Recently, my practice was criticized on another blog for among other things, providing hour-long prenatal care appointments. It was said that “Hour long appointments are medically useless.” It is true that much of the ‘work’ of prenatal care can be accomplished in far less time than an hour.

Typically, offices and clinics schedule prenatal appointments for 15 minute time slots. They have a nurse do the blood pressures, record weight and urinalysis results. This leaves the provider with 5-10 minutes to do a quick belly check and listen for fetal heart tones, write a script for any needed labs, ultrasounds or medications. Not long ago, I heard a local obstetrician comment that he preferred having three prenatal exam rooms. As he said, for every 15 minutes time slot, there was a room ‘for the one checking in, the one checking out, and the one I’m still seeing.”

So why do I schedule hour-long appointments?

Because I can. Running my own practice, I am the one who decides on the schedule that Local Care Midwifery follows (of course, babies willing). Hour long appointments are a luxury that I can provide.

Because hour-long appointments are easy to schedule. They start on the hour, end on the next hour.

Because an hour-long appointment is more than long enough to get the ‘work’ of prenatal care done. That work may include taking a history, performing a complete or targeted exam, checking weight, blood pressure, fundal height, scheduling the next appointment or tests, reviewing tests and records, planning future care.

Because sometimes, people are not on time, myself included. Even if I am running 10 minutes behind on one visit, the next client still has a nice, leisurely, almost hour-long appointment. If a client is stuck in traffic and arrives 20 minutes late, unlike many offices, I do not make her reschedule. We simply have a shorter visit.

Because women often bring children to their appointments. That can make the visit, umm… full. A prenatal care appointment with three small children and one pregnant mother may include five trips to the bathroom, three weight checks, four belly checks and many drinks of water. (Note: Only the mother’s results are charted. :-)

Because clients sometimes need more care during the scheduled appointment than was intended. A woman coming for a normal, 16 week prenatal care appointment might have recently developed symptoms of a yeast infection. Unlike some offices, I do not make her schedule an appointment to come back to deal with the vaginitis. We just include that targeted exam into the current appointment.

Because clients don’t always tell the provider what is important, what is really going with them. Having plenty of time for the appointment may help them to slow down, breathe softly, and begin to feel safe. I do not need to be a woman’s best friend. However, it is important that I know if she is being abused or threatened.

Because sometimes tears happen. Beloved family members die. Poignant birthdays and anniversaries happen. Fear, grief and anxiety sometimes bubble up and overflow as tears. Hour long appointments mean that if this happens, I have time to just sit in warm companionship (and pass the tissues) while the tears flow and then resolve.

Because education and prevention are an important aspect of prenatal care. They don’t happen in a minute. Hour long appointments give time to review diet and exercise, discuss life stressors and management, demonstrate good body mechanics, go over risks and benefits of various tests, treatments or procedures and to discuss available resources.

Because a woman’s time is important. Women repeatedly tell me that at other offices, they sit in the waiting room for an hour or more, spend a few minutes with a nurse and finally get five (maybe ten) minutes with a doctor or midwife. At these practices, most of the ‘appointment’ is spent in the waiting room. In typical prenatal appointments, an hour (or more) is spent in the waiting room, providing the pregnant woman quality time with People Magazine. This should not pass for prenatal care. It is medically useless.

At Local Care Midwifery, PLLC, as in many planned home birth practices, hour-long prenatal appointments are the norm. That hour is spent, face to face, with your friendly, and very useful, midwife.

Michelle
May all babies be born into loving hands