An Appointment with a Midwife

There is a segment in the birth documentary, The Business of Being Born, where an obstetrician is being interviewed about her opinions on midwifery care and homebirth. She says it scares her, and "can they even monitor a baby at home?"

To those of us who are familiar with midwifery care, this is hilarious... and the answer is a resounding "of course!" However, with more than 90% of women never experiencing what prenatal care with a midwife is like, it's completely reasonable for people to be unaware of a midwife's capabilities and maybe have some reservations about the level of care they can even provide.  I admit, the first midwife attended birth I heard about involved a cabin and a boiled shoelace. I was horrified, as I'm sure most modern women would be.

I thought it might be fun to share with you what an appointment with my midwife, Jill, here in Salinas is like. People are usually shocked that my appointments typically run an hour, sometimes more if we get chatting. Some midwives work in offices alongside obstetricians, some work in birth centers (we don't have that option here either), some have their own offices where they conduct appointments and some come to the homes of their clients. That is what mine does, usually while my kids nap.

Jill always begins with how I'm feeling and asks lots of questions about how I'm doing both physically and emotionally, which I appreciate since I have an awful memory and I often forget everything I wanted to ask if I get rushed. We talk about what I'm eating, what supplements I'm taking, and because I have gestational diabetes, we discuss my blood sugar levels over the last couple weeks which I've recorded for her. She takes down my weight and adds notes to my chart.

Then Jill check's my blood pressure. It's usually perfect, better than usual for me actually, but if it's a bit high I lay down and we take it again... just in case.

This is my favorite part of our appointment, and what I most miss when I see an obstetrician. Jill checks the position of baby by palpating my belly. I know that an OB can give me the same information with a quick ultrasound, which is why many OB's don't know how to palpate... but it's not the same.


Baby was awake and very active this day but Jill finally cupped her hand near my ribs and said, "there... that's a little butt there," and near the left side of my pelvis, "and here's a head, baby is really having a good time in there wiggling around."

Then Jill checks my fundal height, which is the length in centimeters from the top of the pelvis to the top of the uterus, or fundus. Every centimeter equals another week. We just want to make sure I'm growing. Here I'm 33 weeks, I measured 35. Baby feels like it's average sized but she could feel lots of fluid. My babies are typically well cushioned... and whoever is unfortunate enough to be in the splash zone when my water breaks usually needs a change of clothes.

This one goes out to that OB in The Business of Being Born. Jill always brings her doppler, which allows her and anyone in the room to hear baby's heartbeat. While we have used it a few times, I usually ask her to use the fetoscope to minimize baby's exposure to ultrasound.

After feeling where baby is Jill typically finds a heartbeat right away, and today was no different.  The first time I saw a fetoscope I thought it was ridiculous looking, but it's specially designed to use the practitioner's forehead to conduct sound. I can't hear baby, but it's a worthwhile trade off to minimize exposure and risk to baby. My choice, Jill and many other midwives are happy to use the doppler too.

 Next I get my feet and ankles checked out for and signs of edema, or swelling, which could indicate problems related to gestational diabetes or preeclampsia. Thoroughly screening for any thing that may need medical attention is a huge part of our appointments and we always air on the side of caution.

We do a urinalysis to check for protein, sugar, blood, ketones and leucocytes (white blood cells)... which tell Jill all kinds of stuff. Late in pregnancy protein may indicate preeclampsia. Protein can also indicate a urinary tract infection or a kidney issue. Sugar could indicate that the gestational diabetes is not being controlled. Ketones show up when the body burns fat instead of carbs and could mean I need to be eating more (never an issue... I eat a lot!). Leucocytes or bacteria would mean that there is an infection.

I totally should have done my nails, that's not a weird happy face on my thumb nail, that's  badly chipped polish. Jill checks my hemoglobin with a simple finger prick. Hemoglobin is a protein in the red blood cells that carry oxygen. Mine is a little low so I supplement with Floridex, a liquid iron supplement that I highly recommend to any mama with low iron.

We finish up with a drum circle and hallucinogenic herbs... ok not true... two people can't make a circle. An appointment with a midwife is really not that much different from seeing an obstetrician, you get all of the same important medical screening, plus added attention to how you are doing as a whole and a more hands on approach to care. I don't feel like I'm being examined as much as I feel like we are working together to make sure baby and I are healthy.