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The Midwife - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
The Midwife
My suppression check this morning was scheduled for 8:00. I was there promptly, having gone to the andrology lab beforehand for the blood draw. I then sat in the waiting room for a while; they were rather behind and it seemed they were taking longer than usual for the patient who was ahead of me. It soon became apparent as to why they were taking twice as long as normal.

When the usual ultrasound person walked in she had an older woman with her whom she introduced as a midwife. I immediately made the obvious crack about my unfortunate non-need for a midwife. Day three of a bad lupron induced headache was probably making me cranky. The tech clarified that the midwives sometimes did IUIs on the weekends. It soon became clear that the exam was doubling as a training session.

I don't mind being used as a teaching tool, or having a second person nudging me in the cervix with an ultrasound wand. I tried to be helpful. When the midwife was taking her turn and having trouble finding things, I informed her that my uterus was retroverted, and regular tech immediately told her to angle the wand more. The midwife also asked the tech if she could see my tubes on this. The tech said no, and I helpfully chimed in that if you wanted to see my tubes you needed to check out the pictures from my HSG. I may not mind being used as a teaching tool, but don't expect my to just lie back passively when I know the answer.

I find that I am a bit bothered by the midwife thing, though. Don't get me wrong, I think midwives are great. I'd probably even want to use one for the actual childbirth part, assuming I get that far and assuming I don't have any nasty complications. Part of it is a branding issue. Midwives do birth. Yes I know they've been branching out into the other OB/GYN areas, and that's probably a good thing, but their job title is just so closely linked to the birth part. They're also known for a low intervention approach, and IVF is about as high intervention as you can get. Now, if I ever get as far as birth I'd love to go the low-intervention road, but clearly the low intervention approach is not working for the making the baby part, so the whole midwife thing seemed out of place. The other part of what was bothering me was the midwife's attitude. She seemed a little too cheery and a tad condescending. "Is this your first IVF," she asked is a slightly false-excited tone. "No, its my third," I replied in a tone I hoped would prevent further questions along those lines. The normal tech then said something about me being a veteran. Whatever. They don't award a bronze star for repeat IVFs. You get another one-in-three shot at a baby and that's it. IVF is not a cheery and exciting thing, its what you do because that's what it takes to get around a reproductive system that is doing its very best to thwart you. I also don't need the false encouragement from someone who is clueless enough to inquire about whether you can see my tubes on an ultrasound, even one with the wand shoved up you-know-where.

I guess I am left with the impression that its probably fine if midwives do IUIs, but it would probably be better if they didn't tell the patients that they were midwives. I don't generally inquire about the qualifications of the person doing the procedures as long as they seem reasonably competant. The branding issue being what it is, seeing a person who specializes in birth when you are inferile before you are pregnant for sure just seems like a sick joke. Also, the cheery attitude might be better suited to IUI patients. If you're doing IUI you haven't given up hope that the less extreme measure might just work. Really, though, I think I want to steer clear of the midwives myself until I'm convinced that I might actually have a baby, say at around 30 weeks gestation.
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Comments
enugent From: enugent Date: June 8th, 2007 07:41 pm (UTC) (Link)
I hate having them do this kind of stuff without asking permission. I almost always give it - the student nurses in the hospital were great - but I want them to say, "Midwife So-and-So is learning to do ultrasounds today; is it OK if she looks at your uterus?" (Ideally, the tech shows some knowledge of me by continuing with, "She hasn't gotten an opportunity to see a retroverted uterus yet," but that's a bonus.)

The cheery attitude is a tougher call. Everyone at my fertility clinic is very cheery, but I'm not all the way to IVF yet. (Getting closer every day, though. :-P) I can understand how it could be reassuring to some women. I don't really care whether they're cheery or not, as long as they answer all questions and seem to know what they're doing.

Just out of curiosity, is there an ultrasound associated with getting an IUI for you? I never had one on IUI day. If there isn't, the fact that the midwife may be doing IUIs doesn't really explain why she's being trained to do ultrasounds.

Just FYI, when you get to the prenatal checkup part, you may not have any choice about seeing the midwife vs. seeing the OB for your early appointments, at least if you stick with Harvard Vanguard. And the midwife was way more concerned about my blood pressure than my OB (and was the one pushing for me to be admitted to the hospital, where the perinatologist wasn't even sure she wanted to admit me overnight, and kicked me out promptly the next day).
greyautumnrain From: greyautumnrain Date: June 12th, 2007 03:11 am (UTC) (Link)
Ultrasounds with IUI... on the first two Clomid ones, no. Then the doctor ordered a baseline ultrasound on day 3, which would have been my third clomid IUI. They say the endometrioma then, only they thought it was just a cyst at first... so I went back next month and it was still there. After my surgery I did an IUI with injectables, and that one had ultrasounds to check follicles. Your clinic may do things differently, but that was how mine did it.
enugent From: enugent Date: June 12th, 2007 04:20 am (UTC) (Link)
Interesting. At my clinic, they do an ultrasound a few days before ovulation is expected, to take a look at the follicles. They keep checking them out every day or two or three until you either get a positive OPK or they see a big enough follicle to trigger. I haven't had to do my own trigger shot - they do it in the clinic when I go in for the ultrasound, then do the IUI the next day.

They're starting to check me way early this cycle - CD9, because I've been ovulating early for the last few months, and never getting a positive OPK.

I have a laparoscopy scheduled for July 13 in case this month doesn't work out. They bumped me up to 100 mg of Clomid to see if that will do anything more useful than the 50 mg was doing.
greyautumnrain From: greyautumnrain Date: June 12th, 2007 01:28 pm (UTC) (Link)
Yeah, it seems that IUI varies more from clinic to clinic than IVF does.

What happened to you blog? It was MIA all yesterday.
enugent From: enugent Date: June 12th, 2007 01:55 pm (UTC) (Link)
Tom moved us to a new server, and there were "technical problems". My email has been bouncing for a couple of days, too.
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