This excerpt from Linda Hessel’s Autonomous Birth blog:
I read midwifery blogs occasionally, and in this same afternoon that I was seemingly everywhere reading about managed DIY birth, I read a birth story that upset me so much that when I stood up my legs were wobbly. Pressure of induction because the baby is “late”, despite the mother’s body clearly not being ready to give birth. Pressure to have cervical exams that the mother is uncomfortable with. The mother feeling like she has to go through the motions of sexual arousal in front of her midwives because that’s what it says to do in Spiritual Midwifery. Cervical exams, conscious pushing and conscious not-pushing. A prolonged second stage, mother leaning back, the midwife’s hands on her breasts and in her vagina, pushing, directing. Pulling on the baby. Stimulating the baby with a dry towel, covering him with blanket and hat. And finally, a realization that the baby wasn’t late after all, but probably early.
The responses (except from the doctors, whose only objections are that homebirth is dangerous, of course,) were unanimously glowing. A beautiful story, inspirational, life-affirming.
I ask: Did she read the same story I did? She has several extreme inaccuracies it makes my knees weak that she interpreted the story so dramatically different than it really was.
I came to this site via a friend of a client of mine… the friend UC’s and we had a great discussion one day in the office, each of us exploring each other’s thoughts and beliefs, very respectful and kind. The friend sent me the link to Autonomous Birth and I read through the entire blog (it’s short) and then found where the Baby in the Breeze story is being discussed on a UC list, also negatively.
The truly amusing part of this whole thing is how horrid the UCers see the birth because midwives “did” things and the doctors see the birth as horrid because we didn’t “do” things! How hysterical is that? The moral of the story (before I even start) is “ya can’t please everyone – EVER – so don’t even try.”
Hessel made the comment that the birth was a typical fear-based midwife birth full of interventions and a lack of belief in the natural course of birth. Interesting perspective.
I’ve also recently been in discussions (in real life world as well as on-line) about what exactly a UC/Autonomous Birth is. Of course, I had one with my second child and I know plenty of women who have had them and many who wouldn’t do birth any other way, but I am delving further than I have in previous UC posts.
I want to know what the definition of UC is exactly. Is it self-defined? Is it a community definition that varies with individuality? (Similar to the definition of midwife which has a variety of connotations and nuances.) I understand why some women choose UC – those that have been so hurt by the medical or midwifery community especially. I understand that some women feel they know as much as a midwife (either they are midwives or L&D nurses or have very educated themselves) and want to UC as a show of autonomy from the medical and midwifery standards of care.
I don’t, however, understand a few things. If some of you UCers can help, it would be really helpful towards my education. As snarky as I sometimes get with this topic, I truly do want to understand. I sometimes think a permanent impasse will be the ultimate result, but I keep trying. I certainly would like someone like Hessel to spend a moment understanding where I come from and how I practice as a midwife. I want to afford the same to you.
I hear/read about "unhindered births" as if they are always conflict-free and intimate. I know that one of the main arguments about having a UC is the sexual nature of birth and how the sexual union that created the child should be the sexual union that brings the child out. I’ve heard this for 22 years now! When I was pregnant with Baby 2, Marilyn Moran and I spent hours on the phone discussing the perfection of a DitY (do-it-yourself) birth. What I learned was that there is no such thing as perfection. And it pissed Marilyn Moran off when I told her the severity of the problem my daughter had being born without assistance. Apparently, it isn’t always about the sexual union being great. It’s about being right.
Hessel, when discussing this sexual union issue, says that there isn’t a “normal” community that finds intimacy and nudity amongst strangers anywhere in the world. I found this astonishingly ignorant considering there are a number of communities in the United States that have just such standards of comfort and normalcy. Also, in other cultures that don’t have the luxury of space we are spoiled with, sexual conduct and nudity is very much a part of daily life (think Dances With Wolves). It is in our culture, fairly isolated in its Victorian beliefs that sex and intimacy should only be between two - and only behind closed doors. Her argument that birth is inherently sexual is correct. She is, however, incorrect that it isn’t normal to share that intimacy with outsiders.
Why, if midwives are so abnormal in birth, are there midwives in every culture around the globe? Why is it that women only birth alone when they have been isolated or shunned? Why do some animals have midwives if they are so unnatural? Why isn't the norm of the rest of the world acknowledged... that men don't go near the laboring woman... that birth is the realm of women?
Why isn't it acknowledged that intimacy has an entirely different connotation in our culture than it does in most others? Anyone take an anthropology course lately? It is not abnormal for women to touch other women's genitals in many, if not most, cultures in our world. The abnormal, if we have to use that term at all, is that women don't touch each other, help each other, view each other in this culture during the wide range of life experiences that include sex, birth, death, body eliminations and more.
I am baffled by the lengths women will go and still call their births unassisted or even unhindered. (This is something Hessel and I actually agree on!)
Why is it okay to climb on-line to get advice from strangers about possible variations (or complications), but it isn’t okay to ask a midwife who might have a tad more experience than the typical Net Surfer? Why would a woman who is having a labor/birth complication (variation) ask complete strangers if they should go to the hospital or not? How can any Net advisor say anything but "If you have to ask, the answer is YES!"
Isn’t it hindering the whole process when ANY outer knowledge is obtained or summoned? Is reading White’s Emergency Childbirth or Gaskin’s Spiritual Midwifery permitted? Isn’t reading anyone else’s birth story… even hearing anyone else’s story… hindering the experience? Wouldn’t preparing for an emergency be considered a disbelief in perfection? Why do some UCers not want a midwife, but want a doula there “just in case?” If there needs to be anybody, why wouldn’t it be someone who can do something besides dial a phone?
Isn’t listening to your child with a Doppler interference? Shouldn’t your instincts tell you all is well? Why learn how to measure blood loss? If you faint, it’s too much, right?
Why do women prepare their husbands for complications? Why would they put their partners through the extremely important task of learning how to be a midwife in less than 9 months? How can anyone who’s never been to a birth (or less than a handful of them) possibly be prepared for complications? What if there is a complication and the partner didn’t perform his/her duties as proscribed… where does that leave the marriage (or their hearts!)?
Tell me this, if it is okay for a husband to learn midwifery and utilize it on a woman, why isn’t it okay for another woman to do so? I suspect the word “intimacy” is going to be used… that that is the main reason… and autonomy, so a midwife doesn’t muck things up with directions, protocols and such. Maybe the problem isn’t the concept of a midwife, but what exactly a midwife does do to and with women in labor. Am I close? Let it be known now: ALL MIDWIVES AREN'T DOMINEERING EVIL DIRECTORS WHO WREST CONTROL FROM WOMEN DURING THEIR BIRTHS. Goodness, most of us love birth and respect its perfection when it unfolds normally. We are present with knowledge many don't have time or experience to know or practice and offer our services to the mothers and babies in our lives. Some of us don't allow protocols or even the law to dictate how we move in our practice with birthing families. The term midwifery is not a generic term. Please see us as individuals.
It’s hard being judged by people who don’t even know me or my style of midwifery. For Hessel to say the “Baby in the Breeze” birth was a “typical midwife” interfered birth is astounding to me. Can she not see the challenges presented and the lengths we went to help this mom have a beautiful homebirth? Didn’t she catch the medical alternatives? How can helping a baby who was in obvious distress by the heat (fetal heart rate of 200 – normal is 120-160 beats per minute) be wrong? Didn’t she hear that the mother herself had her limits and was going to go in for another cesarean if she didn’t birth by her 42nd week? What she couldn’t know is that anytime we left the room/porch to give the parents privacy, the mother called us back into the area because she had to have us there. Mom directed the photo shoot and video taking the entire time!
This mom is ecstatic about her HBAC. She found every second, moments of perfection.
But, Hessel has something to say about this, too. Apparently, midwives can’t possibly understand the distress women feel about their births because it is sometimes years before the woman has an inkling of the anger and sadness her birth experience evoked. She says that it is self-preserving for a midwife to sever the relationship with the mom before that realization hits and she is confronted with difficult emotions or painful feelings of hurt and sadness. The implication is that midwives foster closeness as a mechanism for trust and an allowance to enter the birth space, yet when it comes down to processing, the midwife is long gone. While that may be true in some instances, most of us stay in contact with “our” babies and their families for years and years.
I am always open to talking about the birth or their lives. Always. And I am open to hearing the harsh things about what I might have done or could have done differently. Heck, didn’t I explain that in the Keep Talking (Even When It's Hard) post? Also, this attitude of using a client for our own self-esteem is insulting to anyone who fosters a relationship that might (or will) be limited... friendships in school or work, cousins one sees once every three years, even partners that we might ultimately divorce.
My relationship with a midwifery client is as full and complete as my relationship with friends or family - I give my heart to them. I expect nothing in return, but always receive amazing amounts of reciprocal love and kindness. Even when a client has things to share that hurt, they are said with respect and kindness... no different than when I have to say something that hurts. Any relationship has its joy and challenges. A midwife/client relationship is no different. I put myself out there - for the long haul. Not just the short duration of the childbearing year. It's insulting to be told that is what I do.
Regarding the shifting of perceptions long after a birth, I changed my own views of my hospital birth, too. I thought it was so fabulous, I sent a letter to the hospital and doctor thanking them for such an amazing experience. In retrospect, it was horrible! I wouldn’t wish that experience on anyone. But, that hospital experience led me to where I had more compassion for the overall birth experiences (of all women) and my desire to help others avoid such a cold and painful process. It was in my re-submitting my birth story into an entirely different context that I could see it from a different angle and find it awful. Had I never discovered the natural birth movement, I would never have known that my son's birth was anything less than perfect.
(It is this lack of contextual knowledge that allows women to find their induced, medically paralyzed births fantastic. Is it our job to change their perception? Or is it their responsibility to see things in a different light? Is it right to go into another country and foist our beliefs and religion on them simply because we feel it is the right and true belief or religion? Or is it the path of the "native" to discover The Way if s/he is destined to do so?)
I listen to women who despise their former midwives. Heck, I’ve had clients who've come to me after firing midwives they’ve had for several births! It took them several births with the same woman before figuring out their needs had changed and things she did during the previous births just didn't work for them any longer. What I find interesting in the women's changes is that the blame tends to lie with the midwife instead of the woman accepting that perhaps she chose the midwife for whatever reason and she has outgrown that need now... needing something or someone else. (I'm not speaking about midwife/doctor abuse here... that is a separate topic.)
I get that women’s needs change over time. I get that perceptions change over time. It is a phenomenon I cannot wait to study in school... how one view can seem totally right in one moment and then, over time, with new information, the same view looks dark and horrible. Women wonder what was in their heads when they thanked their midwives or doctors. Too many think they were delusional or even hypnotized or brainwashed into thinking their births were wonderful, when, in fact, looking back, they feel they were being abused and used.
I believe the birth tuly was what the woman believed it to be at the time – even if there weren’t words to express the feelings (as in the case of post-traumatic stress disorder). I know that women who HATED their birth experiences knew it immediately. Even if they thanked the midwife afterwards. Even if they cried in the hospital postpartum. I believe that some women are in shock and it might come slower than immediately, but I also believe that it does not take years for someone to be disappointed or angry at someone's behavior surrounding their births. It might take years to verbalize it (because of shame or lack of words or because no one wants to hear the negative), but I believe it is felt right away. I also know that women can change their minds as their experiences are put in a different context.
I believe everything in life can look different from a different perspective.
Sometimes I don’t know what to make of UCers. I am confused and find myself frustrated with their murky explanations about what is and what isn’t a “true” UC. I am saddened that the women I know who have had bad outcomes, including the mothers of the two fetal demises, are banished from UC lists and groups as if they somehow caused the babies to die – or, more likely, that they might tarnish those that aren’t tightly enfolded in the dogma, spilling the truth that things really can – and do – go wrong even in the most perfect of circumstances and healthy of mothers and babies. Both women whose babies died had 100% unhindered births – and went on to have live babies with a great deal of medical help at their next births. Which birth would seem the better to them?
I think I would be better able to offer a nod (not that a UCer would give a whit what I nod for) towards UC as a viable choice in birth if the women and their partners involved were really informed about what they are choosing to do. Instead of getting caught up in the controversy/headiness of birthing without an attendant (a controversy/headiness many, myself included back in 1984, thrive on), some level-headed thought and consideration about what is really going on in birth – how birth can be extremely unpredictable (don’t I sound like a doctor! it makes me laugh hearing my voice say these words) – these are just some things to think about before deciding to forego a midwife.
I also find it interesting that a midwife might not be invited to the birth, but summoned afterwards to check for tears or to examine the baby. If birth is instinctual and an unhindered experience is sought, why bother with those tears being sutured at all? Why not trust that the bleeding will eventually stop or that the baby’s retractions are just a normal part of that baby’s experience? Why go into the hospital at all with complications? If you’d go into the hospital, why wouldn’t you try to stay out of it with the skills of someone who can be a half-way point between nothing and everything? If you believe that a jittery, sleepy baby will eventually come around, why worry when the baby slides into a coma? If a woman has been pushing for several hours, why consider going to the hospital at all? Why not keep pushing or let the body exhaust itself and allow the baby to fade away? Why not accept the service (and I mean that in a my-giving-you-service way) of a midwife who has methods and skills to avoid many things that might land a woman in the hospital?
(This is one of the arguments I get when people balk that I know how to do IVs, carry pitocin or suture… that midwives shouldn’t have those skills because it isn’t natural. Well, tell that to my clients who would have had to leave their homes, possibly their babies, interrupt their postpartum period to hang out in the hospital while someone who doesn’t love them at all ridicules them and causes untold amounts of pain [spiritually and physically]. They would tell you they are thrilled I have those skills to avoid being admitted to the hospital. The more I can learn, the better. As long as I keep perspective on when to use things and when not to, I will be fine. And so will my clients.)
And I trust that my clients will be the ones to adjust my perspective as the need arises. It’s happened before (humbly and appropriately so) and my behavior has changed because of the different pieces of information given me… and it will happen again.
How else would I have been able to do a Hands Off birth? It couldn’t have been possible until I was enlightened on my Empowered Childbirth list several years ago. There is always room for growth, even in me. Ha! Especially in me!
Much of Hessel’s comments stung because she doesn’t know how far I have come as a midwife. She doesn’t know I work SO hard to keep my hands and wishes out of a birth - so much so that I am sought specifically because I can allow the birth to unfold without my even being in the room. She doesn’t know how I’ve apologized to those I hurt in birth during my training. She doesn’t know I did two vaginal exams in 2005.
I keep listing things and then thinking, “It doesn’t matter. It is never enough. I’m a midwife. An abomination. An expletive. Someone to be eradicated. Birth will never be pure until I am not there.” The exact same thing happens, in the opposite, with the medical folks! I explain what I can do, have done, etc. and I end up thinking the same thing. "It doesn't matter. It is never enough. I'm a midwife. An abomination. An expletive. Someone to be eradicated. Birth will never be safe until I am not there."
I look back at the comments around the web regarding this "Baby in the Breeze" birth and know that, by far, the majority sees the amazing beauty in the birth. I am proud the doctors think I am a loon! I shake my head that a UCer would see the birth as anything but the beauty that it was.
I really can't please everybody. Heck, I can't even get everyone to agree on some basic definitions! My responsibility is to my clients and their families. It is in my honoring them, that I keep moving forward as a midwife. My clients know I listen to them and will for years. (Gotta love email!) I stand with my heart open, listening.
Thoughts? (Especially you, Sage Femme... I really look forward to your comments.)