I woke up early today and went to have my morning coffee and social media time before my house came to life. I scrolled though my news feed and read about people’s dinner from the night before and saw pictures of groggy mamas snuggling sweet babies. As I came across a post by a local midwife I was angered to my core… for most the morning.
She had shared an amazing article from the New York Times. I had read most of it a few days prior when it had been shared by a doula friend of mine but I decided to go back to reread it to allow it to fully soak in. Here are a few important quotes to help you understand my frustration.
“The problem isn’t that we don’t know how to make childbirth safer. Stephanie Teleki, who leads the maternity care portfolio at the California Health Care Foundation, put it this way in an interview: “Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” The problem is not that pregnant women are uneducated or uninformed; the problem is that those in charge aren’t listening to them.”
“It wasn’t until 2003 that states started adding a pregnancy check box to death certificates, and some didn’t do so until the past two years. “This created a data mess where nobody could figure out what the national trends were,” she said. She described this as “a huge missed opportunity for intervention in conjunction with the Millennium Development Goal.” At the same time, “the National Center for Health Statistics, which is the government agency responsible for publishing maternal mortality data, completely stopped publishing it.”
“Claire, who also asked that I use only her first name, was 38 weeks into her fourth pregnancy in 1992 when she went into the hospital certain she was in active labor. She protested when the doctor decided that the baby wasn’t full-term and gave shots to halt the labor. A few weeks later the baby’s head descended and Claire returned to the hospital, but the baby was now so big that she labored unsuccessfully for 24 hours before undergoing an emergency C-section. This is how she described her experience: “They gave me an epidural and asked me if I could feel the knife and I said, ‘Yes, I can,’ and they didn’t believe me. They said that’s impossible. But I kept saying, ‘No, I can feel it.’” Then her blood pressure dropped. “I hear my husband say, ‘Look at her blood pressure.’ And the doctor said, ‘Oh, that must be a malfunction of the machine.’ Then I hear, ‘Oh, my God, she’s going into shock,’” she explained. “At one point I heard them say, ‘We’re going to lose her, we’re going to lose the baby’. Claire still remembers it as one of the most terrifying experiences of her life. “I never completely got over it,” she told me. “I have a daughter now who’s pregnant. I’d like to just be happy about it but I can’t be.”
(Here is the entire article so you can see the full picture. https://www.nytimes.com/2018/11/16/opinion/sunday/maternal-mortality-rates.html)
The local midwife went on in her post to rally for midwives, doctors and hospitals to join in the care of women to help ensure the safest outcomes for moms and babies. In her declaration she included Certified Nurse Midwives to have a place in the hospital birth setting and Certified Professional Midwives (CPM) in the home birth setting.
“I mean this with all love and sincerity. I’m not bad mouthing anyone or any institution. I’m not criticizing any hospital, doctor or nurse. I’m tired of the finger pointing. Especially when women get blamed. I’m tired of hearing administrations saying it’s the doctors and doctors saying it’s the administration. We need Hospitals! We need Doctors and Nurses! We need Certified Nurse Midwives in hospitals in Wichita! We need home birth and Certified Professional Midwives. We need doulas!”
Sounds great right? YES! Women need the option of Certified Nurse Midwives. YES! Women need the option of Certified Professional Midwives. The dilemma is that there are also women wanting traditional midwives and there are women wanting no midwife at all.
What is a Traditional Midwife? A traditional midwife is a midwife who has received her training and knowledge in the form of apprenticeship, non-MEAC* accredited school, self education or a combination of all 3. These types of midwives are also referred to as Direct Entry Midwives. (*MEAC stands for Midwifery Education Accreditation Council)
Why would anyone want a traditionally trained midwife?
These kinds of midwives are not bound to the limitations that Certified Professional Midwives (CPM) are because they are fairly sovereign, they are able to be more flexible and truly serve the mother, follow her desires, intuition and choices. This allows women like me – who have experienced something in a previous pregnancy or birth that some caregivers see as high risk or would want to manage in a way that the client did not want and women who have had previous unassisted births and are looking for support for subsequent pregnancies – to have a birth attendant who listens to them and supports their choices.
We need to consider the disastrous message we are sending to birthing women when their choice of provider is limited. Essentially we are telling them that
1. THEY CAN NOT BE TRUSTED AND THEY CAN NOT TRUST THEMSELVES
2. THEIR VOICE DOES NOT MATTER.
3. SOMEONE ELSE KNOWS BETTER THEN THEY DO
The reason women are dying in labor is rooted in the fact that they are not being listened to, not being heard and not given options.
How is limiting their options helpful at all?
How will it change the bad outcomes we are trying to avoid by not really changing anything?
What the local midwife did here was to exclude TWO options. (1) Direct Entry Midwives also known as Traditional Midwives and (2) free birth. This is misleading and, to some, is proof that she’s not really hearing what women are saying. She acknowledges the need for midwives and then makes it appear as though there are only two types of midwives, which is not true, especially in states where the government does not regulate midwives. In these states, WOMEN regulate the midwives and the midwives regulate themselves. This means that women can find someone better suited to fill their needs.
Trying to limit women’s birthing options is deadly and dangerous, as we are learning. When the midwives who supposedly want us to be heard are ignoring us and not offering and supporting all, valid and very legal options in our area, we are in grave danger! Especially when she knows that limiting such options is killing us.
Women have fought for decades to be heard and respected. We continue to do so to this day. Many of us were born in the time where we were taught to use our voice and stand for what we believe, but what happens when we do use our voice and no one listens?
What happens when we voice exactly how we want to birth and our care provider drops us or tries to manipulate us because they don’t like our choices?
Women are fleeing their states in late pregnancy to escape the limitations their CPM’s and state regulation are setting on them.
Women are choosing unassisted births due to lack of choices, lack of truly autonomous care and providers who are not hearing what women say they want.
When I was a doula who worked in the hospital setting I can vividly remember nurses taking my clients birth plan and behind her back throwing it in the trash at the nursing station audibly laughing about the mother’s plans for a normal birth.
I had numerous clients who would tell me that they had a strong desire to birth at home but their husbands would not allow it. Read that again. Their husbands would not allow them to birth where they felt most comfortable and safest. These women quieted their inner desires and their intuition and did as he said.
I had a family member, very physically active and fit, who reported to her OB that she had an incredible pain in her leg . They told her it was simply sciatica, a common ailment in pregnancy. As the pain grew in intensity she pressed for more inquiry, which is when they found a large blood clot. By the time anything was done about it she was having to use a walker to get around.
I had a home birth client specifically ask their midwife to please not do any cervical exams in labor, only to have the midwife insert her fingers just before the baby was crowning, no permission asked, no discussion of procedure, no consent . Just fingers in her vagina as her labia is bulging, full with the pressure of baby head. Some would say “ come on, that just comes with having a baby.” But does it have to? Just because women’s wishes have become routinely ignored and they are regularly traumatized in pregnancy and birth does not make these things right, moral or less of a violation. When did women become weird for not wanting uninvited hands inside their bodies?
An increasing numbers of sexual abuse survivors are seeking refuge from provider abuse in unassisted home birth. This can be an amazing thing and very healing for most women and families, whe the woman listens and heeds her body’s wisdom.
Recently an unassisted home birthing family lost their baby. The labor was long and became rather unusual, the mother felt as though her labor was no longer in the normal range and she reached out online for support. The moment the mother felt she needed to reach out was the moment she should have known her intuition was speaking. Did this mother feel as though another woman knew her body better then she did? Was she worried about the treatment she may receive at the hospital if she transferred?
Unfortunately most women have been instilled with the falsehood that they cannot trust themselves to some degree. I am a staunch supporter of unassisted birth but also am a staunch supporter of mothers intuition and her ancient maternal wisdom. Even in the unassisted birth community women are looking to someone else for guidance on what to do, even when their body is telling them the answer. What would have happened if this family had had a midwife or doctor that supported their plans for the unassisted birth?
Women have been emotionally beat down with a deaf ear to what we want and need for so long that even when we are heard and its partial, we are grateful.
“At least you got your home birth”
“At least it wasn’t a c-section”
“Healthy mom and healthy baby is all that matters”
“It sure could have been worse”
”You would have died if you would have been at home”
I have heard all these things validating very heartbreaking situations where mothers were ignored or lied to and an emphasis is made on the scraps of our goals are what we are left with. These terms are also used to manipulate mothers into being thankful for their trauma.
Of course, sometimes birth does not go as planned but we need to accept it for what is was to the mother and make sure that we as care providers, are NOT the cause of the trauma, only part of the healing.
Women are dying at epidemic proportions in childbirth in the United States. We rank 45th in maternal mortality…. That means it’s safer to give birth in 44 other countries than the US. It is also estimated that in the US there are over 900,000 cases of postpartum depression annually. Could these be related to the epidemic we have of ignoring women?!
We are just now learning the ramifications of mothers emotional state on the growing baby, imagine the unknown damages we are causing to babies through damaging their mothers self confidence, autonomy and sense of mental security.
How long will we let this continue?
When will ALL care provides really start to listen?
When will women finally be heard and actually honored for their innate knowledge and intuition on making, growing and birthing and raising their babies?
When will we respect a woman’s need for privacy and seclusion while birthing and not see it as bizarre?
We have to start hearing, believing and trusting women. They have to know that we hear them and what they are pleading for.
We MUST start supporting their birthing options, even if we personally would not choose the same. We have to provide care that does not walk out when they don’t do what we, as providers, want them to do. They have to know we trust them, their abilities and intuition.
Only when we can hear them – truly hear them – by listening to their questions & concerns, emotional upheavals, fears, excitement, acknowledge their physical aliments and affirm what they already know will women feel that they are strong and capable. They will know that growing their babies and birthing is programmed in their DNA and all they need is within them because they will feel it as they feel secure in looking deep and listening to themselves. They will know that the wisdom they feel rising in their soul as their baby grows is an ancient calling for all mothers to help preserve our future and keep birth safe.
YES! We need hospitals, doctors, and nurses. YES! We need Certified Nurse Midwives in hospitals and birth centers. YES! We need Certified Professional Midwives in birth centers and at home. YES! We also need traditional direct entry midwives at home.
We need ALL the options from free birth with their partner and family only to ALL types of midwives at home to midwives in birth centers to midwives in hospitals to obstetric surgical specialists. Women desperately need providers who HEAR them AND give them what is needed…..truly autonomous trauma-informed prenatal care.
Laura Hamilton is a wife, mother, caregiver, activist, former birth doula and currently working as a Birthkeeper/Midwife with Private Womb. She resides on the prairie with her family of 10 and a myriad of animals. Laura works out of her home providing support and care for women seeking genuine mother/baby centered, trauma informed, autonomous midwifery care.