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.

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Anonymous Anonymous said...

My midwife is a 30 minute drive from my house, at least, and usually a 30 minute (or longer) wait before I get taken to a room. However, my midwife's office is so comfy, that I don't mind. She has a massage chair, comfy wingback chairs, tea served in real china (not paper cups), a fountain and a gas fireplace in her waiting area. And all her exam rooms are equally as nice. My GP's and former OB/GYN's were cold and sterile, crummy and uncomfortable chairs, water (not tea) in paper cups, and magazines that were months or years old. They were all about the turnover, not making you comfortable. And none of them ever asked about me personally, my daughter, my career, my husband, etc. Patty, my CNM, always sits down with me for at least 5 minutes (once we talked for almost an hour! I felt bad for her other patients, but that is why I NEVER complain about a long wait) before beginning an exam. We show off pictures of each other's children, and she always tells me to stop by with my daughter and visit, even if I don't have an appointment. I would never trade a quick commute for that kind of service! My daughter is only 21 mos old, but I hope that Patty is still in business when my daughter needs to have her first gyn exam. (BTW, my CNM always has a nurse in with her during the exam. I always thought it was protection against a lawsuit.)

7:34 PM  
Blogger Elizabeth B. Alexander said...

Hm, I've always had male doctors, but that is my preference. I'm a black and white kinda girl when it comes to medical visits, and I've moved a lot so a nice rapport wasn't necessary as I'll prob only see them one more time. I also choose practices that are "full service" like WalMart. No matter what female related issue, it can be taken care of there.

My calcium intake has always been inquired, but that's prob b/c I'll obviously be at risk down the road. Birth control decisions are the lengthiest discussion point. I can't remember any specific exterior exam, but as a nonmed prof, I prob wouldn't notice as much going on under the sheet. No Kegel test either, maybe b/c I've never had a baby or pap cramping? Nurses have always been present to hand the scrapy sticks, qtips, etc. They've all been pretty much the same.

Interesting comparison.

3:21 PM  
Blogger Nadine said...

Interesting post. I always leave my OB/GYN wishing I had asked this or that. I've gone to several different doctors over the years and none of them have ever felt approachable to me. They seem so hurried that there's no time to ask them anything. I've never been to a CNM, but if that was the only difference I'd switch in a heartbeat. Maybe I should try!

11:09 AM  

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