I am in the process of reviewing for my certification exam – the test that will prove I can be trusted by the community to be safe and competent as I work with families to maintain their optimal health. This is such an interesting experience for me as I realize how much I have learned in the past two and a half years, and continue to realize how much more I have to learn. This has also caused me to reflect on my clinical experiences and the things I have learned about being a good health care provider.
I find myself continually pausing at the importance of a physical exam. The sheer amount of information I can obtain about a person’s health by looking and touching. But I live in a society that seems uncomfortable with both looking and touching. These most basic of human interactions are reserved for only the most intimately connected to each of us. Yet, somehow, I must look and touch if I am to participate.
On the one hand, I think of the importance of the midwife being willing to look and to touch. My very fist semester of nursing school I was struck with how difficult it was for some of my fellow students to walk into a hospital room and introduce themselves to a stranger. This seemed such a simple act, but at the same time was felt as such an invasion of privacy. The first clinical learning was to be comfortable taking a step into someone’s private world, to risk being rejected. As a midwife, this step into the private world is even steeper. I ask her to tell me about her most intimate details of her life. How is her menstrual bleeding? Does she have any discharge? Does she have a new sexual partner? The physical exam is also more intimate – STD testing, PAP smear, assessment of uterine enlargement.
On the other hand, I think of the willingness of the woman to be looked at and touched. On some level she is ready for the intimate exchange that is about to happen because she made the appointment, she is here. But at the same time I am most likely a stranger to her. I have only a short time to allow her to trust I will help her achieve her health goal. I have only a few minutes to make or break this opportunity to be invited into her private world – her fears and her brokenness. If I am invited in, she may share things she’s never revealed to anyone. If I am unsuccessful, even my best advice will seem unimportant to her.
As I reflect on the importance of the first few moments of the first visit, part of me wonders if this exchange is easier for homebirth midwives. Does it not seem logical that having more time for that first visit allows for more building of trust? Some of my homebirth midwife friends feel the longer visits are key to establishing a relationship with the mother. But is this relationship built because more time allows for the building of trust; or because the trust is successfully established in the first moments of the first visit, the time allows for a more broad relationship with the woman.
And I begin to wonder how it works when things do not go as planned on that first homebirth visit. When a relationship of trust is not able to be established in the first minutes of the visit, is it then less likely trust will be developed at all? Does more time without this trust cause the woman to feel she cannot be connected, or does it allow the woman the time she needs to be connected. My best guess is that it is different for every woman and every midwife. Personalities are so hard to categorize and people are never “average.”
So then my thoughts return to the world of the nurse-midwife and abbreviated visits. What can I do to be ready to enter her world and be willing to touch…and to help her be willing to be touched.