This week’s clinical scenario felt both surprising and successful.
A woman came in for her first visit of the third trimester. Following the typical list of questions midwives ask, the midwife from whom I’m learning the computer system asks if the woman is interested in any contraceptive methods after she has the baby.
A grand-multip (more than five births), a non-English speaker, and not originally of the United States culture, the woman expresses that she does not want to have any more babies, that she’d like the surgery to get her tubes tied, but her husband wants more children. We immediately advocated for her to do what she wanted to with her body, but her shoulder shrugs indicated that her relationship might dictate otherwise.
Our conversation continued around options other than the surgery, including the equally efficacious intrauterine devices (IUDs), or the Implanon or Depo-provera shot for other long-term methods. Unfortunately, though she’d be interested in the IUDs, these are no longer covered by the state insurance women receive during pregnancy, and thus would require up-front payment of either $300 or $500. The surgery is free. She doesn’t think he’d be interested or able to front the IUD money.
She repeated, I don’t want to have any more babies, but my husband does.
I offered the suggestion that she could potentially present the conversation with her husband in terms of money: free for surgery, or he could front the payment for the IUD, and she could pretend like one day she’d take it out if they decided to have more children. But her response was the same, and she repeated herself a third time: I don’t want any more babies, but my husband does.
I realized that we hadn’t really listened to her, we hadn’t heard her, and possibly we hadn’t given her space to say what she really wanted to. I waited, and she didn’t say anything more. I waited again, and she sighed. Clearly our visit was not yet finished – we hadn’t yet understood each other fully.
I asked if she was interested in finding a way to get the surgery without her husband knowing. She nodded, and the rest of the visit was spent speaking about that.
Leave space to listen.