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Red Flags

Remember when I talked about intuition vs. premonitions? How it can be hard to tell what is what and wondering if I should listen to those inner thoughts or not?

Just as it happens with regards to birth, it also happens beforehand, with some clients.

Red flags.

I'm not too bad at seeing red flags, but what I am terrible at is acting on them. I know they are there, but think I can dye them a different color or or think I can remove and replace them without anyone noticing or seeing.

A client comes to me telling me she isn't sure she wants to birth at home or not... or, more classically, her partner doesn't. She thinks that, with time, he will come around. In prenatal visits, he seems mildly interested, but when it comes to talking about the actual birth, he shuts down. No amount of talking to him elicits the true feelings. I never try to convince anyone to birth at home - ever - because it just isn't safe to do so. But, mom will email me, telling me he is 100% on-board and I will breathe a sigh of relief; until the next visit when the same semi-apathetic father sits on my couch.

A mom wants to choreograph every second of her birth. She wants to know what books to read to make sure her birth is perfect and won't settle for a few books in the vein of Birthing From Within or Spiritual Midwifery. Even after seeming to understand that homebirth is different than the defensive stance of a hospital birth, she remains en guard. She believes if she knows how often she will need to pee or exactly what foods she will be "allowed" to eat, her labor will progress in exact steps that are measurable and predictable. No amount of explaining the unfolding of labor and birth seems to increase her understanding.

A mom comes in very late in the pregnancy, having wanted an unassisted birth, but has gotten scared now that the moment is drawing near. She demands that I do nothing. Even if she or the baby need help. If someone is supposed to die, then let them. Explaining what a midwife is - and who I am as a midwife - leads them to nod acquiescingly, but in their eyes I can see the mistrust and even disgust. They still ask me to attend.

A woman comes in telling me she wants a homebirth and through a great deal of interviewing, I learn she wants to avoid "The System" because of a history of drug use, but is promising to be clean now. Erratic behavior ensues, yet mom, straight-faced, swears she is not using drugs.

A raw foodist with extreme anemia insists she is eating more variety and taking her supplements, yet her hemoglobin stays in the toilet.

All of these and more have happened to me or others around me. Sitting in Peer Review, we present the cases and watch the reactions of our sister-midwives. When it comes to Red Flag Women, we are point blank asked, "Why are you keeping her?" I'm able to justify my reasons, but they sound so hollow as they come out of my mouth and float around the room. What was I thinking?

I am so bad at listening to red flags, I have enlisted another midwife, her apprentice and now my own apprentice to be voices of reason and remind me of previous cases that started as red flags and ended up train wrecks.

The common thread of the red flag scenarios is one of trust.

It takes a LOT of trust to allow a midwife into a woman's pregnancy and birth experience. Now, I am aware of women's trust issues because of birth abuse or their own histories of abuse. But, there comes a time that trust needs to occur or the situation can deteriorate in an emergency. How am I able to do what I was hired for if, in a crucial moment, mom or dad is asking, "Do you have to do that?" (It isn't like I assault women with a vaginal exam or pull on their placentas... I am talking about resuscitating a baby or staunching the flood of blood coming after a placenta is born. Similar life-threatening situations.)

When a client trusts, they answer my request with movement/action. Similarly, when they ask me to do something, I will do the same for them. Trust isn't just their doing what I ask, but also my believing in their own inner knowledge and listening to it - especially when it comes to something not being quite right, or conversely, when they say everything is perfectly fine. When I trust - and they trust - it all works beautifully.

I know it isn't unheard of for doctors to refuse care to lawyers or their families. I also know plenty of doctors (the majority, in fact) who refuse care to women wanting a homebirth. I've known OBs to fire women who insisted on taking Bradley classes. These red flags seem absurd to many of us who work with natural birth clients... lawyers, physicians, Bradleys, or otherwise. But, aren't we permitted our own red flags? I am sure the above scenarios will sound silly to some midwives or clients, but they aren't sitting in my place of responsibility and, having been burnt by similar situations, I am wary.

I want to serve everyone. I tend to be a midwife others come to when no one else will take them. It pains me to have to turn someone away that has been midwife-hopping because of their struggles or personality difficulties. But, because of past experiences in not listening to my own red flags and paying dearly for it, I am trying to do better at saying, "No."

It's a struggle every single time.

Reader Comments (7)

what's the point of having a mw present at an unassisted birth if they don't care if there is a death? why would they want anyone there? talk about a huge red flag!

August 3, 2006 | Unregistered CommenterSage Femme

I am a new reader and love your site. I just wish that homebirth was more of an option here in NC. I know that I could probably find a midwife to attend our next birth but it stinks that its illegal. (Sorry, not really about the red flags.) One of my close friends homebirthed all 5 of her children, the last was unassisted. I really want to be home if we get pg again.

Keep up the great work. I really admire what you do.

August 3, 2006 | Unregistered CommenterKate

well I was going to rant a bit I started a reply and then stopped- there are people I have a heart for and there are things I think are crazy and won't extend myself at all.
although I started midwifery as a recovery project for myself, that time is long gone- not all hospital births are horrible and I don't have to save everyone- well I need to try to protect or save lives when we are at home but I don't have to save everyone from themselves or their choices-
we rarely have women who's DHs aren't atleast accepting of home birth, but I don't require that they are deeply involved- they define their own relationship which may mean that he is not too involved on this level-
and UC birth has become one of my pet peeves - and will not rant about it a few points though- once they come to a midwife, and they want you at their birth- then they have already followed some intuition to seek help- they need to back that up with following through and respecting that decision and stop trying to control every move another person makes - when they transfer in alone to the hospital most end up with" the works"- so some how "medical professionals" end up getting more respect. another point is if you really do not want someone to do anything - then you really don't want anyone. and last point I will make today-is a question for moms if you have a migraine, or a kidney stone or are trying to concentrate on a book, the computer or even having good sex- how much can you pay attention to and be tuned into your child/children? Some people can multi-task to a point, labor is something that takes focus at the very least- and how do you know you are actually tuning in enough to your unborn child and their needs over what you have going on yourself?
as for reality checks in dealing with clients- always good- I have a several midwives I call incase there are things I am a bit uneasy about- and I have an online community as well that I can question,ask for help or get support.
another pet peeve is the new do nothing trend in midwifery- there is a difference between orchestrating every birth a certain way and timely useful recommendations or even hands on actions- some things are very important to know how to do including rupturing membranes- and a seasoned skilled midwife will have a bunch of skills up their sleeve-- an example there is a long time mw near where i live and she never ruptures membranes- grand multip in her care ends up transported for failure to progress- complete for 5 hrs- they rom in hospital and baby is born within 5 minutes- now wouldn't you have tried rom before you took her in to the hospital? When midwives promote complete inaction on their part they are either unskilled or underselling themselves- there is a set of useful skills that midwives have and good judgment on when to use them is what should be promoted not completely abandon the skills- and I agree with you about the clients who have some trust- they are so much easier to help and more often than not they need much less of my "skills" to give birth --- when I ask a birthing woman to move because the baby is stuck there is no time to muck with lengthy explanations
is it hard to say no to your children? My own kids are much closer and I care for them deeply but I say no to them far more often than clients- and when I think of this it makes it easier to say no to clients as well. take care

August 3, 2006 | Unregistered CommenterAnonymous

This makes total sense to me.

I was briefly confused about why declining "red flag" clients feels okay when declining clients for the reasons in the article I posted yesterday doesn't - but now I'm clear.

Declining or referring out a client because of concerns with that specific client, where there's something going on that makes you feel unsafe either physically or emotionally, or it's just not a good fit and you can set them up with a better one, is fine. (Gee, run on much?) Declining an entire class of clients because of a certain characteristic is not cool.

There is a difference between being discriminating and discrimination.

August 3, 2006 | Unregistered CommenterLucina

Isn't it weird how an Ob can "fire" you when you have selected them to provide a service and are paying them to provide such service? I can imagine how hard it must be for you to turn away someone who has chosen to have a midwife and homebirth in first place when you feel it is your calling and part of who you are. I commend you for your strength!

August 3, 2006 | Unregistered CommenterTendaironi

Wow...I'm going to need to read this a few times. Lots to chew on here.


I agree it's all about trust... I have got to find a mw I click with and can trust, because my mw for my daughter's birth really betrayed my trust. I trusted her to do what was best for me, and instead she tried to hurry me up. Of course I bear responsibility for not speaking up about my concerns but I *trusted* her. Maybe that's why so many women are so guarded. You have to find the balance of when to question and when to just have faith in your mw.

August 4, 2006 | Unregistered Commenteranastasia_wolf

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