Doctor vs. midwife

The differences in care provided by a doctor vs. a midwife (especially a homebirth midwife) were on full display at Q's follow-up ultrasound today.

When C scheduled the appointment on Monday, she warned me that she might not be able to come, as it was at prime school pick-up time (3:45 pm) and she lives all the way on the other side of the city. I was a little worried, because my husband couldn't come, either, and while I had a feeling everything would be fine, I really didn't want to face bad news on my own. Well, C called me last night to say that she had made arrangements for her kids so that she could be at my ultrasound! I was so relieved that I almost cried.

The ultrasound was with the same perinatologist who did Q's NT scan. C beat me to the office. When I arrived, I checked in, and the receptionist said that they had no record of my appointment. Say whaaaaa...? Luckily, they were able to just add me to the schedule.

Perhaps due to the appointment confusion, we had to wait about 30 minutes to be seen, so C and I passed the time chatting in the waiting room.

Finally, we went back to the ultrasound room. (No Barbie cars in this one.) The nurse asked me if I knew the baby's sex yet and I said no. She asked if I wanted to find out and I said no. She said, "OK, well, the doctor will look anyway and it will be in the ultrasound report." Sigh.

The perinatologist breezed in. He appeared to have no clue who C was and why we were there -- again, perhaps due to the appointment confusion, or perhaps because he just didn't care. So, he basically repeated the entire anatomy scan from Monday. He did explain what he was looking at, but was very businesslike about it.

When he got to the right kidney, he noted that it was dilated. Duh. He asked the nurse about my Down's syndrome risk from the NT scan. I guess this problem can be a soft marker for Down's, but since I had the NT scan done and my risk was very low, we know it's highly unlikely that the baby has it. He explained that the extra fluid doesn't look serious, and will likely resolve itself in utero as the baby grows. We'll continue to monitor it via ultrasound, and if it doesn't resolve itself, we'll just need to follow up with our pediatrician to get the baby examined after the birth. It could eventually require surgery, but it might also resolve on its own post-birth.

Then he asked (again) if I wanted to know the sex, and I said no (again). He said, "OK, we'll, I'm going to scan that area now, so look away." He did this at the NT scan, too. I'm not sure why he's so obsessed with my baby's genitals.

He concluded by reminding me to schedule another ultrasound in three weeks and to follow up with "my doctor" to do the AFP test (a second trimester blood screening for Down's and other chromosomal abnormalities, which I have no plans to do). Clearly, no clue who C was. Oh, and he asked once again if I wanted to know the sex... seriously? NO! C quietly said, "Surprises are the best." Love her.

And then he and his nurse left. The entire visit lasted perhaps 15 minutes. Maybe it would've been 14 minutes if I hadn't been asked about finding out the sex three separate times.

C told me that she could give me some more information, so I checked out and got the next ultrasound scheduled, and then we stepped out in the hallway.

C started off by saying, "That's the best possible outcome!" We spent about 15 minutes discussing it all. In short, even if the issue doesn't resolve in utero, I can still do homebirth. The only thing that would necessitate a transfer of care would be if my amniotic fluid gets low, which can happen when the kidneys aren't processing properly. But my fluid levels have looked great at both ultrasounds, and so C thinks it won't be an issue, especially since the left kidney is fine. We both laughed at the perinatologist's genital obsession... C knows we don't want to know the sex (I don't have to tell her multiple times per appointment) and so she has taken care to look away at the appropriate times as well. Because if we don't want to know, she doesn't want or need to know, either.

Once all my questions had been answered, I thanked her for taking the time to come, she said she was happy to and gave me a hug, and we went off to pick up our respective kids.

And that, in a nutshell, is why I'm thrilled that I'll be able to stick with midwifery care.