An Open Letter To the Midwife Who Trained My Midwife, RE: Sexual Abuse

Dear Founder of PowerBirth,

It's been brought to my attention that my midwife is encouraging you to sue me and the other women who have spoken publicly about their negative PowerBirth experiences. I believe you're being misled that such a law suit would end favorably for you, but I suppose stranger things have happened in our judicial system. I'm not writing to try to discourage you from doing whatever you feel you have to do. 

I heard that one of the Powerbirth midwives said after my birth story went viral that "there's no such thing as bad publicity." Where PowerBirth is concerned, I believe this is true, since more women in my community are asking the right questions of their midwives these days, and are making more informed decisions about who to hire based on the type of births they desire.

I do sincerely hope that threatening to sue is not just another attempt to bully other PowerBirth survivors into continued silence. It is easier to heal and move on when you let go of secrets. I encourage all women who are recovering from traumatic births to find a safe place to talk about it. It can be hard to discuss openly, particularly when the trauma took place in a small community, involves an abuse of power in the caregiver relationship, and the caregiver has demonstrated a willingness to twist facts, revise history, and accuse victims in an effort to manage public perception.


The reason I'm writing to you is to discuss the speculation you posted on your business website recently that the women who have been traumatized by the PowerBirth technique must all be victims of sexual abuse. (Because birthing women who haven't been abused enjoy a hand in their vagina during every contraction--enjoy having their cervixes and perineums forcefully stretched and their babies pulled out?) You wrote on your website that you pray for our healing...


So, first of all, Thank You. Thanks for your prayers. Because it's true: Some of the women who have been traumatized by PowerBirth are survivors of sexual abuse/assault and have a lifetime of healing ahead of them. Prayer certainly can't hurt. Some of the women who have been traumatized by PowerBirth are not survivors of sexual abuse and deserve prayers for continued healing as well. But let's talk about the sexual abuse survivors who are also survivors of traumatic PowerBirths.

I would like you to understand the prevalence of abuse and how important it is for care providers to approach prenatal care sensitively and with full candor and respect for the mother's ownership of HER body. It would be great if you could see how an abuse survivor's history may influence her experience of being PowerBirthed without her consent. Maybe then you will begin to see the big picture. This is primarily an issue of maternal rights, not midwifery theories.


It is estimated that one in four women in America has been the victim of some form of sexual abuse at some point in her life. In Utah, where some of your PowerBirth midwives practice and where I had my PowerBirth experience, the rate is slightly higher than the national average. So midwives should assume that at least 25% of their clients have a history of sexual abuse. They may not know which clients have been abused because some survivors do not have any conscious memory of the abuse, and some may be incapable of acknowledging it openly. As Penny Simkin tells us, "Lack of memory of abuse does not eliminate the pain." 

It would be reasonable for midwives to assume that possibly many more than one out of every four clients has been sexually abused, because abuse survivors may be more inclined to choose homebirth than women who have not been abused. This is because the abuse survivor needs greater control over her surroundings and what is done to her body during the vulnerable act of giving birth. She may be hyper-vigilant about her own and her baby's safety and choose homebirth to avoid separation from her baby and disruptive routine medical procedures.


I think it's statistically reasonable to assume that out of the thousands of women who have experienced the PowerBirth Technique (or PBT, as it was commonly called until recently), at least 25% were predisposed to being triggered and traumatized by a midwifery method that routinely invades the mother's space and exerts control over her body. Especially when the mother's first introduction to the method is during her labor, instead of during the prenatal education period, the application of the PowerBirth technique can feel like a reenactment of previous abuses.

"Many abuse survivors, for very good reasons, have issues with control, helplessness, exposure, restraints, trust in their bodies, trust of strangers and authority figures, pain, especially genital pain, penetration of their bodies, and discomfort with new situations. Those who choose hospital birth try to lessen distress by prior planning and preparation and communicating their needs to staff. Those who choose out-of-hospital birth do so in hopes of avoiding those issues, but must also prepare for the possibility of transfer, which will bring about the circumstances they had hoped to avoid." When Survivors Give Birth, by Penny Simkin, PT, and Phyllis Klaus, CSW, MFT


In the above excerpt, there is an implied assumption that the abuse survivor birthing at home will be able to avoid the type of care that inflicts trauma unless she needs to transfer to the hospital. There is no warning that midwives can routinely inflict the same emotional and physical trauma at home, because this type of midwifery is not well-known around the world. When most people think of homebirth midwives, they picture the BirthKeeper, the midwife who believes in birth, in women's bodies, and in allowing things to unfold naturally, without interference, unless there is a true emergency necessitating action.


There are many things you've written about women and childbirth that I wholeheartedly disagree with. I do not subscribe to your theories which contradict research about the physiology of birth and I find many of your statements outrageous, such as your claim that "most women" prefer to give birth on their backs, that the lithotomy position coupled with perineal massage adequately approximates the benefits of squatting, that all women feel the instinctive urge to push at 5 centimeters and increase their risk of cesarean by not pushing at 5 centimeters, that it is safer to have an elective cesarean than to give birth with a "hands off" midwife, that digitally pushing aside the cervix during contractions is what a midwife is "supposed to be able to do", etc. etc. But these arguments have been debated ad nauseum for years with entirely too much ego involved, and too little regard for who really owns birth: Mothers.


My purpose for continuing to write and talk about PowerBirth is to do what I can to make certain that mothers in my community are not having their rights to informed consent and informed decision-making stripped away during their home births. There are others championing patient autonomy and reform in hospital settings.  But when women decide to have homebirths and end up with hospital-births-at-home, having hired midwives whose standards of practice include routine, unnecessary, not-evidence-based interventions that are not being disclosed prior to labor, I feel an obligation to sound the alarm.

Regardless of her history, every birthing mother deserves to be involved in all decisions that affect her body, her baby, and her birth. She deserves the truth right from the beginning about what prejudices and practices her midwife brings to birth. 


If I had had ANY IDEA that my midwife's standard of care involves attempting to speed up labor by inserting her fingers into the mothers vagina during every contraction, without explanation or permission; constantly assessing dilation by fractions of centimeters; digitally pushing and stretching the cervix during contractions; requiring the mother to lie on her back on the floor to push regardless of the mother's preferences; manually stretching the perineum with her hands while directing pushing; pulling baby out by the head; and pulling the placenta out by the cord moments after birth, I would not have hired her. I DIDN'T SIGN UP FOR THAT. These interventions were performed without my consent. They were excruciatingly painful, terrifying, and degrading.

As an abuse survivor, to have this technique sprung on me during labor was to experience a heartbreaking theft. Once triggered by my midwife's disrespectful actions, I lost touch with my surroundings and the purpose of the pain. When I pushed my baby out and she took her first breath and I heard her first cry, my first thought was "Who would bring a baby to this?" I had forgotten why we were there and didn't recognize my baby as my own for a while. I have healed a great deal in the years since my first birth, but there is a lingering hurt and shame.


All I am asking from you and the midwives in my community is full disclosure so that other mothers can avoid what I went through. Stop the cover up. Tell mothers during the initial consultation what they can expect if they hire a PowerBirth midwife. The ones who want what you're offering will hire you and those who don't won't. Hopefully all mothers will do their due diligence in researching the pros and cons of different theories and ways of birthing. I openly admit that I was under-educated and relied too heavily on the midwife's reputation, rather than my own intuition and research. Thankfully, the iatrogenic complications that my baby and I experienced at her hands did not cost us our lives, although they could have. We got lucky.

Bulls in the China Shop: Hands-On Midwifery Versus Instinctive Birth

I wish every mother could experience an instinctive birth. There is nothing else like it on earth. When a woman births in integrity with her own mind, body, and spirit, all elements converging with singular intent under the guidance of her feminine power and wisdom, the experience is transformational. Once you understand instinctive birth on an experiential level, you know that birth has an innate intelligence and spirituality. As Jeannine Parvati Baker said: Birth is the most obvious expression of "what is" that we can experience...for a conscious woman childbirth is self-evidently holy.

I wish every midwife could experience an instinctive birth, too. Because it would completely put to rest the debate among midwives about the merits of being routinely "hands on" versus being "hands off" (except in a true emergency). Why wouldn't women want us to manage their births and just, you know, speed things up a little? some hands-on midwives in my state are wondering. 


If those midwives had given birth instinctively at some point before attending other women, they wouldn't have to ask. 

"Birth is instinctive and what is instinctive cannot be taught, only experienced." ~Cathy Daub, Founder of BirthWorks

Instinctive births are undisturbed births. They may be unattended or they may happen in the presence of birth attendants who understand the hormones of physiologic birth, but they do not happen with "hands on" caregivers who routinely intervene. The mother's autonomy and feelings of privacy and control are crucial for the birth hormones to flow, which is how birth transcends the mechanics of the process and becomes instinctual and ecstatic. Without privacy and control, the mother loses access to her inner knowing and she cries out to be delivered.


A midwife who has, herself, never experienced a hands-off birth, who has never educated herself about the hormones that flow during hands-off birth, who has not apprenticed under a hands-off preceptor, cannot understand instinctive, hands-off birthing. She doesn't know why it's safer. She doesn't know how it promotes bonding and empowered mothering. She has no knowledge base from which to judge the merits of being hands-off. 

"Birth is an involuntary process and an involuntary process cannot be helped. The point is not to disturb it."  ~Dr. Michel Odent

I can tell you from experience that hiring a hands-on midwife to attend your home birth is like hiring a bull to supervise your china shop. The bull might eventually convince herself that it's her presence in the store that keeps the china safe, because she has some fancy tricks up her sleeve and has learned to rescue some of the plates she knocks off the shelf before they smash on the floor. I can tell you that she'll try to justify her actions by claiming that the china was falling anyway and you're just lucky she was there to save it. 


I also speak from experience about instinctive birth. I've had three drug-free "natural" home births, but only two were instinctive. Sarah Buckley wrote a magnificent article about how the exquisite hormonal orchestration unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby. 


When birth attendants don't understand the hormonal aspect of how birth works, they do outrageous things. Here are some hallmarks of midwives who don't understand the physiology of birth. They:

• Invade the mother's space without explanation, treating her like a passenger
• Induce labor for convenience sake
• Do frequent vaginal exams
• Talk during contractions
• Invite "helpers" into the birth space without the mother's prior permission. 
• Move the mother out of the position she's chosen, for their own convenience or comfort.
• Ask if the mother "feels like pushing"
• Tell the mother how/when to push
• Convey their own impatience, either through words or body language
• Cause the mother to feel observed/judged
• Use fear to gain the mother's compliance (playing the dead baby card)
• Manually dilate the mother's cervix to speed things up
• Manually stretch the mother's perineum
• Don't allow the mother to birth in water (or wherever she feels most comfortable and secure)
• Touch the emerging baby and/or pull on the baby's head
• Pull on the cord to get the placenta out faster

As saddened as I am that there are so many birth workers unwittingly doing harm to women and babies because they've never been educated about the physiology of normal birth or how routine interventions thwart instinctive birthing and introduce iatrogenic complications, I'm beyond sad that so many of them are not upfront about their practices. How can mothers make informed choices if they're being fooled?


Imagine you've hired a midwife to attend your homebirth and you've never heard that there are midwives who do constant vaginal exams during labor, manual dilation of the cervix, and directed pushing without the urge. Suppose that sometime in your 7th month someone informs you that your midwife practices a patented method of midwifery that involves just that. You do some research and find out that this method is the exact opposite of the natural, gentle home birth you thought you had hired your midwife to be part of, so you ask her if it's true.


And she chooses that moment, when you are 7 months pregnant and have already paid her thousands of dollars, to stop lying by omission. "Yes, I practice that way. Here, watch this promotional DVD. It will explain everything."


Really?


Birth attendants who respect mothers are up-front about their mode of care during the initial consultation. Hiding the way they practice, or only disclosing when they're "caught", just isn't right. It robs women of the right to informed consent.


A midwife who does not trust birth cannot pretend to trust birth when the time comes. It is impossible for a midwife to switch styles of midwifery without first switching paradigms of thought. Mothers deserve to know early in the relationship what kind of prejudices their midwives bring to birth. 


I respect every mother's right to birth however, wherever, and with whomever she chooses as long as she's fully informed, but I'm convinced that when mothers truly understand how birth works, they choose their own instinctive abilities over external routine management. The question of whether a mother should hire a hands-off midwife or a hands-on midwife can be answered by deciding whether she wants to have an instinctive birth or a disturbed birth.

Knowing what I know now, I would never hire a hands-on midwife. No more bulls in my china shop, thanks. 






************** 
Beautiful hand painted mandala plate by tindink