A Satisfied Patient Views Nurse-Midwifery Ann Simon

An their mos.

in and Kenneth Simon w . daughters, Erika (2 yr. ) and Sabrina (5 mos.).

pith . 9

“Why not?,” I asked myself as I considered the possibility of having a nurse-midwife deliver my second child. Through local publicity and the first-hand report of a friend, I had recently been hearing about the Maternal Health Service (Springfield, Ohio) -then a fledgling program in its sixth month of operation and just announcing the addition of a second nurse-midwife to its staff.

The idea of relieving the work load of over-busy doctors sounded very sensible to me. As I thought back on my experience with a private obstetrician during my first pregnancy, I realized that I certainly hadn’t needed a highly trained specialist to conduct the routine pre-natal examinations. And I hadn’t really required his expertise at that particular (unusually easy) delivery either. So, why not place myself in the care of nurse-midwives? There would be a doctor to double-check that the pregnancy was normal, and one of several specialists would be on call for delivery if any complications were to arise. I was satisfied that I would receive medical care of good quality, and 1 liked the idea of trying out something new. So I did.

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As it turned out I was delighted with my decision. I had certainly concluded correctly that I would receive good medical care; in fact I found that the nurse-midwives and overseeing doctor did a superior job of providing the medical attention that I required. But when I was first considering the Maternal Health Service I hadn’t given a single thought to another aspect of obstetrical care. It wasn’t until I entered the examining room on my first visit that I received a glimpse of what has turned out for me to be the real outstanding benefit of the program.

There on a bulletin board above the desk were prominently and proudly displayed several dozen snap-shots of newborn babies. I was delighted and astonished: the nurse-midwives had cared enough about these babies and their mothers to put their pictures up! Little did I know that they would also “care enough” to express real human concern for their patients’ complete emotional and personal well-being (as well as their physical condition) throughout pregnancy, labor, birth and recovery - from start to finish. They would regard me a total person with a full range of needs and interests unique to the pregnant woman, and dedicate themselves to meeting as many of these needs of all kinds as possible. And futhermore I would enjoy being regarded as a whole person, and would end up feeling absolutely deserving of the dignity and respect with which I was being treated. What an unexpected pleasure that turned out to be.

Let me make it clear that I was very satisfied with the obstetrician whom I saw during my first pregnancy. I looked forward to having him deliver my second child, but by the time I was pregnant again he happened to be delivering at a different hospital that was inconveniently located and did not have some services I wanted. He is a young and enlightened obstetrician, responsive to the interests of young, educated couples. He is friendly and personable, he always seems willing to take time from a busy day for conversation, he’ encourages his patients to attend pre-natal education classes (which my husband and I did). He was willing to consider our personal desire for a delivery with minimal medication, insofar as possible, and with my husband present in the Delivery Room to assist me; and he was jovial with us both during the actual delivery. Nevertheless, the warm and all-encompassing care I received at the Maternal Health Service was of a completely different nature.

I now consider nurse-midwives more than a convenient substitute for busy obstetricians. To me they represent a unique approach to obstetrical care which is quite different from that of most doctors, and one which is

. superior from the patients’ point of view. I became aware of this approach only gradually as my pre-natal visits grew more frequent; after the baby was born my impressions finally crystallized.

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I first noticed a special quality of the pre-natal oftice visits. The nurse- midwife entered the room, sat down comfortably, and asked if I had any questions. After discussing all my concerns, she usually had some information or suggestions of her own to add before asking me to lie down so she could examine me (gently, I might add). Revolutionary procedure. I always had to wait until after being examined in order to ask my doctor questions. I was left lying on my back to shout my inquiries to his retreating figure (unless I sprang up from the examining table by myself in time), and with each answer he took another step backwards toward the door.

That the nurse-midwife volunteered information I didn’t even ask about was even more amazing. I later learned she was following an informal agenda of topics to discuss at each visit if the patient hadn’t already brought them up. The topics included general information that would satisfy the woman’s natural curiosity about what is going on inside her body during pregnancy and what to expect during childbirth and her hospital stay. Instructions were also given about crucial aspects of maternal care, such as nutrition (with more individual attention than a list of foods passed out casually at the first visit), the importance of rest and naps, future plans for birth control, and the necessity for giving thought to organizing her home and meeting the needs of all the members of her family at the time of the new baby’s arrival. Incredible. I had been given the impression by my doctor that too much curiosity about my body changes due to pregnancy meant I was “worrying too much,” and neither he nor I would ever have dreamed of talking about how to help prepare my two and one-half year-old daughter to accept her younger sibling.

By the time I learned that I would be joined early in labor by a nurse- midwife who would remain present until the birth, I knew enough about the Maternal Health Service not to be surprised again. The contrast of this practice to the obstetricians’ usual brief check-ins and streamlined arrival timed to coincide with the completion of first-stage was obvious. But once more I was unable to anticipate what a treat was in store for me.

My husband and I were well-prepared by our previous childbirth experience (and a refresher course) to work together to keep me comfortably participating during labor and delivery, and we were expecting to do it basically by ourselves. But the encouraging presence of the nurse-midwife made the job much easier and more enjoyable for us both. I was so confident of her sincere dedication to me as a person that I was able to relax and trust her absolutely. She interpreted the progress of the labor much more accurately than we could have by ourselves, and she supported both of us - emotionally and physically - through a

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period of fatigue and discouragement. By the time she held up our new daughter for us to see, my husband and 1 felt a real bond of intimacy and gratitude to the woman who had assisted and joined us in the joy of giving birth.

It was clear to me during labor that the benefits of the nurse-midwife’s presence are even greater for the more usual patient who does not take the initiative to attend childbirth preparation classes and whose husband doesn’t know how to assist and support his wife. While the labor is progressing, the nurse-midwife can show the woman how to remain comfortable and can allay her fears by explaining what is happening. Her positive attitude can give the mother the confidence and support that could make the difference between a terrifying and excrutiating labor and one worthy of remembering.

While I was alone later with my new daughter happily recalling the past months and hours of my association with the Maternal Health Service, it occurred to me that I had been participating in a well-designed program with a coherent goal above and beyond that of producing a healthy mother and baby. All the aspects of care I had enjoyed so much were aimed at encouraging the mother to be an informed, confident and responsible person capable of giving birth with dignity and prepared to care lovingly for her growing family. Underlying the program also was a basic attitude toward pregnancy and childbirth that seems to me to be responsible for the unique mother-centered approach which came as such a delightful surprise to me.

The nurse-midwife regards pregnancy and-childbirth as a real, living heart-felt experience, as well as a series of important physical signs and events scientifically to be observed and dealt with. She is concerned with the feelings and the life of the pregnant woman, as well as the condition of her uterus, blood pressure and related physical details. During labor she concentrates on the mother’s own perception and control of her comfort and presence of mind, rather than merely regarding these hours as an inconvenient but necessary period preliminary to the “important” business of getting the baby out.

By expecting the labor and delivery to be manageable by the mother and nurse-midwife together with the minimum medical intervention necessary for the patient’s comfort (unless a complication arises, of course), the nurse-midwife includes the mother as an important participant in the significant and potentially gratifying event of giving birth. She regards the mother as a human being in the midst of one of the most exciting moments of her life, rather than a body to be manipulated through a series of procedures designed to promote optimum efficiency on the part of the doctor and hospital staff.

Any woman who is regarded with such consistent respect and individual concern throughout pregnancy and childbirth could not avoid

.

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liking herself and her baby as a result. Given the choice of selecting obstetrical care again at any time in any place, I would go far out of my way to find a nurse-midwife if I possibly could. I enthusiastically encourage my friends to take advantage of the benefits I enjoyed so much, and I look forward to my own two daughters having the opportunity to do so some day.

As I anticipate the increasing participation by nurse-midwives in obstetrical care throughout the country in the future, two concerns come to mind. I think it should be made widely known that nurse-midwifery programs provide unique advantages of warm and comprehensive attention above and beyond meeting standards of medical excellence, so that women will be informed about the nature of care available to them if such a program is established in their community. Even more important, I hope that the established professions will share my conclusion that the nurse-midwife has far more to offer than an additional pair of arms and eyes to aid the busy obstetrician, and will incorporate the mother- centered attitudes and approach of nurse-midwifery into their own established office and hospital routines.

If the women of America are to receive the superior obstetrical care our nation should be capable of providing them, it will be as a result of a growing awareness of the need to regard the mother seriously as a total human being - which nurse-midwives are already doing and an increasing number of young mothers are beginning to demand.

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