I woke this morning full of energy for the first time in many months. Wide awake at 6:45 am and chose to relax for a bit in my warm bed while listening to the silence. Then I grabbed my phone to check the bank account balance, whether or not items I have listed on Amazon and eBay have sold, and then to see if there were any messages or comments to respond to on Facebook. As I scrolled down, I saw that a small town newspaper in Wellington, KS has shared an article titled “The Failure: Midwife assisted births outside the hospital more dangerous, GateHouse Media investigation finds”
I’ve seen this article shared in a variety of locations and, today, took a deep breath to read it. It appears as though things are starting to heat up again where women’s birth options are concerned. As a midwife serving Kansas and Oklahoma moms, this article more than frustrates me because it gives just enough information to scare the reader into believing that midwives don’t know what they’re doing, midwives and doctors hate each other, and women are idiots for choosing to birth at home with a midwife.
Here’s what consumers don’t know they don’t know…
(1) You can’t compare in hospital “birth” to at home birth. It’s not apples to apples. In the hospital, the woman is being acted upon and in some cases isn’t even aware that she can’t give full informed consent for anything because she’s not being told nor given the time to find ALL the information about what’s being offered and/or forced upon her. Not to mention the fact that birth isn’t what happens in the hospital most of the time. It is a system of care designed to move consumers into and out of the bed as quickly as possible. Birth happens on it’s own schedule and at it’s own pace. Sadly, many birth centers and even midwives are choosing to offer this type of “care” that includes coercion as part of the “informed consent” process.
(2) It’s been my personal experience that the issue between doctors and midwives in the US is mostly coming from the doctors. Currently in Wichita, KS Certified Nurse Midwives aren’t an option at the hospitals because the hospital requires the midwife have a signed collaborative agreement with an OB and there aren’t any OBs who will give the Certified Nurse Midwives this type of agreement because of their malpractice insurance. Women had nothing to do with this decision that greatly impacts their birth options.
(3) Most of the Midwives I know would welcome dual care. This is where the home birth client sees both an OB and a midwife AND pays them both. Most Midwives I know also would welcome collaborative care. This is where the midwife collaborates with an OB on areas of concern before making recommendations to her home birth client. I’ve experienced collaborative care with an OK doctor. It was an amazing thing to experience as we both respected the others opinion AND agreed that our client had a voice in her care too. In Wichita, KS the obstacle midwives are facing comes from multiple groups of OBs who “fire” all patients who have had even one conversation with a midwife. I’ve seen the letter because many of my clients have received one. There are some OBs in Wichita who will allow dual care even though they are openly against the midwifery model of care. This is because they recognize that the woman has a voice in the type of care she receives. Dual care works best when the client is honest with both providers. The client should not be planning one thing with the midwife while leading the OB to believe something else is going to happen.
(4) There are different types of midwives….Certified Nurse Midwives and Direct Entry Midwives. Direct Entry Midwives can also be Certified Professional Midwives, Licensed Midwives or Traditional Midwives. There are varying types of education one can pursue to become a direct entry midwife. Certified Professional Midwives have chosen to take an exam and show competency in a variety of BASIC skills. Some Direct Entry Midwives choose to not go this route because they either live in one of the states that doesn’t require it and/or they believe the basic skills being confirmed are too basic. Licensed Midwives are required to obtain a license from their state in order to offer midwifery services.
(5) In the states that license midwives, the regulations set forth seem to assume that in hospital birth is the safest option. Therefore, what happens in the hospital is what should happen at home. This – in my opinion – is what can make home birth unsafe. Everything that happens to laboring women in the hospital increases risk to both mother and baby. Bringing these things into the home can make birth at home dangerous. Birth at home is safest when it’s left alone to unfold naturally. YES! Midwives should know what “not normal” looks like AND how to proceed when things are not normal. YES! Midwives should all know how to handle vaginal breech birth because none of us can predict with 100% certainty the baby’s position AND baby’s can still change positions during the birthing process. YES! Midwives need to know when something is outside their skill set and call for assistance or get the client into someone else’s hands sooner rather than later.
(6) There are some things that happen at home that would have happened in the hospital. There is no crystal ball that can warn us.
(7) Any midwife who is afraid to call 911 for ambulance transport or to transport in her own vehicle should not be doing home births.
(8) Some of the “fear” of transport has nothing to do with the midwife at all but rather with the way she and her client will be treated by the EMTs and/or received at the chosen hospital. Did you know that currently there is no home birth transfer protocol setup at any Wichita hospital?? This isn’t because Midwives haven’t asked for one. This is because the powers that be won’t sit down with the midwives to create one. Guess what some of the midwives are doing instead? When a client goes into labor, the midwife notifies the Labor & Delivery Charge Nurse. Once the baby is born at home the Charge Nurse is notified that all went well. If there’s need to transport, the Charge Nurse is given a heads up that they’re coming and what to expect.
(9) If all you’ve ever known is hospital “birth”, then hearing that someone is planning to birth at home will scare you. Why? Because all you know are the stories that end with “if we hadn’t been in the hospital we would have died.” The absolute truth is that in most cases the circumstances that created the “we almost died” scenario were CAUSED by a system of care that believes it can regulate birth and force it into the confines of a very small box where it does not belong. What happens in the man-made baby delivery system
(10) YOU – the birthing woman – are responsible for regulating your midwife AND your midwife is responsible for regulating herself. Some are scared by this statement. We’ve all been led to believe the current system of care is “best” for everyone. When the truth is that the current system of care causes trauma and re-traumatizes women daily. We’ve been led to believe that the assault on women that occurs within the most widely used system of prenatal care in the US is inevitable. It doesn’t have to be this way. Women have the right to say NO and to walk away from the system. We’ve all been led to believe that licensure and certification means the licensed or certified person is safe and it does not mean that at all. What it does mean is that the person met the requirements of the licensing or certification board and guess what? YOU had no say in what those requirements are. In some states, women are forced to have cervical exams because it’s a required procedure during pregnancy and birth. THAT’S RIGHT! Women are being forced to open their legs and allow someone to stick their hands up inside her REGARDLESS of how the woman feels about it. Her right to refusal has been taken away. Sadly, evidence-based care does not include routine cervical exams and the licensing/certifying board doesn’t change requirements based on the evidence. In some states women have to obtain permission from an OB before they can even hire a midwife and plan a home birth. In other states, women are bullied into procedures they intuitively feel are unnecessary simply because the baby is breech and vaginal breech babies can’t be born at home or the hospital.
BONUS (11) The midwives who either choose to not be licensed or certified or who live in states where midwives are not required to be licensed/certified/regulated are not automatically uneducated and dangerous. Some have advanced degrees in other partially related fields. For example, I have a Bachelor’s degree in Natural Health Studies and a degree as a Doctor of Natural Health. One of my partners has a degree as a Doctor of Naturopathic Medicine. Licensing, certification and/or regulation does not mean educated and safe. As a matter of fact, women are crossing state lines from states where midwives are regulated to states where midwives are unregulated in order to have their babies on their own terms. Some women are also packing up everything they own to move to states where midwives aren’t regulated because they’re sick and tired of what happens to them in the man-made baby delivery system
WHEN will you find your voice and stand up for what belongs to you?
When will YOU take charge of your body and insist on truly autonomous trauma-informed prenatal care?
When will YOU surrender to the fact that no one else will do it for you?
YOU are the consumer. YOU pay the bill. YOU keep the lights on in the hospital, birth center, midwife office. TAKE BACK WHAT BELONGS TO YOU! STOP allowing others to take from you.
There are care providers who offer truly autonomous trauma informed prenatal care. Wondering what this is?
Autonomous means that you’re in charge. YOU do the allowing. If you don’t want it done or don’t feel that it’s necessary, it isn’t done. You may need to sign a waiver or consent form. Bottomline, your provider knows that he/she works for you.
Trauma informed prenatal care means that your chosen provider understands that a large number of his/her clients have experienced some sort of trauma in their lifetime. This type of provider asks for permission before doing anything. Yes, even before taking your blood pressure. This type of provider spends time getting to know you so you can get to know him/her. This type of provider knows they have the opportunity to be part of your healing journey or another person to cause harm. This type of provider, especially where home birth is concerned, knows that their relationship with you will play a major role in your birth experience. This type of provider will build a strong trusting relationship with you such that if there is a need to transport or to manage any part of your birthing process you will remain relaxed and know that what is happening is necessary. If this type of provider needs to transfer care for any reason during the prenatal period, he/she will often times offer to attend all appointments with you. If this type of care provider needs to transport you to a hospital during the birthing process, he/she will go with you and stay with you for as long as necessary or possible.
You have rights even when you’re pregnant and giving birth to another human being. If you need help finding the courage to access your voice, contact us.
Angie Taylor is all about guiding women along the path to finding their voice and coming out of the shadows in all situations. In midwifery Angie shows the importance of this by offering autonomous trauma informed care. It’s her way of showing women that she sees and hears them.