In the 12 weeks I’ve been pregnant, I’ve had two episodes of light spotting and two episodes of some pretty intense pain.  Two years ago, these might not have concerned me much, but after my miscarriage last spring I find myself a bit more jumpy at the possibility of anything being wrong.  This new unease has led me to seek out more medical care than I usually do during pregnancy and I was struck by the chasm of difference between my primary care provider (midwife) and my medical care provider (physician’s assistant).  Before I start describing the differences, let me lay out their similarities:  they are both women, they both know me personally as well as professionally, and they both are supportive of my choices (although the PA doesn’t always agree, she does acknowledge that my choices are my own to make).

The first stark difference is when there’s a problem.  The first time I had some spotting, I called the midwife immediately.  I was in a state of panic and could barely control myself when she answered the phone.  (For those of you who have only experienced OB care, I can imagine how shocking it must sound that my care provider not only was available but answered the phone herself!)  We talked for several minutes about the specifics of what was happening, how I felt and what remedies to try.  By the end of the call I was feeling more peaceful and reassured.  I feel very confident that the swift administration of herbs/vitamins aided in keeping my baby here with us.  I was also told explicitly to call anytime.  That’s right, ANY TIME, day or night.  We had more contact towards the end of the day, but I will never forget her calm advice and loving words in my time of panic and grief.

In contrast, I called the office of the physician’s assistant after having some serious pain for an ultrasound.  When calling (8:30am), I had to first speak with an appointment scheduler, who took down all the information and then passed it on to the PA’s nurse.  The nurse then had to call me (10:00am) to set up an appointment (1:45pm), after checking to make sure the PA had an opening and that my situation warranted same day care.  Then I had to see the PA so she could verify that I did indeed need/want an ultrasound and call the technicians to schedule that (4:00pm).  Whew!  I get dizzy just thinking about all the various channels that must be gone through before getting the needed care.

At my first prenatal visit, the midwife asked me if she could take my blood pressure, check my pulse, feel for baby and listen for a heartbeat with a fetoscope.  Not once did she lay her hands on me without asking my permission first. 

When I saw the PA, she never once asked me about anything she did.  She simply put her hands where she wanted and that was that.  The nurse didn’t ask either, come to think of it.

This may seem like a small and petty thing to notice, but I think it’s actually quite huge.  As I said earlier, I know both of these women outside of their professions and I know that the PA is a very kind, respectful woman.  However, when she is in “doctor” mode, she does what she was trained to do…assess the patient (me) in whatever way seems necessary or warranted by the potential problem.  Imagine if every time you went to the doctor, instead of holding the cuff for you to put your arm in, the nurse or doctor asked, “May I take your blood pressure?” or before he/she touched you in any place asked, “May I touch you here?”  How would that change our perception of our own bodies, our own power?

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