The midwifery model and pediatric care

5 April 2010 at 1:52 am 3 comments

So, we’ve talked before about the midwifery model, and about how it sees pregnancy and birth as normal events rather than as sources of danger or causes of harm. I was thinking recently that my approach to pediatric care–the well-being of my son now that he’s nineteen months out of the womb–really flows naturally from and is completely consistent with the midwifery model. 

My default assumption is that my son is healthy and his body knows what to do and is functioning properly. I know, of course, that there are some very sick kids in the world–I don’t at all mean to trivialize their experiences or downplay the importance of real medical care in those cases–but I generally just assume my son is fine.

I didn’t realize this assumption was uncommon until very recently, when we took him in for his eighteen-month well-baby checkup.

“So he hasn’t been sick since he was here last?” the doctor asked.

“Oh, no, I wouldn’t say that,” I said.

He looked questioningly at me. 

“You know, runny noses, one really bad cold with coughing, one bad stomach virus. . .” I elaborated.

The doctor kept staring. “But no fever at any point?” he asked.

“Uh, no,” I said, “he had a fever with the bad cold and maybe two other times with smaller colds.”

Meanwhile, my son was running all over the exam room, grabbing the doctor’s computer mouse, trying to open up the heavy door and escape into the hall, and was obviously–at least at that moment–a sturdy kid in good health. The doctor seemed to think about it and then let it go, but when I started reflecting on this exchange later on, I realized that a lot of parents would indeed have taken their kids into the doctor–or at least called into the office–for the illnesses we just figured were a normal part of childhood and my son would get over.

In a playgroup last week, I talked about this with a mom of three (roughly ages 2, 4, and 7). She said that yes, with her first child she absolutely called the doctor’s office and even went in for every cold, every fever, ever cough, but by the time the second rolled around–and certainly by the time the third was here–she had realized that pretty much all that happened was the doctor would say something like, “Well, it’s probably viral, just make him comfortable, keep him hydrated, and wait a few days.” My friend said she decided it just wasn’t worth the hassle anymore, for such an equivocal response, so she decided (though she says it was nothing so firm or deliberate as a decision) to let these things go and just not worry about minor illnesses as long as the child seemed in good spirits.

Basically, she reverted to the midwifery model from the medical model–instead of looking for pathology and disease, instead of screening and testing, she decided to wait and see how the body processes things on its own and in due time.

It makes sense to me, personally–I haven’t gone to the doctor for anything other than a check-up in 13 years, I think, and neither my husband nor I are big proponents of cold medicine when we get sick ourselves. We just try to rest more, drink more, and get through it, and as long as our son is happy, that’s been our approach with him as well. I don’t know if there’s any research out there on the subject, but I’m wondering if women who choose midwives (and who therefore might have a less “medical” outlook) tend to take their children in for fewer pediatric sick-baby visits. I’m not sure how you’d be able to screen out the factor of underlying good health (do healthy women have healthier kids, who need fewer sick visits, and do these women go to midwives specifically because they’re healthy to begin with?) unless it was a really well-designed study, but it’s something I’m curious about, at least.

What are your experiences? Do you call the doctor whenever your baby has a fever or a cough, or do you wait for his body to get over it?

–Christina

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3 Comments Add your own

  • 1. Johanna S  |  5 April 2010 at 7:08 am

    We have one child. She is 30 months. I called a fair bit during her first year. I rarely call or go in now. If it is something unusual or that hangs around for a while, I call and bring her in, of course. For example, last January, she had persistent diarrhea. The pediatrician had told me in the past that diarrhea could last a few days, the better part of a week. When it had been a week, I brought her in. The pediatrician explained that some kids might have diarrhea for months but might be healthy otherwise. After 10 days, my daughter was back to normal. It was viral. Our pediatrician has similar views. She is not quick to prescribe. She says antibiotics and cold meds are over used. One time, my daughter was limping and there was some swelling on her leg. We brought her in right away and the pediatrician did an x-ray and blood work. I like this setup. It feels reasonable.

    Reply
  • 2. Kiki  |  5 April 2010 at 9:28 am

    I never take my kids to “well child” visits…i used to…I would take my healthy, ‘well’ child in only to return with some funky virus they caught and then they would no longer be well.

    I did take my daughter at 18 mo old to the ER for crazy diarrhea (which end up up being that rotovirus deal, which just ran its course…no pun intended) and learned a valuable lesson from the ER dr. He said if her attitude/temprament was normal, most likely all would be well and to give it time. But if they are ever lethargic, unresponsive…that type of thing…that’s a red flag (along with really high fever of 104 or more that lasts for 3 or more days).

    for me, those are the red flags and we head to the dr. If it’s just your run of the mill low grade fever, cough, sneezing, etc, we stay home.

    and yes, my kids were born at home with a mw.

    Reply
  • 3. bubbasmama  |  8 April 2010 at 9:11 am

    oh yes, we’ve never been to the doc except for well visits. my little guy’s had colds, fevers, stomach bugs, hand foot and mouth, chicken pox.. and he’s always gotten better — and more importantly — he’s never been so sick that i’ve been worried. if he had ever been lethargic or unresponsive or wouldn’t nurse or had a really high fever for too many days, i would have taken him in (or called our pediatrician’s office for advice). but he was never THAT sick, so i was never THAT worried. i think it’s great that pediatrician’s encourage folks to call in if they get nervous — i can see how many parents would appreciate that kind of reassurance. i just don’t need that kind of reassurance myself 🙂 i think it’s interesting to think of this attitude as a sort of “midwifery model of child care”. i think that’s pretty accurate!

    Reply

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