Monday, March 02, 2009

The Gynecological Exam: Physician versus Midwife

I had my annual gynecological exam today. For the first time in a dozen years, I saw a physician instead of a nurse-midwife. My reason was convenience. Our family practice doctor's office is about 2 miles from our house. The CNMs are more like 13. And they're usually running way behind.

Since finding them for my obstetrical care, I have stuck with the nurse-midwives for my gynecological needs for three reasons. First, being a believer in the midwifery model of care, I wanted to support CNMs with my business and my insurance dollars. Second, it was a way to stay connected with practitioners that I would encounter at births (the only births for which I've been a doula at the smaller-volume hospital in town have been with this nurse-midwife team). Third, I liked them. At least one I consider a friend.

But in this busy year (hence the pathetic blogging record of late), I am trimming time where I can. Cutting an hour and a half experience in half won out. I will write an apology note to the midwives soon.

Long back story. What I wanted to write here were my observations about what was different with my physician exam compared to the midwives. By and large previous exams and this one were very similar. I felt comfortable (physically and emotionally) at all of them; I had my breasts palpated, my cervix scraped, my uterus and ovaries squeezed between a finger in the vagina and one on my abdomen.

But there were a few things I noticed that were different about this exam.
  • My doctor did not ask about my calcium intake. The midwives always ask about my diet generally and calcium in particular. Each year I leave their office with a photocopied list of foods high in calcium.
  • My doctor did not examine my labia before putting in the speculum. Typically my midwives look at the exterior before diving in for the pap.
  • My doctor did not ask me to do a Kegel. The test I fear at every exam is the midwife's request that I do a Kegel squeeze on her finger. Let's just say it is always clear I do not regularly squeeze and release. Every year I vow to practice nightly -- at least weekly -- and forget as soon as my pap cramping goes away.
  • A nurse was present. I might attribute this to the fact that my doctor is a man. But my previous OB/GYN was a female and she always had a nurse assist, too. Midwives do it all for themselves.
  • I was not asked for updates on my family. Usually I spent at least 5 minutes telling the midwives about what my boys -- the ones they caught -- are up to.
Is there anything to extrapolate from this? I doubt it. I still felt like I had a thorough exam, that my whole health was considered. But maybe these differences are telling. I can't think of anything my doctor did that the midwives do not. It was all loss going from them to him, not a trade-off of some questions or procedures for others.

The differences were small. Small enough that I suspect I'll return to my doctor next year. But that is not to say that other things being equal -- namely the distance from me to health care -- I wouldn't choose a midwife over a doctor.

Labels: ,