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It’s no shock that the season finale of Call the Midwife left me feeling emotional. I tend to be a sensitive person as it is, and living through a global pandemic with two small children, a full-time job, and a spouse with a full-time job has heightened my emotions. I was overcome with pride when Trixie stood up to defend Nonnatus house, and its midwifery service, and help the board see how vital their services were. The nagging feeling of uncertainty has been hanging over my head since Sister Julienne first got notice of the planned demolition of Nonnatus House.
It seems that defending and rationalizing the budget for midwifery care is a common theme in our country, especially right now. Many hospital systems and private practices have been forced to scale back on the types of services they are providing during the COVID-19 pandemic, and unfortunately, I’ve seen many midwives now out of work. I’m grateful that midwifery services at my health system have been valued, and we have been largely unaffected by furloughs (save for a few cancelled office days here and there).
I’ve heard time and again that obstetric services do not make health systems much money. Most of the time, obstetric care is a “global billing service,” which means that regardless of how much we see a patient during their pregnancy, the health system gets the same dollar amount (there is a minimum number of visits to get this global billing fee, but exceeding the normal amount of visits doesn’t increase the revenue). I think hospital systems are undervaluing the important services that midwives provide when they look at this type of revenue.
Many times, I’ve had a pregnant person on my schedule who I’ve never seen before, and they may already be half way through their pregnancy. This could be their first encounter with a midwife in their lifetime. When I come in the room, sit down, and ask them how they’ve been doing and what questions they might have, some of them tell me that no one else has ever sat down and taken that time with them throughout the whole pregnancy. It doesn’t often matter if this is someone’s first baby or their fifth, I think everyone deserves their prenatal appointments to be a time to check in, address questions and concerns, and discuss any recommended upcoming testing or monitoring, as well as what to expect in the coming weeks. I usually take a bit of time to explain midwifery, our philosophy of care, and our scope of practice as well.
Sometimes, I meet people during their annual exams, or at a visit for birth control. I might only be spending 15-20 minutes with them, but I try to use that time to really see if they have any health concerns, and to utilize shared decision-making to be sure that I’ve met their needs to the best of my ability. By the end of the visit, I hope we have come up with a plan that everyone is comfortable with. I’ve offered my knowledge and expertise, but also worked to meet the individual where they are. Maybe I won’t always agree with the birth control option the person chose, but as long as the option they picked is safe, it’s truly not up to me. Maybe I think that an IUD will solve their heavy periods, but they want to use birth control pills, even though they have had trouble sticking with taking pills in the past. Maybe from discussions we’ve had, I might think someone is at risk for pregnancy, when that is not what they want, but they aren’t ready to use a prescription form of birth control at this time. I can give them the information, but they are truly the experts on their own bodies, and I have to respect that.
I have lost track of the amount of times that, at the end of a visit, the patient thanks me for taking time with them, and then asks me if they’re able to continue seeing me for annual exams, pregnancies, or their delivery. I’ve had clients refer their friends or family to me, which is the ultimate compliment. Some of the people I see haven’t felt truly listened to at a health visit in years. My heart swells and breaks at the same time. I serve a good amount of lower-income clients, and it’s not fair that it’s taken them years to find a provider who is willing to listen.
When Trixie got up in front of the board and succinctly, firmly, and proudly defended the work done by Nonnatus house, I watched with tears in my eyes. Her delivery was powerful. Her words echoed down to the generations of midwives before her and the ones after her, and all to all of the health care providers who work with vulnerable populations that are often underserved. Just because our work isn’t always monetarily valuable, doesn’t mean that it’s not absolutely essential to society. Maybe when we look at it that way, we would realize that this form of compensation is deeply flawed, and we should return the focus from “how much money can the system make” to “how many people can we help improve their health and the quality of their lives?”
As always, I am looking forward to the next season of Call the Midwife and all of the emotions that watching it might bring. I love getting a glimpse at midwifery practices from the past and never stop being amazed at the parallels with our present day practices. I hope the next time we come together, the COVID-19 pandemic will be behind us, and I pray that we will find our new normal. I think there will still be a lot of processing and working through trauma and grief of living through this pandemic, but there is always hope on the other side. I hope to see you there.
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