Dear Midwife,
Thank you for your email regarding my blog post about my first birth at home, entitled "Power Birth--Not to be Confused with Empowered Birth."
You're right that as a first-time laboring woman, I didn’t understand the reasons for the things that were done to me. I still don't. No one (be they midwife or doctor) has the right to do anything invasive to a woman’s body without explanation or permission, including manually dilating a woman's cervix to speed up her labor. Your statement that “a laboring woman often doesn't understand why the midwife does some of the things she does” is particularly true if the midwife believes that her authority is paramount and that explanations are optional. That attitude, which you demonstrated clearly at my birth, shows a lack of respect for the birthing mother. If the mother doesn’t understand why you’re doing what you’re doing to her, stop. Explain. It’s her body and her birth. She has a right to informed consent no matter where or with whom she is giving birth.
I don’t agree that I’m just one of the inevitable “unhappy customers” that a birth professional is bound to have now and then. If I go to a car dealership to buy a functioning car and they sell me a lemon that breaks down on my way to work, then I'm an “unhappy customer.” If I go to a care-provider for a safe, natural birth and get physically assaulted and coerced, my rights stripped away, and end up with life-threatening iatrogenic complications, I’m not “unhappy." I'm grateful to be alive. I'm obligated to speak out. I've met another woman who gave birth with you and is now recovering from a hysterectomy and rectum reconstructive surgery that she attributes to the start-pushing-at-5-cm/forced dilation technique. Is she just an “unhappy customer,” too?
Scolding me for writing about this on the grounds that speaking up about my experience will breed distrust of midwifery as a whole and will damage the home birth movement, causing childbearing women to run for the hospital, is backwards thinking. First of all, I don't align myself with any "home birth movement". I love home birth and I would like to see it normalized, but I'm not interested in convincing any woman that she should give birth a certain way. Each woman will give birth best wherever she feels safest. What I would like to help achieve is a world in which every mother has a full array of options open to her and perceptions of safety are based in reality. Covering things up, pretending they didn’t happen, and trying to silence the women who speak out about birth trauma is what breeds distrust of the profession. Secrets will keep this birth community stuck forever. Telling the truth dissolves fear and creates understanding, which increases safety and trust.
As more survivors come forward to tell their stories (many of them never will, because they’re afraid of the social fall-out. Some of them have been bullied into silence…) I hope you and every other care-provider who has practiced this technique will take a moment to just listen. Women everywhere are outraged at the thought of forced manual dilation. Birth belongs to the mother and baby, not the midwife or any other authority figure or expert. Birth should unfold according to the mother and baby's own time frame, not be forced to conform to the midwife or doctor's schedule.
I agree with you and I felt encouraged when I read this in your email: "As women and midwives, we spend too much time criticizing and placing ourselves above each other without understanding where the other is coming from. We also make no allowances for each other to grow and evolve into better midwives as we gain experience. We are constantly learning. I, for one, am a very different midwife than I was 25, 10 or 5 years ago." I'm glad to hear that. If you're no longer practicing this technique then I would like to know. I'm not interested in destroying anyone's reputation. I'm focused in the present, hoping to make here/now a safe and sacred space for expectant mothers.
I am also a very different woman than I was when we met. I'm not afraid to talk about what's happening in our birth community or to raise awareness about every mother's right to be spared unnecessary and unwelcome interventions and abuse. I believe this dialogue can be a catalyst for healing, growth, and evolution for all of us.
Your sister in peace and progress~
Mandala Mom, you are right on. Shame on your midwife for trying to silence your story. In the absence of true medical emergency (baby or mother in imminent danger of death), there is NO EXCUSE for any care provider to neglect informed consent. The attitude that you, as a first time mother, just weren't able to understand, and that her "technique" was somehow helpful in the situation you described at your birth, is complete and utter nonsense, and smacks of elitism and arrogance. What your midwife did was an abuse of power.
ReplyDeleteThank you for speaking out.
Many women (myself included) chose a home birth in part to avoid interventions and have the chance to birth naturally. I think your post about "power birth" underscores an important point about the need to choose a qualified caregiver who is truly aligned with your birthing wishes.
ReplyDeleteNot all midwifes are true advocates for birthing women, just as not all obstetricians are looking out for the best interest of women and their babies. Many people operate on an agenda (like your first midwife), and it's up to women to make the discerning choice as to who will be their best care provider.
Thank you for your honesty, bravery and candor. You're a true inspiration to birthing women everywhere!!
While I never experienced this particular atrocity, I've also had the experience of being "betrayed" by a home birth midwife, someone I thought I could trust (I refused to consent to an induction at 37 weeks at home). I found myself 36 weeks pregnant, due right before Christmas, and without a midwife. Not only that, but my midwife was one of the most prominent and respected midwives in the area, so finding a new one meant not only finding someone who wasn't afraid of my "risk factors" but also who wasn't afraid to accept the risk of going against the opinion of one of the leaders in the midwifery community--my eyes were opened as to the politics of that community, which I had no idea of before! Long story short, I did find a midwife, had my perfectly healthy baby in a perfectly uncomplicated spontaneous birth at home. But I also learned that not all home birth midwives are created equal, and that many of them will put their careers and personal agendas ahead of their clients' best interests. I have no interest in bashing a specific midwife, but I think we have a duty as women to share our stories, and not to keep them quiet in the interest of "protecting" the profession of miwifery. There is power in honesty and openness.
ReplyDeleteThe hallmark of midwifery care is that a laboring woman should know precisely why her midwife is doing what she is doing at all times. In fact, she should have chosen what her midwife is doing, in any instance except in an emergency, in which case she should still be informed as to what is happening and why to the greatest extent possible. I shudder that there are women who call themselves midwives who believe otherwise.
ReplyDeleteIn regards to Anonymous' situation - if your midwife wasn't just making excuses and trying to induce out of convenience, then I have to say that I think she was well within her rights to place limits on the kind of risk factors she's willing to attend. Even wonderful midwives who do have their clients' best interests at heart and believe in women's right to self-determination also have to consider their own lives. Every birth a midwife attends puts so much on the line: without malpractice insurance, she risks losing everything she owns, her life savings, and her children's financial future; in some states she risks a murder charge if the baby dies even if it had lethal birth defects; she may also risk the present or future legality of a midwife attending a birth with that risk factor and/or the legality of midwifery in general; if practicing legally, she risks her license and thus her career. She has to balance her responsibility to care for you with her responsibility to her children, to all the other women she will care for in the future by keeping her license, and all the other women any midwife could care for with legalized midwifery. This may sound extreme but it's a reality.
ReplyDeleteStill, if a midwife risks someone out, I think she should be honest in explaining why, and offer to connect her to other midwives who may have a different comfort level with whatever those risks are.
What birth trusting midwife induces at home at 37 weeks? Or induces at all? Sounds like a convenience issue to me, without knowing the specific risk factors.
ReplyDeleteAnonymous(@3:22am) hit the nail on the head when she said "...not all home birth midwives are created equal, and that many of them will put their careers and personal agendas ahead of their clients' best interests."
We will see more midwives practicing to protect their licenses and to meet insurance regulations with this "Big Push" that's happening right now.
I hope everyone is looking at the issue of licensing and insurance coverage from all angles (but especially the angle of what protects the long-term rights and freedoms of birthing mothers).
Mandala Mom, it sounds like a convenience issue to me too, not knowing the risk factors... but I can think of reasons I would want my midwife to offer or recommend induction at home at 37 weeks - for example if I had creeping blood pressure and she was worried that I would risk into hospital birth for pre-eclampsia if I didn't give birth soon, I would expect her to tell me - a) here's what you're presenting with b) here's what I'm worried is going to happen soon c) we can try a home induction to try to get the baby out before that happens d) risks, benefits, alternatives e)let me know what you choose. And potentially, depending on the situation, f) if you choose xyz I can continue to care for you at home but if you choose abc I will refer you to the hospital and attend you there or help you seek another homebirth midwife.
ReplyDeleteWhy would a midwife induce at all? To prevent an increase in risk factors that would cross a threshold at which hospital transfer would be appropriate.
For women unwilling or unable to consider such a threshold, there are indeed midwives out there who would be willing to attend those births, and there is also UC available. Most women I know who choose homebirth are not looking to avoid hospital in any except the most dire situation, however - want their midwives to keep them apprised of any variations outside of normal, physiological birth that evidence-based to be safe at home, and make decisions together based on the midwife's and client's comfort level with the situation.
Midwives who aren't protecting their licenses may be protecting their freedom, as alegal midwifery practice can indeed lead to jail time, so I'm not sure this particular concern about the "Big Push" is true. Although I do live in a state that lets licensed midwives have a bunch of freedom and I understand that some other states have lots of rules and regs about what midwives do, so perhaps I have a rosier view of licensure. I think licensure ought to mean a required level of education, continuing ed, and a way for clients to report malpractice issues to the midwifery board such as what you have experienced, and to keep midwives out of going to jail for "practicing medicine" (as though they were posing as doctors) but not for the state to control what midwives get to do.
I don't mean to argue with you because I think it's pretty clear that we both believe that moms should be the ones in charge of their bodies and births, and that it's true that not all midwives are created equal (what I describe above is a far cry from what you have described and some of the other less horrible - but still not midwifery model - homebirth stories I've heard). I just also think that midwives *should* be able to put their career (not their personal agenda) ahead of maternal self-determination because that is their own right to self-determination - and that usually, in doing so it's because the woman's or baby's health is in a place where the midwife feels it *is* in the client's best interest to [transport, induce, insert intervention here] and doesn't feel she can safely put the client's right to determine her own best interests above her clinical opinion. I understand that not all midwives are doing so for these reasons but for more selfish reasons. I also understand that some women expect that the midwifery model should allow complete and total client self-determination, but we also need midwives to stay in practice, which I believe requires that they can place limits on their comfort level.
Thank you, I appreciate your perspective. Curious to hear what others think, particularly on the issue of induction.
ReplyDelete"Scolding me for writing about this on the grounds that speaking up about my experience will breed distrust of midwifery as a whole and will damage the home birth movement, causing childbearing women to run for the hospital, is backwards thinking." An incompetent and apathetic Midwife breeds distrust of midwifery as a whole. I think this midwife owes an apology to her midwifery peers as well, for I am sure many of them are fuming at HER while reading this blog. Hell, I know I am, I love the midwives in our area and I truly hope that faith in midwifery is not damaged by this "Midwife"s actions.
ReplyDeleteI could not agree more with Amber. Well said.
ReplyDeleteThis sad, sad story has nothing to do with midwifery or home birth. This was abuse by someone who mistakenly thought they were an authority in your birth. I'm so very sorry this happened to you and you are doing the right thing by calling her out. We all need to share the truth whether people like it or not. In fact, it is the ones that like it the least that need to hear it the most.
That's an awfully strong opinion for an 'anonymous' post. It would lend a bit of credence if you identified yourself.
ReplyDeleteMandala Mom - I respect the way you speak your truth clearly and bravely in your letter without a tone of vindictiveness or malice. If we all could discuss our disagreements with this kind of mutual respect and desire for peace and growth, imagine how much better we could make things, working together. Beautifully written.
ReplyDeleteI admire you for speaking up about being let down by your midwife. I hope one day I have enough energy to do the same - or maybe I'll 'get over it' ;) Well done for informing yourself and speaking up for other women. Well done for challenging the behaviour of your 'care giver' yet again - you are very brave. Since I know how hard it can be to face up to a traumatic birth I admire you for continuing to face it head on with courage.
ReplyDeleteI just read this post http://www.themidwifenextdoor.com/?p=1359 and thought of this particular blog piece, because she talks about controlling midwives. Interesting about how "trust birth" midwives can also be controlling.
ReplyDeleteI also read this post of hers tonight http://www.themidwifenextdoor.com/?p=1362 and thought it was interesting in relation to some of the discussion here.
Also wanted to say I love what Amber says here: "An incompetent and apathetic Midwife breeds distrust of midwifery as a whole. I think this midwife owes an apology to her midwifery peers as well, for I am sure many of them are fuming at HER while reading this blog." YES.
I am so deeply saddened that this happened to you! Each woman's birth experience should be about her and her baby...never about anyone else. Although we often do not see "the rest of the story" and can never know the things that go through another's mind, we cannot change the past. We CAN, however, change the future.
ReplyDeleteTo me, your post is not about "attacking" a midwife, it is about forcing a woman's cervix to open before it is ready. Thank you for sharing your experience - be assured that this student midwife will learn from it.
" I, for one, am a very different midwife than I was 25, 10 or 5 years ago."
ReplyDeleteI wonder how old she was when she started.
My experience, and the experience of friends I know well seems to show that age matters lots, both with midwives and with obstetricians. Our midwife made a terrible mistake, one that she believes she wouldn't have made had she more experience as a midwife (She had attended 450 births, and had been practicing as a midwife for almost 5 years.) She is a delightful person, very calm for her age, but we relied on her judgement when we shouldn't have.
I believe had she would have been much much better, calmer, wiser had she simply been older when she started the whole process of becoming a midwife (she started at 24). Midwives and doctors would be better if they first had their own children before they even started formal studies in birthing. 24 just seems crazy young to assume a role that in traditional societies is associated with crones, or at least matrons.