Most people get into nursing, and therefore midwifery, out of a desire to help others and make a positive impact on their lives. Sometimes, we can get so wrapped up in the tasks that need to be completed that we can overlook the relationship with the patient, but it’s so important to build rapport and trust. This week on Call the Midwife, we were able to see Joyce quickly identify that her patient, Edna Bristow, was in need of some connection. Edna seemed to shut down when Cyril and Shelagh brought up that she could reach out for financial support through the government. Joyce easily saw how uncomfortable this offer of help was for Edna and was able to redirect the conversation. It seemed like Edna wanted to be treated like a capable human being, and she was worried about being treated with pity since her husband had left her. Joyce treated Edna with kindness, empathy, and respect, and I could see their patient-midwife relationship forming right away.

We also saw an amazing example of connection between the healthcare providers and the patient Sahira Khan. I need to just take a minute to give some recognition to Dr. Turner! His commitment to finding out what was ailing Sahira despite her blood work and urine testing being normal is kind of a rarity these days. He did not dismiss her concerns, or tell her that these were “normal symptoms” for women. We know that women’s health concerns are dismissed very frequently as anxiety, or as “normal menstrual discomforts.” It takes, on average, 8 years before someone is diagnosed with endometriosis! They can be complaining of debilitating menstrual cycles, heavy bleeding, or even nausea and vomiting during their cycles and will still be dismissed. I was so grateful that Dr. Turner asked Nancy to reach out to Sahira, thinking that she might be more comfortable discussing her symptoms with another woman. It was through their diligence and quick response when Sahira’s husband called for help, that Sahira was able to get the diagnosis and care that she so badly needed.

I’ve seen a lot of people in my office lately for pelvic pain, painful intercourse, or “severe dysmenorrhea” (excruciating pain associated with their periods) that have been dismissed for years by other care providers. I have found that listening, discussing the possible diagnoses, and ordering tests to look into their concerns is sometimes far more than healthcare providers have been willing to do in the past. While I do not treat all of these conditions as a nurse midwife, I can refer them to colleagues of mine who specialize in this care and I always encourage them to reach back out to me if they are having a hard time feeling heard. It boggles my mind that women (and anyone with a uterus, for that matter) have been conditioned that severe pain is normal every month. We have repeatedly been gaslit by medical professionals and society into feeling like we are inadequate if we require extra rest while on our periods, or if we refuse to believe that living with acute or chronic pain is normal. This can lead to a generalized distrust of medical professionals or an unwillingness to share what their health concerns are, for fear of being dismissed or marked as a complainer.

It is so important to remember that you are the best expert on your own body. No one knows your body as well as you do. If a healthcare provider is not willing to listen to your concerns or take them seriously, you should ask them to document that they are not willing to complete any testing to look into this problem, and then find yourself a new care provider.*

One of the cornerstones of midwifery care is shared decision-making. It’s so important to take into account a patient’s values and preferences when making healthcare decisions. Pupil midwife Joyce, Nancy, and Dr. Turner showed us great examples of prioritizing a patient’s values and preferences when coming up with a plan of care. Joyce never shamed Edna for choosing to stop breastfeeding because she was concerned about getting back to work. She also was able to help Edna realize that accepting help from the government was not “taking away from those more in need,” nor was it a sign of weakness. She showed Edna that she was worthy of support. Nancy was able to speak with Sahira in private to allow her to feel comfortable sharing more about her symptoms. She also went the extra mile to try to get to know Sahira a little more, knowing that this would help Sahira to trust her healthcare providers more, as well as allow them to give her the best possible care.

It’s very important to remember that healthcare is not about a power dynamic. The doctor, nurse, or midwife is not “above you” and does not always know what is best for you. It is so important to me, as a midwife, to truly talk through all possible options and the risks and benefits so that the patient feels comfortable coming to a decision. This isn’t always easy, and there have been times when I have told patients that I am uncomfortable with their decision, and have discussed my reasons for concern. However, I cannot and will not force someone to do something that they do not want to or that they do not feel is right for themselves. If you truly feel someone is making an unsafe decision, it is okay to tell them that and to document that you’ve thoroughly explained the risks. However, once you get a little more comfortable with the idea that no one wants what is best for a baby more than their parents, it becomes much easier to accept that people can make their own choices.

I came away from this episode feeling grateful that so many people will witness this episode and realize that feeling cared about, seen, and heard by your healthcare provider should be the norm. And for healthcare providers, this shows that we can truly make a huge impact on patients’ lives when we take the time to acknowledge their lived experiences. It’s so important to have a community of physicians, functional medicine specialists, physical therapists, mental health professionals, and more to be able to refer patients when you’ve exhausted your abilities within your own scope of practice. Everyone deserves quality healthcare.

Have I been stumped before, when all testing is normal and I don’t know where to go from there? Absolutely! But I do have a wonderful team of physicians, functional medicine specialists, physical therapists and so much more that work for my healthcare system. And will I refer to them when needed? Also yes!

*I understand that having the time and ability to attend multiple appointments and shop around for a healthcare provider who will listen to you is very privileged. Some people are stuck with one provider in their area who takes their insurance, or they may not have transportation or time off work to attend additional appointments. Healthcare in the United States could use a major overhaul, but that is a blog post for another day.