Shortly after suspecting that I was pregnant and confirming that suspicion with a drugstore pregnancy test, I called my doctor’s office. My husband and I assumed that the next step in this journey we were now on was to see the doctor. The nurse on the other end of the phone, however, seemed to wonder why on earth I was calling. It didn’t help that I’ve seen three different doctors at that clinic over the past several years when I get a bad cold or strep throat, and the last time I was sick they refused to take walk-ins and I had to go to a different clinic. But finally she booked the appointment for me.
At my appointment, they repeated the pregnancy test, and when I saw the doctor, he told me that I was indeed pregnant. (I already knew that.) Then he asked me, “Do you want to keep it?”
I didn’t know what he meant. “Keep what?” I asked.
“The pregnancy,” he responded.
“Of course,” I said, but I was shocked by his question. My husband and I told ourselves he probably just had to ask it as a routine question, but it still unnerved me. I thought doctors were to be advocates of health and life, and if I didn’t “want to keep it,” then I wouldn’t have been there.
The doctor calculated my due date, laughed when I mentioned what the date of conception was, gave me a little pamphlet, and sent me off to the receptionist to book my next appointment. I was a little disappointed. But I dutifully showed up for the next appointment, and the next.
For most of the appointments, I spent more time sitting in the waiting room than seeing the doctor. When I did see him, he took my blood pressure and heart rate and asked me if everything was fine and then went off to his next appointment. One appointment was a bit more detailed (and painful), but still only took about fifteen minutes. I felt hurried over, and though I didn’t have many questions, I didn’t feel I could ask them.
Then a friend told me about the local midwife program, and my husband and I headed out for an information session. The speaker explained midwifery, the program’s development (pioneered by a doctor I knew), and their theory of natural birth. She showed us the birthing rooms at the hospital. I felt much more comfortable with this program, and the next week I transferred my care from the doctor to the midwife.
Our first appointment was half an hour, very informative and relaxing. The midwife explained to me the results of the tests that the doctor had sent me for (and never explained). She was happy to hear what date the baby was conceived, as that gives us the best indication of a due date. She answered our questions about ultrasounds and genetic testing, clearly explaining both and understanding our concerns. She included my husband in the discussions and let him run the machine to hear the baby’s heartbeat. Overall, I felt like she gave us much better care than the doctor had (or was able to). She wasn’t rushing off to the next appointment, but was able to focus on us and to get to know us and what we wanted for our unborn baby.
Today was my next session with the midwife, run as a group session with all the women who are due in February. We each filled in our own charts and had a few minutes with the midwife. Then she talked to us about how we could prepare for giving birth. The other women shared their experiences, as several of them have children already. I thought how natural that seemed – women supporting women and sharing this most womanly of duties. For those of us who are pregnant for the first time, and trying not to freak out over the thought of labour, it was helpful to hear from the women who had “been there, done that” and had a good experience.
With the doctor, I felt like I was part of a system and had no choice or voice, just had to go along and hope everything turned out okay. With the midwife, I feel like I am a woman and how I want to give birth is up to me. With the doctor, I wondered how much my husband could be involved; with the midwife, I know that he can be there supporting me. With the doctor, I felt like I didn’t know anything; with the midwife, I feel like I should know as much as I can. And I know that every woman is different, and that other doctors may be different; but for me, for this baby, this is where I am.
though my position on the author’s stance on many moral issues is whole-hearted opposition, I would like to commend her for her decision to opt for a mid-wife to help her make sense of and enjoy her pregnancy.
midwifery is an ancient practice – midwives have been assisting pregnant women and delivering (or “catching” – a common term used by doulas and midwives) babies for centuries. there is absolutely no reason at all to assume that the addition of a doctor makes this process somehow infallible – Canadian midwives have had rigorous training, usually first obtaining a nursing degree, and then undergoing at least 2 more years of school (at least 6 years). people give birth all over the world without assistance from doctors. two of my closest friends delivered their own babies at home, by themselves. they chose to do this because they were extremely disatisfied with their midwife; they had never even considered giving birth at a hospital.
good for you, KBW and husband, for exercizing your right to choose, for not being subsumed by the dominant course of action. I hope this allows you to connect with your baby, and with each other, in a way that truly allows you to embrace and enjoy your experience.
Hey there KBW, only just read this post for the first time. Well, I’m sure you know exactly what I would say about everything you posted and all the comments that have come after it. IF YOU WANT TO AVOID THE BIRTH BECOMING A MEDICAL EMERGENCY THEN AVOID THE OBSTETRICIANS. It is appalling to hear that the ob had a 100% c/s rate, and he should not be in practice.
The World Health Organisation says the c/s rate should be no more than 15%, so exactly why our so-called developed nations have rates more than double that is a very interesting question indeed.
I definitely agree about C-sections, it’s totally ridiculous when women request them for cosmetic reasons.
“Medicine has gotten to be cold and impersonal.” – Janet, thanks for understanding what I was trying to say here! This is a journey, and I’ve been exploring where it has taken me so far and why I’ve made the choices that I have.
Hecky – perhaps this post would have been clearer if I’d made it a whole pile longer and given all the stories that I’ve heard which have coloured my experiences and opinions. Friends of our went to see their doctor when they were expecting and found out that, in the thirty years he’d been delivering babies, he’d never had a natural birth. Every delivery he did by C-section. I’m sorry, but that turns pregnancy into an ailment requiring surgery. Now, I’m not against C-sections, when they are NECESSARY (I was born that way), but when it becomes a routine procedure, there’s something wrong.
As for my comment about “tons of treatment…” well, I’ve heard several birthing stories where it seemed that the woman in labour was given just that, and that none of it was necessary. Or that it was all given before it was deemed to be necessary. I don’t want to be routinely given a treatment that isn’t necessary, especially when most of them have nasty side effects for myself and my baby.
For your concern, Hecky… there is an obstetrician available for the midwives to consult with, as well as two doctors involved with the program (one of whom is the one I know). Once the baby is born, I will be finding a GP or pediatrician, as the midwife only gives brief postnatal care. If complications develop during my pregnancy, the midwife is able to refer me to an obstretician.
I’m happy with the doctor monitoring my progress for the next nine months… but I’d like to know what he’s doing when he’s doing that. Perhaps the fault is mine, in that I should have asked more questions, but as I tried to express in this post, I felt I couldn’t do that. Particularly when the doctor laughed at me at one point in time for trying to provide information that I thought (as did the midwife) would be valuable.
First of all, thank you for sharing your very personal experiences and feelings with us. I’m sorry the responses are mainly more debates. I don’t think that was your point!
Medicine has gotten to be cold and impersonal. The sad part is that doctors and nurses who truly want to give good care and be there for patients emotionally and such, simply don’t have time.
But women helping and supporting wormen through these times is an age-old, God-given thing. A beautiful thing. I’m glad you found somewhere that you feel comfortable. This is an exciting time. Enjoy it!
I think the HO is still used, but obviously it’s a completely irrelevant creed that fails to address most of the issues in modern medical ethics. For one thing, it embodies the “paternalist” tradition of medical practice, whereby the patient is little more than an afflicted rube in need of treatment. Modern medical ethics takes the autonomy of the patient to be fundamental, as expressed in paragraph 2 of the CMA policy, and especially paragraphs 21, 22, and 24. (Section 23 strikes me as a throwback to the paternalist days of “hippocracy”, haha.)
If what you say is true, your doctor is clearly ill-suited to treat you, given your particular beliefs, values, and aims for the course of treatment. You were wise to go shopping elsewhere, although I personally wouldn’t recommend relying entirely on midwifery. For the sake of your child it would be foolish not to have any doctor at all.
Next, you do realize that people were also dying of cancer and other ailments for thousands of years before they came to be considered medical conditions: does that mean they aren’t medical conditions? All states of health and unhealth are “natural” in this trivial sense. I don’t see why calling pregnancy a medical condition has to automatically mean that it is a state of unhealth. Obviously it’s very healthy. But it also happens to be a condition which requires very little treatment or intervention on the part of the physician. I guess I’m not really sure what it is that you expected of your doctor in this situation beyond monitoring your progress for nine months. Pregnancy is a routine, usually safe condition, that requires almost no medical attention. Doctors are well aware that it has been going on for thousands of years, which is exactly why they don’t need to do much when it happens. As with many conditions, the body has evolved to basically take care of itself. So I’m confused when you say the medical field requires “a ton of treatment” for pregnancy, since I thought the whole problem here was that your doctor WASN’T giving you what you considered to be adequate attention and treatment (which is perfectly normal for such a healthy medical condition).
Also, the CMA policy makes very clear that in your situation, your baby is not your doctor’s patient. YOU are the patient. Therefore the doctor’s first responsibility is to you, not to your baby, although obviously he’s going to do whatever he can for both of you. But to expect him to be considering the welfare of each of you equally would be to expect him to violate his code of professional ethics. If it came down to you or your baby, and he couldn’t save both of you, believe me, he would save you unless you had instructed him to do otherwise.
First, I object to the statement that pregnancy is a “medical condition,” as if I were “sick” and in need of “intervention.” One of the things that I’ve liked about the midwife program is the attitude that pregnancy and birthing are NOT medical emergencies, but rather very natural processes and part of a woman’s life. The medical field has turned it into a “condition” where a ton of treatment is required, when women have been having babies for thousands of years without all of that.
Further, my main point here was that my doctor wasn’t laying out all the options. I didn’t feel that he adequately explained all the tests that he sent me for or even what he was doing when he examined me. Nor did he mention that I had options such as homebirths, midwives, doulas, etc. It simply felt as though he had a little checklist to cover and then he was on to the next person, and I didn’t matter much in there.
I also went to the doctor with the expectation that he is going to take care of me and my baby, and it’s a bit shocking when the first thing he says indicates that he doesn’t care about one of us. What would you think if you went to your doctor with pneumonia and he asked, “So, you want to get better?” You assume that the doctor is going to take care of you, and you go because yes, you do want to get better.
The doctor’s comment also caused me to go look up the Hippocratic Oath (which my husband put here), though I’m now wondering whether doctors still actually swear that.
Thought I’d try and let the doctors speak for themselves. The Alberta College of Physicians and Surgeons uses the Canadian Medical Association’s code of ethics. Along with articles outlining positions on specific topics, it can be found at:
P.S. Hecky, while I appreciate your reading of the blog and comments on some of the more controversial or contentious topics, I would also love to hear your response on the main issues in the original posts.
Written 400 B.C.E
Translated by Francis Adams
I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
Taken from: http://classics.mit.edu/Hippocrates/hippooath.html
Doctors aren’t supposed to be advocates of anything. They are supposed to inform patients of all options for treatment open to them (yes, even pregnancy is a medical condition that can be treated). Patients are regarded as totally autonomous with respect to determining the course of treatment for any condition they have. Doctors lay the options on the table as clearly as they can, and patients tell them what to do. And the customer is always right on this commercial model of medicine, even if they choose to not treat their malignant lung tumour or to abort their pregnancy.