance. At the very least, a note describing the fasting and so forth required for the test is not an unreasonable expectation.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I find it unacceptable to be prescribed (in error) antibiotics for a UTI that are contraindicated for pregnancy – had they been taken without the patient looking it up herself, the consequences could have been severe.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">These are a few small instances of the breakdown in communication that I am talking about.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">I understand the considerable constraints you operate under. Understaffed, over worked, difficult hours, operating on principle instead of profit – I have been there and done that. I know the work load, the responsibility and the obstacles. That this issue exists is entirely understandable. But it is also entirely unacceptable.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">You must understand the weight of informed patient care. Many women may come to you for other reasons I'm sure, but the reason I come to you is because I believe in informed health care, where options are open and my rights as a patient aren't superseded by the conveyor belt of standardized medicine.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">This is a reasonable expectation of any midwifery practice.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">My request is simple. Please provide your patients with information about the care they can expect to receive from your practice. You obviously have a set standard of care with a schedule of events YOU expect to impose on the patient. It should be very simple to communicate this schedule of events to the patient themselves, so that they know what to expect and so that they can make the decisions about their health care as informed as possible.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">Your patient should know what tests you expect to conduct at a given visit, what it entails, why it's being conducted, and whether it is considered necessary or is elective. Most genetic and deformity tests will fall into this category, and women have the right to know and the right to having more than 15 seconds to find out about it and decide.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">You can obtain this goal by providing an information sheet outlining your standard visit protocols at the very beginning of a woman's prenatal care. This way she has time to get questions answered, and do any research she feels necessary to make the best decisions about her upcoming visits and the pending birth, and time to make any preparations required.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">You could also obtain this goal by fully disclosing to the patient what to expect at her next visit, and providing her with resources and information about the events that will take place.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">You could also obtain this goal by outlining in written material how common complications are treated and handled – for instance, a UTI during various trimesters, or the protocols for a failed 1hr glucose test.</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"> </p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">An hour of work compiling the information necessary could have saved the peace of mind and health both emotional and physical for 4 out of 4 patients that I am aware of. You have many women under your care at any given time, and if it's 4 for 4 on just my count, I would imagine the number is not limited to this select group, but that it is felt by others as well.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">Please consider my request, I make the observation and the request with full respect for your position as a women's health advocate and as a midwife and midwifery practice with a most excellent reputation. I don't wish to seek care anywhere else, I only wish to experience the fullness of excellence within your practice that I know exists and can thrive with little effort.</p>
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<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;">Thank you for your time,</p>
<p style="margin-bottom:0in;border-collapse:collapse;font-family:arial, sans-serif;font-size:10.8333px;"><span class="Apple-style-span" style="font-family:arial, helvetica, clean, sans-serif;font-size:large;"><span class="Apple-style-span" style="border-collapse:separate;font-size:16px;line-height:16px;"><span class="Apple-style-span" style="font-family:arial, sans-serif;font-size:medium;"><span class="Apple-style-span" style="border-collapse:collapse;font-size:13px;line-height:13px;">(my name)</span></span></span></span></p>
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<p>I think you've done a really great job with the letter. I'd probably send it as is, but you can probably edit it down if you want to.</p>
 

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<p>okay...personally I see where you are coming from. but IMO the letter sounds very accuasatory.  To me, if I was receiving that letter- I would say maybe you should go get care elsewhere because you just tore me apart and the way I run my practice.  I don't think that is what you meant to do.  I understand that you have a lot of ways that you feel she could better her practice but I think that as I read that letter I felt a lot of blame.  I think this would be a good letter to send if you were fed up, frustrated and leaving the care of that midwife.  It does not come across to me as constructive crticism- just criticism.  I know you provide examples of ways that she could fix some things but when you get to those points I think the tone of the letter is set and it is almost belittleing. </p>
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<p>I think that it is a great 1st draft because it has all of your important points or it is a great letter to say this is why I am terminating care with you but for someone you wish to coninue to have a professional relationship with I would say maybe go through and "nice" it up a little but.  Does that make sense? </p>
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<p>that is my completely 100% honest opinion.  I just feel people aren't as receptive to "you do this" "this is bad", etc.  as much as they are to statements like "I really feel/don't feel like you take the time to explain abc and perhaps your practice would benefit from xyz" </p>
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<p>hope that helps and I hope you get everything resolved.</p>
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<p>Using "you this.." and "you that..." really tends to get people on the defensive. For example, you said (quotes are being wonky): "Your patient should know what tests you expect to conduct at a given visit, what it entails, why it's being conducted, and whether it is considered necessary or is elective."</p>
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<p>That could be re-worded as: "As a patient, I would like to know what tests you expect to conduct at a given visit, what they entail, why they're being conducted and whether it's necessary or elective."</p>
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<p>Other than that, I think you make excellent points. I would not be happy with a midwife like that either! I go to a free standing birth center and the midwives explain EVERYTHING. They give out an abundance of hand outs. They don't tell me they are going to do anything, they mention what they'd like to do and ask me if it's okay.</p>
 

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<p>I agree--it did come across as a bit accusatory/aggressive (I felt my hackles go up) and I like Lauren's re-wording--softens the tone without softening the important underlying point. I also might consider editing it down a bit--for me, the most effective paragraph is the 8th one down, which begins "I expect..." because this is grounded in your perspective/experience, is clear, and non-confrontational. I have to admit the earlier reference to "the consensus among my family members" sounds a bit like an anonymous panel passing judgment from above, which I think would make it hard for the recipient of this letter to read the rest with an open mind.</p>
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<p>That said, I admire that you are willing to articulate your concerns at such length and so clearly--I just think the tone is a little alienating but can be easily fixed.<br>
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<div class="quote-container"><span>Quote:</span>
<div class="quote-block">Originally Posted by <strong>Lauren82</strong> <a href="/community/forum/thread/1279903/rough-draft-letter-to-my-midwife-thoughts#post_16052694"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a><br><br><p>Using "you this.." and "you that..." really tends to get people on the defensive. For example, you said (quotes are being wonky): "Your patient should know what tests you expect to conduct at a given visit, what it entails, why it's being conducted, and whether it is considered necessary or is elective."</p>
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<p>That could be re-worded as: "As a patient, I would like to know what tests you expect to conduct at a given visit, what they entail, why they're being conducted and whether it's necessary or elective."</p>
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<p>Other than that, I think you make excellent points. I would not be happy with a midwife like that either! I go to a free standing birth center and the midwives explain EVERYTHING. They give out an abundance of hand outs. They don't tell me they are going to do anything, they mention what they'd like to do and ask me if it's okay.</p>
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Discussion Starter #6
Thank you SO much. Those are very helpful suggestions, I think I can nice things up with those wording changes.<br><br>
Both of my sister-in-laws broached this topic during their pregnancies with the midwife, and apologies were made but nothing changed. 6 months later, my sister and I are experiencing the same frustration and I am determined to induce change by making it a serious complaint and by offering as much solution as I can.
 

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<br><br><div class="quote-container"><span>Quote:</span>
<div class="quote-block">Originally Posted by <strong>othersomethings</strong> <a href="/community/forum/thread/1279903/rough-draft-letter-to-my-midwife-thoughts#post_16052983"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a><br><br>
I am determined to induce change by making it a serious complaint and by offering as much solution as I can.</div>
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As a professional who cares about my clients satisfaction I take any complaints seriously and as a way to improve my services and if needed I ask for suggestions how they think things should be changed if I see it fit. </p>
<p>I think you letter will bring more change if you offer suggestions in a form of "I" statement ( I expect) instead of offering ways to solve the problem. If they care about their client's satisfactions they would come up with solutions and ask for your input if they need help. However when you make suggestions like "it it can be rectified with very little effort on your part – perhaps an hour of work" It most likely would not be taken as you expect. I would not be per say offended but annoyed and less likely to be willing to change something that has worked for me in the past.</p>
 

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<p>I think it's a tad on the wordy side, but they should be able to sift through it.</p>
 
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