Wednesday, January 27, 2010

Midwives Do Gyn Care Too

Let's talk today about gynecological care. Specifically, who do YOU see for GYN care?

The reason this is on my mind is because I recently stumbled across Kate Harding's original post on "Why Don't Fat Women Get Checked for Cancer of the Nasty Bits?" I don't know how I missed the original post but I did.

If you haven't read it yet, it's a post well worth reading, especially if you are a healthcare provider or are not a woman of size yourself.

It can help you gain some insight into the negative contacts women of size have had with the medical profession and why we can be so reluctant to go to the doctor. It may also shed light on why we don't get screened as often for cancer, or why our cancer may be more advanced by the time it is discovered.

Definitely a post worth reading.

However, as I read the comments on the post, I thought it was telling how not ONE person talked about using a midwife for GYN care instead of an OB.

Midwives Do Well-Woman Care Too

Newsflash: Midwives don't just catch babies. They do well-woman and GYN care too.

And chances are you'll get better treatment with them.

Although not universally perfect on fat-acceptance issues by any means, most midwives are far more size-friendly than most OBs. And even if they don't perfectly "get" size acceptance issues and HAES, most midwives will take far more time and care with you than most doctors will, and most midwives listen to your perspective and work with you on healthcare issues more than doctors will.

Why is an OB the automatic go-to when women think about getting well-woman care? Do people not know that midwives are perfectly competent at doing regular well-woman and GYN care? Why don't more women automatically go to a midwife for such care?

Most Certified Nurse-Midwives (CNMs) are covered by insurance, are well-trained and experienced in doing well-woman and GYN care, and work in a practice with OBs so that if something comes up that needs to be seen by a specialist, they can refer you to a person within their own practice group.

Most homebirth midwives (who can have various letters after their names, but who are most often Certified Professional Midwives/CPMs and/or Licensed Midwives/LMs in the USA) do GYN care as well. Some are covered by insurance, some are not.

The advantage of CPMs/LMs is that they are likely to be able to take even more time and care with you than OBs and CNMs, because their time is not so tightly controlled by insurance guidelines. Some are also trained in certain birth control methods (like cervical cap) that most doctors (and even many CNMs) are not.

The disadvantage of CPMs/LMs is that you may have to pay out of pocket (or at least out of network) for your care. Some women feel the extra time and support is well worth the extra money. Financially, I wish it were a realistic choice for all women....but if you can't do the out-of-pocket or out-of-network thing for a CPM/LM, you can usually get coverage for a nurse-midwife.

For years, I got all my pap smears and breast exams etc. from an OB-GYN office. I just thought that's where you went. I tried to get a female doctor (or a female nurse-practitioner) for these exams, but I went through an OB-GYN most of the time.

I did not realize until after I'd had kids that I could use a midwife for my well-woman care. Doh!

Now I go see either the nurse-practitioner at my family doctor's practice, or I go see the CNMs associated with my local hospital. I'd really prefer to use a CPM, frankly (and I do on occasion), but generally speaking I don't because of insurance coverage. (Sad, because the best care I ever got was from a CPM.)

I find I get MUCH more woman-friendly care by seeing midwives, and much more size-friendly care too.

That's not to say that all midwives are automatically size-friendly (clearly some are not, and I have heard a few bad stories), and of course, not all OBs are fat-phobic. There are good doctors out there too, so let's not knock them all. The good ones deserve our business too.

But generally speaking, you are more likely to find woman-friendly care and size-friendly care from a midwife than you are from an OB.

The Take-Away Message?

Challenge the dominant paradigm that means GYN care = a visit to an OB. Consider going to a midwife instead.

They're not just for catching babies!


Molly said...

Hooray for that! (And yes, I do really think people have no idea midwives do anything other than prenatal/birth/postpartum care. I certainly didn't until I was seeing midwives during my pregnancy.) The extra time you get with a midwife can be incredibly helpful if you are in any way 'nonstandard'--for instance, I deal with extreme anxiety about pelvic exams because of an earlier trauma, and while I've never found a doctor willing to alter her routine to suit my needs, the midwives and nurse practitioners at the birth center where I gave birth truly listened to me and offered me individualized care. Makes a huge difference.

Anna Geletka said...

I see a midwife at my clinic (which happens to be a Planned Parenthood). It never occurred to me that midwives could handle regular well woman exams until she happened to be assigned to me. I love, love, love her. She keeps me laughing and chatting even during the exam!

Zayna said...

So true. At my ob/gyn I see the nurse practioner-I like her attitude. When I asked her to do some bloodwork just to check my hormones as I was thinking about TTC she said sure. No-you need to lose 100 lbs. Just okay. I did not get that vibe with the ob/gyn.

I actually have an appointment Tuesday and I'm looking forward to talking to her about other TTC related issues.

Unknown said...

Great read! I am a mom of three and a student midwife becoming a CPM. I have been seeing a CPM for all my well-woman care since the birth of my son in 2005. It really is the best and they spend so much time with you personally. It's great!