I knew I wasn’t ready to be a midwife yet. Instead, I worked for CNMs in birth centers, continued attending births in hospitals and learning all I could about birth. I then went back to where I’d studied for over a year, practicing as a primary midwife and I knew I was ready to take the spiritual, physical and emotional responsibility of two spirits in my hands. I acknowledged that I cannot save everyone, but I can do a phenomenal job helping women to have a far safer birth than if they chose not to have anyone present at all.
I’ve listened to the pain of women who’ve experienced birth trauma and birthrape. I know that some women have no trust of anyone but themselves when it comes to their follow-up births. I listen to the women who comment in my Myth of the Vertex post who speak of betrayal in midwives they once trusted.
But, I ask (as I have before)… how can a midwife succeed (in retaining trust) if she has to say something the mother doesn’t want to hear?
“But I do have one issue--I *thought* I could trust my midwives. But because they were working with backup doctors and a hospital that were not trustworthy, and had to protect their liability and that of the backups, I ended up feeling betrayed. They were very, very sweet, and gentle about it, but I felt the pressure nonetheless. They were correct in predictions about a large baby, but I felt very betrayed that they let the consulting doctor threaten me and tell me that if I didn't induce early or schedule a section, there was a high probability of my baby dying and me being severely injured."
“It was very frustrating to me to be told through my whole pregnancy ‘You're fine, we believe in you, you can birth a big baby!’ but the minute I crossed a certain liability point (not sure what it was-could have been several factors) to feel like I either had to fight for a natural birth on my own or go under the knife. That is why I arrived at the hospital pushing. On purpose.”
This isn’t a direct response to this poster, but it is a great springboard for discussing the crux of the issue:
Her story isn’t unusual, but she wrote so eloquently, I want to use her words as my “But…” and speak to her – and the others – about experiences like this.
Midwives who have back-up are in a precarious place. If the law requires the back-up and they will lose their licenses if they don’t have the blessing of the doctor, it is really hard to counter what the OB says when he makes the final call. Midwives with a good relationship are able to verbalize their thoughts about the situation, but if a midwife happens to be on-call with someone who doesn’t like midwives or who has power issues, then she is trumped.
Midwives who lose their privileges no longer are able to help the multitudes of women they could have helped.
Weighing the risk of being dismissed/fired/alienated versus one woman’s needs in labor can be a painful position to be in.
She can pray that the woman picks up where she left off, but all too often, women in labor just aren’t in that position. Doulas can’t help when there are extreme power/medical issues at hand. Doulas, too, have to stand by, helpless, watching the woman’s birth plan go down the tubes.
Even midwives without OB back-up have pressures upon their decision-making process; even those that swear they don’t. Some situations just bring the thoughts of lawsuit, malpractice, court appearances, finger-wagging lawyers and Medical Boards bubbling up in the gut.
When I became a midwife, I said I would never allow the Medical Board to influence a decision of mine with a woman, only my experience level. That was until scary situations arose and I saw the risks of giving women free reign to do anything in labor, with me as their midwife, just wasn’t going to cut it. It wasn’t long before I figured out I had the skills I have for a reason and I was being invited to births for a reason – and I was doing a disservice to women if I didn’t use my skills – of judgment, especially.
I know the arguments about allowing the Medical Board/lawyers in the birth room, but might there not be some place for guidance about situations that go far outside the realm of norm? Should midwives (or women!) be permitted to do anything they want, all in the name of autonomy? Is there no room for parameters? Anywhere? Ever?
(Depending on your beliefs,) We have chosen to live in this place where rules guide much of what we do in order to keep chaos from reigning. We all have to control our anger because if we lashed out as our anger led us to do sometimes, we would hurt people. Our culture fosters civility, not violence (although, it’s sometimes hard to tell by looking at the media!). We obey (most of) the rules of the road even when we are in a major hurry. We are punished when caught when we don’t. And we pay the fines because we know that’s what we’re supposed to do. We incarcerate criminals. We reward good students. We have hierarchy in most of our businesses, schools, groups and organizations.
The dichotomy, of course, is “It’s my body; it’s my choice.” Many of us work towards a more matriarchal community than a patriarchal one. Consensus sneaks into places where democracy would be expected. Many (if not most) of us reading this regularly buck many systems by homebirthing, homeschooling/unschooling, extended breastfeeding, co-sleeping, non-vaxing, baby-wearing and not circumcising our sons. We question authority (to quote the popular bumper sticker), we vote for the most just candidate, we support social equality, we march against causes, we take pride in being the black sheep of our family/friends/community (but, also find comfort in joining the other black sheep at the health food store).
Stretching the point, wouldn’t most of us do something if we knew someone was going to get hurt? The thought of a baby suffering certainly makes most/all of us ache to our core.
Doctors and nurses share that same inner turmoil we all do when thinking about a baby about to be hurt or damaged. They just look at things from a different vantage point.
I think about my dogs that bark at anyone that comes near the house. It drives me crazy when they both get to yapping, but I also know they are trying to protect me from danger. That there isn’t any danger doesn’t faze them because all they know is, “Someone’s coming close that doesn’t belong here. DANGER!” and they bark. I would never consider teaching/punishing/training them to not bark because the one in a million times they do bark, it will be to warn me of someone who doesn’t belong here.
Doctors, too, are barking dogs, warning, warning and warning of dangers. Most of the time, they are heralding nothing but potential dangers, especially if nothing changes to shift the concerns. But, because of their instinct/experience/training, they do recognize and are ready to defend the baby and mother against severe trouble and turmoil.
Do we really want doctors to stop barking altogether? (I try and keep my dogs from barking inside, instead sending them outside to bark.) Perhaps we can encourage them to use their indoor voices when the mom/energy needs to change positions instead of screeching so loudly we cover our ears.
And then, the question becomes: Who is the translator? Who really knows if there is danger or not? I know many believe a mom will intuit something amiss, but I have been around enough births where the woman was the least aware of what was going on. Do we take a vote from everyone present? Do we ask for a second or third opinion? (I am reminded of people with severe illnesses who traverse from doctor to doctor, looking for the response they desire, it not mattering that they really are sick; they just want to hear that they aren’t.) Do we ask for more time? Who is holding the hourglass? (The baby?)
How can anyone say to a woman who’s worked for nine (or many more!) months to create the birth of her dreams that she’s out of time and her dream is morphing into a nightmare… how can that messenger not be attacked/hated/resented by her? Are there words care providers don’t know about that would help them/us to impart shitty news without having flailing arms swinging at our heads (and hearts)?
In the example above, I just don’t know how the midwives could have done anything different, nor do I think they could have done anything to remain in the good graces of the laboring/birthing mom. She speaks of their kindness, yet they are still demonized because they had to turn her out-of-the-range-of-not-even-normal birth over to an OB who made a decision someone had to make. By her own admission, the baby was big! Yet, that doesn’t remove even a droplet from the mist of guilt surrounding the entire lot of ‘em.
Sometimes, we (providers) have to tell women bad news. Altering news. News that changes the course of the whole birth experience.
I think, “If most providers didn’t howl at the moon, maybe it would be more palatable to hear that not-so-sweet stuff from us.”
So, how does one earn trust?
You know the annoying saying that doctors only see birth as normal in retrospect? Is that how a provider is judged to be trustworthy? Only in retrospect? The same saw says, “Midwives see things as normal until proven otherwise.” How come we don’t get trust that easily? (I know the answer; it was rhetorical.)
When birth is something the woman didn't expect, she's often left to pick up the pieces by herself, which is, I believe, what Cappuccinosmom seems to have been left with. What do women do with it all?