Reply to Trying to understand the midwife route

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I won't rehash all this ob vs midwife cage match stuff (which is ridiculous IMO because both are looking out for moms no matter what people say, although I would never work with a midwife that was not a CNM).

But the diet stuff drives me insane. Probably I am way too biased to really make an observation but I had hyperemesis three times and pregnant women should, within reason, eat what they can eat. Any group that has a uniform dictation of what pregnant women should and should not eat is suboptimal because every woman is different. What a hyperemesis mom should/can eat and what a GD mom should/can eat are totally different and having a blanket policy up front like this is IMO, bad maternal care. [/quote]
The GW midwives do not push the diet when you have morning sickness- I was told eat whatever I could keep down (for me popsicles and saltines) and then once I was able in later trimester I incorporated more of their diet suggestions. I don’t know why everyone gets so worked up about the healthy diet. They are not strict about it. Personally I liked having some guidance on what would be an optimal diet. [/quote]

I’m 20 weeks and we haven’t discussed diet even once. They just said “try to eat as healthy as you can tolerate”[/quote]

Except the trouble is the guidelines as written are rigid, one-size-fits-all. The words in them are overly prescriptive. Every day eat this, and every day avoid this. They are unrealistic for most women. And sure, it’s great that in real life the midwives are more flexible and do not rigidly promote adherence to these guidelines but then, why have them at all? Or at least, why not revise them to make them more flexible and accommodating of the variety of healthy diets that exist?

There is not one right way to eat healthy. The guidelines ignore individual circumstances, varying cultural backgrounds, different food budgets, food allergies, different eating styles and food preferences, etc. I would argue that they are biased against women from lower socioeconomic backgrounds who may live in food deserts, or be living on food stamps, etc. and therefore are exclusionary of a particular type of patient that they don’t want. Is midwifery care really for everyone? Or just affluent, educated women who are skinny, able bodied and privileged enough to have the time to exercise for an hour a day, who have time and funds to purchase and prepare whole/organic foods for their meals, who have funds to hire a doula, who have partners engaged in the birth, etc?

Frankly, words matter. The impact of those guidelines matters far more than the intentions behind them. Clearly, enough of us have strong feelings about them or were turned off from them enough to avoid becoming a patient that they have an impact. Is that the one they want?

As a former patient, I frankly in hindsight wish I had understood that the rigidity inherent in those guidelines was illustrative of a rigid practice. One that doggedly adhered to a belief in natural birth above all else and in birth, meant providers hesitated  to clearly recognize and identify when a birth was beyond their skill set and bring in physicians when needed. I didn’t realize the extent to which they acted as gatekeepers to the doctors, when I thought the word collaborative meant a team based approach. I don’t think promoting maternal suffering is a good thing. You can still be a great mom even with an epidural, a C-section, a formula fed baby, etc. As a FTM I wish I had never bought into their ideology. It is really damaging. [/quote]

When you get the welcome package from the OBs you get a similar set of dietary guidelines (that also tell you yo avoid white flour!), but since this guideline is shared privately the GW OBs are never accused of being rigid.

I do agree that they might need to find a way of providing the midwifery model of care to people that don’t have the privilege of having two support persons and don’t have the time and budget to follow the guidelines. They could phrase it better as suggestions and emphasize the “do your best” part as they’re doing once you’ve joined the practice.

I have to say that at the meet the midwives event I went to, I was turned off by one of the midwives that came across as more rigid and fundamentalist, but all the others that presented didn’t and that’s why I decided they were a good fit for me. I’ve had visits with three different midwives so far and they are definitely not pushing the diet or exercise guidelines on me, we only discuss topics I need to discuss.[/quote]

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