Fearing and Daring

Originally posted December 15, 2011

It’s been a strange couple of weeks for me professionally.  On one hand, I got news that an article I’ve written about building lactation communities has been accepted for publication by Midwifery Today (my mother ship). What truly exciting news! The article will be published in February 2012s issue.

On the other hand, I’ve been deeply questioning what I think I know about midwifery, birth and professionalism…

Let me explain. My goal as a midwifery practitioner (whenever that comes to pass) is to offer my clients the safest, most empowering, most joyous experience I possibly can. In order to do that, I must REALLY know what I’m doing (to safeguard their passage), I must remain humble (to allow their experience to be front and center) and I must have confidence in the situation (so mom and baby can both relax and just allow their bodies to work).

But over the past few weeks, I’ve encountered people who worry about midwife attended birth- because they personally have had bad experiences. I’ve read about a particular midwife who has lost four- FOUR- babies recently and who openly flouts a court order to stop delivering babies DURING her trial. I’ve read about a CPM who has left midwifery because the local midwifery community didn’t value her perspective. And I’ve seen for myself a midwife who allowed a client to go to 36 weeks without resolving financial issues so that the client is now- in her last month of pregnancy- trying to scrape together a care team and is viewing a hospital birth as an unwanted failure.

Now, of course, there are entire TOMES dedicated to hospital/physician caused birth trauma, both physical and psychological. In my circles, this failure on the part of the maternity/obstetrical system is almost assumed. But I’ve never encountered families who’ve had horrible non-hospital, midwife attended births before. I was surprised as most of those who denigrate Direct Entry Midwifery are usually pretty ignorant of the facts and are just responding out of unexamined assumptions. But to find that women HAVE trusted midwives and have terrible experiences?- well, my faith in the ‘trust birth’community I’ve so proudly belonged to has been shaken.

Why don’t we as a midwifery community listen carefully to the stories critical of Direct Entry Midwives and do our best to learn, to make sure the horrible things these women report don’t ever, EVER happen again? Why aren’t we as a professional birth community rising up and demanding REAL ways to discipline practitioners who harm the public- if we award certifications, don’t we assume SOME responsibility for those who use the credentials? Why aren’t we embracing the experienced voices who demand more stringent standards for midwives- don’t every mother and baby deserve an attendant who has been thoroughly tested and monitored, especially if she chooses a midwife who has been credentialed by a professional organization?

I’ve even been afraid to ask the questions above- what if my peers or clients worry that I don’t ‘trust birth’ enough? What if my ‘lack of faith’ means I can’t be in the birthy clubs I love so much? I’ve been afraid to be too ‘techno-minded’ and I’m afraid to be simply ‘intuition-guided’…

Let me be clear: I absolutely believe that every mother deserves to labor and deliver in the location of her choice with the attendants of her choice. I do NOT believe in a hierarchy of birth attendants; highly-trained midwives (CPMs, CNMs and traditional) are the best attendants for normal,low-risk births. Obstetricians and Maternal/Fetal Specialists are the physicians who should monitor and attend higher-risk pregnancies and births (what makes a pregnancy/birth high-risk is a different post all together). I absolutely believe that there is a place at the table for all perinatal specialties.

I’ve realized that I don’t “trust birth”. I don’t “fear birth”.  I respect birth. I understand that healthy, normal, low-risk pregnancies will almost always be healthy, normal, low-risk deliveries if they are not disrupted with interventions. I also know that a normal birth can become abnormal quickly, which is why skilled birth attendants are a family’s best bet for the health and safety of all involved.

And more than anything, I’ve realized over the past few weeks that my questions and concerns about current U.S. midwifery practice are valid. Genuinely answering these questions- meeting these concerns head-on and finding better, safer ways to practice- can only strengthen midwifery and better serve women and babies.

So I will continue my independent midwifery study.  I will continue learning from anyone touched by midwives whether they’ve had good or bad experiences. I will try to separate the propaganda on both sides of the ‘midwifery question’ from real challenges, concerns and questions. I will internalize those to become a truly excellent midwife.  And I won’t fear to speak up and to ask questions.