Do I trust birth?

I have told many people in my office when they sit down for an interview and say, “I’ve read your blog!” that it’s a little embarrassing…this blog is ME, unfiltered, uncensored, raw.  I don’t edit my posts beyond a spellcheck – I sit down and speak from my heart.  If you read my blog, you know me!  And I hope that anyone who is close to me would be able to back that up.

That being said, there are some movements happening within the birthing community with regards to birth and midwifery that I would like to respond to…raw and unfiltered.

34494_134550286579834_6172327_nTRUST BIRTH

One of the things going around is a “trust birth” initiative….the group’s idea is that licensure for midwives is a BAD IDEA.  The leader of this group can feel free to correct me if I mistakenly misrepresent her as that is absolutely not my intention…but her basic premise is that licensure or any regulation of midwifery is bad, it limits a woman’s right to choose who will be at her birth.  She claims that a midwife isn’t doing anything MEDICAL since birth is not a medical event…therefore nobody should have the right to tell her who she can and can’t have at her birth.

First off, nobody is telling the family who they can and can’t have at her birth – what they are doing is saying what the midwife can and can’t do as a health care provider.  And yes, I view myself as a health care provider.  I see no difference between midwifery and any other medical provider – why can’t I have WHOMEVER I want perform my plastic surgery? Why do they need a license?  Why do you need a prescription for drugs?  Why does a family doctor need a license?  Why can I not sell an organ –it’s my body! I agree with less regulation and if all of us had free access to medications, medical proceedures, etc…then I’d be 100% for deregulating midwifery.

I do more than catch a baby….and often it’s the DAD that even does THAT!  There *ARE* medical things that I do such as drawing labs, ordering ultrasounds, resuscitating a baby, giving pitocin if she is bleeding uncontrollably after the birth, fixing up a perineum when she needs it.  I do pap smears and contraception counseling, I diagnose with urine cultures and blood pressures…I do more than catch a baby.  Birth is a natural event, sure…and you should be able to have anyone there you want, and that I agree with.  But to call a midwife “not a health care provider” because birth is a natural event is to strip her of all of the other things she does.

The leader of this movement says that a midwife shouldn’t be licensed because she doesn’t do anything medical…I asked her if she saw a midwife as anything different than a doula?  She has yet to answer that question and became hostile towards me.

The thing that I find ironic is that this woman runs a leading midwifery school!!  She has an amazing curriculum educating midwives across the country – and let me tell you, BOY is it comprehensive!!  Truly impressive!  I find it ironic that she has such a medically comprehensive school, she educates midwives so that when they leave her they have such an extensive medical knowledge it’s incredible.  Yet she claims that they are not health care providers.  She teaches emergency procedures, suturing, detailed information on prenatal testing and procedures…but midwives are not health care providers.  It really is quite confusing to me.

She says that licensure puts restrictions on the midwife – keeping her from attending VBACs in many states, or breeches or twins.  My argument is that what it allows a midwife to offer her clients is even greater (certain medications, O2, diagnostic tests, suturing, etc).  Rather than attacking licensure….attack the restrictions within the license.  Allow midwives to keep her ability to do the medical care and expand on THAT – rather than restrict her by stripping her of her license and making it so that she can’t perform any true medical things and must refer to a physician for EVERYTHING!

28455767-young-family-are-awaiting-for-childbirth-symbolUNASSISTED CHILDBIRTH

There is a movement even more drastic called Unassisted Childbirth (UC) – those who believe that birthing with a care provider there is detrimental to the process and that it shows a lack of faith and trust in the birth process (and in some circle, God).  One of the original founders of this movement is someone that I know and respect (like the founder of the Trust Birth initiative – someone I know and respect even if I disagree).  Like the trust birth initiative, however – I have to disagree with the UC’ers.

I agree in a woman’s RIGHT to birth alone….that’s not what I disagree with.  I disagree with the notion that having a midwife is saying you don’t trust the process.  I trust the process!  But I also know that there are things that, even when you are left alone, can go wrong.  Acknowledging things doesn’t mean you don’t trust.  I wear my seat belt in my car…I have faith that I won’t get in an accident or I wouldn’t have gotten into the car….but I put my seat belt on because I acknowledge that there is the possibility of an accident despite my belief I will be fine.

And more disturbing to me yet is the notion that you can have a party while giving birth – aunts, sisters, doulas, neighbors….so long as there isn’t a midwife present.  To me, that does not show trust in the process, it shows a lack of trust in the midwife.  You can’t trust her to leave you alone, to respect your wishes, to respect your autonomy in decision making, to grant you privacy…you’d rather birth without assistance than bring someone in that knows what’s normal and what’s not and is able to deal with what’s not – not because of how you feel about birth, but because of how you feel about US!  About midwives…meddling, bossy, overbearing, disrespectful midwives.

I view my role as a lifeguard…I sit on the edge of the pool and watch. I don’t direct the games, tell people how to swim or how to play…I merely observe.  Most of the time I never need to get my toes wet…but occasionally someone will dunk, gulp water, and get into trouble.  You have to trust the lifeguard to leave everyone to play as they want or the pool is no fun!  But you also have to trust the lifeguard to know when to jump in and take action if someone’s in trouble.

I have a hard time believing that UC’ers don’t think anything bad CAN happen at a birth….I think that they don’t trust midwives to keep the hell out of the pool and therefore are willing to risk having a bad outcome rather than risk having an interfering midwife there that they don’t trust!!

There are babies and children who are nursing, growing, going off to school – that I do believe are alive because I was there when they were born.  Babies that were born needing resuscitation, babies that had a prolapsed cord or that had shoulder dystocia.  I’ve seen babies born with a 1 minute apgar of ZERO (meaning not even a heartbeat present).  If anyone would think about accusing these babies of needing assistance BECAUSE I was there, they can stop reading my blog right now.  And if it wasn’t because I was there…then it would have happened if I had not been there in which case I did save that baby’s life.

When I had my baby #5, I knew my body could do it…I trust that birth usually goes without a hitch, and as a midwife I know how to resuscitate a baby or how to respond to a postpartum hemorrhage!  But I don’t want to – especially not with my own baby!  I don’t want to be the one to have to bag my baby if she needs it…I don’t want to be the one making the decisions in that moment of whether I need to transfer in for bleeding.  Instead, I found someone I am close to that I trust.  I found someone who I knew would respect me, respect the process, who would know when to help and when to leave us alone.

I believe firmly in my heart that most UC’ers simply can’t find anyone they trust…because I don’t believe that they are so naïve or stupid as to think that bad things CAN’T happen.  They can…in every aspect of life!

Do I trust birth?  Yes, I think I do, I trust that it usually goes just fine…but I also want a midwife that can provide comprehensive care…and a midwife that I trust as much as I trust birth.

11 Comments

  1. Lindy wrote:

    First of all, I loved that you started a blog shortly after I started seeing you in the beginning of the yr b/c it allowed me to get to know you and your philosophy in ways that went well beyond the already thorough talks during our hour long prenatals.
    As for Trust Birth, I have to say I understand the movement against lincensing, but I think it’s still good its regulated. One, helps keep out the bad eggs. Two, less life threatening and un-medical professionals such as therapists and counsellors have to be licensed in most states- and they aren’t going to be drawing blood, saving newborns, sewing stitches, and so forth!!! So why not have midwifes get lincenses? That said, rethinking the current restrictions is needed, but proper licensing would help with this and potentially could give MWs the ability to write Rx’s and attend “riskier” births, given that they have proved their compentence. Besides do you know how ridiculous I thought it was that I had to go to an OB office for a MetroGel Rx for that bout of BV??? My goodness- I one didn’t even see the dr, but the NP and two she just looked at the lab YOU drew and wrote the Rx. Seriously, like you couldn’t have done that??? Come on now- some of the hoop jumping you have to do is insane… Also seeing women as a MEDICAL professional for things beyond just pregnancy and birth, such as routine paps, would be great. My doula and I were just discussing how we wished we had known a MW to go to BEFORE we were pregnant. I went to that same OB to confirm my pregnancy right away, but had I known better I would have just went to you:)
    As for UC, well I see the appeal, but it’s so risky. Maybe if one lived right near a hospital and could transfer quickly but even then why put up with all the issues of our hospital system if all that was needed were some stitches??? Why not just hire a MW to be there in case of an emergency and just have her chill in the other room? Ppl do that! Frankly if you don’t trust your careprovider, then the issue isn’t with the profession, but the professional! I understand wanting to not be poked and prodded, as well as needing space without lots of ppl in your way. I needed that during my labor just 11 days ago 🙂 but even in my small one bedroom apt, I got it with the birth team just staying out of the way yet were still there to encourage me and check my status to reassure me everything was ok. (How the hell else could I have known in a tangible way what was normal and what was not, especially as a first time mom?)And during pushing, even in the little bitty space at the foot of my bed, we (you, your assistant, my doula, my husband and myself) all fit ok without me feeling claustrophobic, which was a concern of mine about having a homebirth in my apt. (And to all you who unlike myself and Steph, weren’t at my birth, the area in my bedroom I birthed in was about 4 ft by 10 ft, and I was able to move a LOT- squatting, standing, on all fours, a little bit of pacing, plus we had a birth stool set up… Granted our sixty pound greyhound got shoo’d from the room and Steph’s assistant and my doula where more in the hallway… I at least was comfortable enough, as much as one can be with an almost 9 lb baby coming out LOL!) As for the party thing, ugh, that’s just inviting trouble. Who wants to try hosting any sort of gathering while birthing? I felt a little strange not being able to play “hostess” to my birth team, but isn’t that how it’s supposed to be??? Besides, it was a good excuse to keep questionable family members at bay- we got almost a full week of a Babymoon to have the baby all to ourselves- it was HEAVEN!
    THX BTW for everything:)

    Tuesday, September 14, 2010 at 10:27 pm | Permalink
  2. Ana Hill wrote:

    Well said, Stephanie. Thank you!

    Wednesday, September 15, 2010 at 7:29 am | Permalink
  3. Kristina wrote:

    I have also heard nothing but the most exemplary things about the AAMI program. I have a lot of mixed feelings about it, for me, it’s a confusing message. Some days I get it and most days I don’t but I really love how many discussions the TBi existence generates. It has definitely caused me, as a professional, to review who I am in the birth space and what my role will be as a midwife in ways I hadn’t considered before. I have been able to try on their perspective and see if it’s a match for me and in someways it is and in other ways no. I enjoy that a lot- a chance to learn.

    I do agree with much of what you said, if not well, all of it actually- I feel sometimes like there is something that is perceived as egotistical to say that one human being saved the life of another- people are quick to argue the other ways it could have gone down when in reality, they weren’t the person there, in that space, energy, time, with those decisions and responsibility and everything to wade through. It’s easy to quarterback it when it’s not your consequences.

    How does it feel to say that you’ve saved the life of another human being and know that it’s true? (That is so wild to me.)

    One benefit I’ve seen to the TBi efforts is that while I don’t think they’re graduating folks at a fast pace, they’re pumping out a lot of midwives and student midwives who believe that being hands off FIRST is best, rather than having to unlearn how to use the technology they’d previously grown comfortable with.

    However, if the midwife is present and has her intentions in alignment, it’s no one’s right to question her, IMO, at least no one who isn’t someone she has to answer to. 😉

    As far as licensing is concerned, I rest on teh side of licensing because that is who I am, but I admit to struggling with it because I do see the limitations. Thank you for pointing out the ground where I feel most comfortable – usurp from the inside! For some reason I had missed that. I had planned to become an OB for the very same reasons. Someone has to be on the inside working for the ‘right’, it can’t all be done b dissent.

    Wednesday, September 15, 2010 at 12:53 pm | Permalink
  4. maria wrote:

    I think that which is meant by the TBI is that *birth* is not medical. Not medical like an appendectomy. I don’t think anyone is saying midwives do not perform medical procedures at times when needed, hence AAMI’s focus on teaching everything.

    I used to believe that it was possible to change things from the inside, but I don’t anymore, for various reasons. I am not against midwives licensing, but I do want there to be the possibility for those who do not wish to do so, to remain unlicensed. In OR, where VBAC and breech birth are being scrutinized for home birth, I’d hate to see moms having no alternatives to hospital birth one day.

    As for UC, I don’t know of any UC-er who does not know that things can happen. I always cringe when a woman chooses UC because of anything but an inner call to go that route with a particular baby. And yes, as UC-er, I would have known what to do.

    Wednesday, September 15, 2010 at 8:38 pm | Permalink
  5. Kelli wrote:

    Joe and I very seriously considered UC for quite some time before becoming pregnant and went into our midwife interviews still on the fence. It was a combination of completely trusting birth and not trusting providers, but we were always aware of complications, I studied them, even made Joe listen to me explain what it could look like and what he could do to help. I figured learing these things were good for me no matter what we chose, good to learn as a flight attendant who may come across birth at 30,000ft, and as a student midwife and mother. I did want “an extra pair of hands” because like you, even if I know how to respond I didn’t want to take that on overwhelmed or have to explain to Joe what to do while I was birthing, and after Orion’s birth this June I am so much more aware of how difficult that could be. His birth was so calm and I felt calm but still shaken until almost an hour after I birthed my pesky placenta, I could have *done* if I had to but at the time I really didn’t feel up to *doing*, I just needed to *be* for a while. I did and do believe that the complications that can occur naturally are much less common that the complications caused by a provider trying to “manage” birth and so I truely saw UC as a way to reduce risk. I fortunatly found you, a provider I wholeheartedly trusted to discreetly lifeguard my birth, to keep your hands in your pockets and your heart on your sleeve and enjoy the fact that I never needed you, to never *make* me need you, and to intervene as minimally as possible if it did become needed. I am very happy with my choice, I am very happy to have shared that with you, and our trust was well founded.

    I understand the limits a license can put of a mother and midwife but they are ways to wiggle and make things nice safe AND legal, though I know that I am a rare mama refusing to take no for an answer. I personally could feel comfortable with an unlicensed midwife but I do expect her to have the ability to provide medical care in the rare instance it becomes needed. I feel a midwife is a medical provider whose goal should be to not be needed in a medical sense but able to perform at a moments notice. A license should have the benefit of insuring that this person has skills and should warrant the respect a midwife deserves as a competant and quite worthy provider. I can respect a midwife for choosing to be licensed or not but I can’t respect the idea of not allowing licensure to be available. It certainly is the restrictions that should be addressed not the license itself.

    Thursday, September 16, 2010 at 1:03 pm | Permalink
  6. I wrote a sort of similar post a few months ago, at least about the Trust Birth part of it…
    http://redrockmidwifery.com/2010/07/04/do-you-trust-birth/

    Monday, October 11, 2010 at 10:15 pm | Permalink
  7. Alyssa wrote:

    I know I’m late posting this, but I just found your website a few days ago and just found this post today. I love your philosophy about being as hands on as the mom wants or doesn’t want. My problem is that I am being forced into a UC because I cannot find a midwife in my area willing to attend my VBA3C. I know my baby and I can do this without a doubt, but without the money to pay for an out of state midwife, my options are extrememly limited. Just wanted to throw out there that not all UC-ers want to be, sometimes, we financially don’t have a choice.

    Tuesday, March 8, 2011 at 9:29 pm | Permalink
  8. Sara wrote:

    I am choosing UC because I don’t want a midwife. I feel safer without one.
    I don’t trust licensed midwives or midwives that don’t believe that a mother’s intuition could possibly guide her, or that she could be sufficiently educated to handle problems when they arise.
    I loathe the status of midwifery in this sate of AZ (license only) because it restricts a mothers right to choose who she wants at her birth. Licensing is not developed in the interest of women but in the interest of midwives.

    Friday, September 16, 2011 at 3:42 pm | Permalink
  9. Thank you, I found your blog last week and I have been reading the posts that stand out to me! My goodness, this one was wonderful! Thank you, I am a doula, and go back and forth on if I want to become a midwife one day in the future once the kiddies are grown. I also follow both initiatives you speak of in this post and until now I just didn’t know how I felt about it all. But what you wrote could have come from me. If I were a midwife I would want the families to trust me. As a women who will have more children I want a midwife I can trust. And you are right, with my first baby I labored alone for 20 hours and had planned to birth at home unassisted, not because I wanted to but because I couldn’t get in with a midwife, they were all full for my due month. So thank you, I am so enjoying your knowledge and I think I will get to know myself and my birth perspectives better through your honest questioning and writings. I also loved the cervical checks, who needs them immensely!!

    Tuesday, July 24, 2012 at 3:59 pm | Permalink
  10. Erin wrote:

    For me the decision to UC (I am currently pregnant) is due to the fact that there is no one willing to help me. I live in a very rural area, the closest home birth midwife is 4 hours away and unwilling to travel her for the birth. The doctors here are not VBAC friendly and won’t take me unless I consent to a c/s. I literally have no options. I would much prefer to have a midwife here for the same reasons you addressed above, but I don’t have that option and I know I won’t get a fair shake in the hospital.

    Wednesday, October 31, 2012 at 12:05 am | Permalink
  11. Jessica wrote:

    As a first time mom UCer… I chose this route because I feel I can do this on my own. I am a very independent frugal DIY personality so this is just me. While money is a factor, it is not the major factor. I can be a serious introvert when it comes to bodily functions like birth and I would rather do this on my own. Even if I did hire a midwife, I would still do all the research regarding emergency childbirth… so why pay someone to stand by and do nothing because I will want to do it myself anyway?

    I figure if a woman can birth a baby in the back seat of a car with no prior education on the subject, I can have a planned UC with education and prep and things most likely will turn out just fine. And if they don’t, the hospital is a mile away from my home. 🙂

    I just wanted to give how I see UC… good to see all the perspectives.

    Thursday, August 14, 2014 at 2:42 pm | Permalink

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