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Sunday
Mar142010

The UC Oxymoron

The Trust Birth Conference is going on as I write this. Throughout the year, I was asked if I was going to attend since it was so close to my San Diego home. No. Still feel “trusting birth” is asking for being disappointed –or worse. I continue “Respecting Birth” –understanding that birth has a power of her own, but that power can be unpredictable and wild at times. That unpredictability is why midwives are hired to attend births. I suppose if you trust birth, especially, implicitly, you could merrily skip through your pregnancy and birth without a midwife. 

Pamela Hines-Powell, SageFemme, spoke at the conference about how midwives can help UCers. (UC = Unassisted Childbirth) After her session, she put her UC Contract up on her blog and it was this contract that has gotten my knickers in a twist. Mind you, I respect Pamela very much and enjoy her blog, yet her thoughts and beliefs definitely move me to think and write more. 

Pamela writes in part: “A non-refundable midwifery care deposit of $500 ensures that Pamela Hines-Powell will be available to answer questions or concerns, order desired labs or ultrasound, collaborate with other healthcare providers during the course of pregnancy, birth and postpartum. This fee also ensures that she will be on call for the birth, whether or not she attends the birth.” She goes on to outline different circumstances where she might attend the birth at the client’s request or even transfer to the hospital with them if that was needed. I’m glad she has a limitation that says, “If an emergency arises and the midwife feels the safest option when consulted is a transport to the hospital, she has the right to refuse to attend the birth at home.” 

Over the last week, the NIH VBAC Conference stated new guidelines to increase VBACs, yet the reality is docs and hospitals continue limiting them (refusing them) to a significant portion of women. A woman’s right to birth how and where she wants to have been in the forefront of the discussion. Intertwined with the issues have been references to reproductive rights, a woman’s sole choice of who touches her body (even if the baby is in danger) and what would constitute informed consent (and who defines it). 

The UC supporters embrace these same considerations; that women have a right to birth alone, even if it endangers the baby, they decide who touches their bodies and one cannot be pro-choice without being pro-UC. It’s an interesting concept and one that certainly makes me pause, trying to wrap my mind around that logic. 

I think I could squint and see my way to agree that autonomy and choice are valid reasons to UC (not that anyone cares if I think they are “valid” or not), but where I get perturbed is when UCers pull midwives into their autonomous world. 

I just cannot figure out for the life of me how a UCer can call themselves a UCer if they consult with a midwife. Pamela equates consulting with a midwife as if a homebirthing woman needed to consult with an OB, say, for antibiotics. That she still is a homebirthing woman, but needs outside information/help to keep them on their path towards their goal. 

But, the U in UC is unassisted. Un. NOT, assisted. No help. No one assisting. No one helping. Not, U-except-when-I-need-the-help-of-a-midwife-C; that would be called assisted. I don’t care if all the midwife does is tell a woman who calls herself a UCer how to listen to heart tones, that’s giving assistance. But, if a UCer calls a midwife in the throes of labor? If the midwife comes to deliver the placenta? To suture? How is that considered unassisted? Is it merely a badge of honor to say you birthed unassisted? That the midwife sat in the other room, on the porch, in her car, in her house? 

And what of a midwife who joins in this game of semantics? Is she the UCer’s midwife? Is she the UCer’s consultant that just happens to be a midwife? Is she the Un-Midwife? 

Why is a midwife smart enough, skilled enough and experienced enough to consult with, but not cool enough to have at the birth? How come “trusting birth” comes with the parentheses “unless I need a midwife to pull me out of danger or fear.” 

(Sometimes I don’t like it when all I do is ask questions, but asking and getting answers helps me formulate my own answers.) 

Recently, I’ve written that I serve women. That that is my role/job/calling: I serve women. But do I really serve women? All women? If I can help a woman find help terminating a pregnancy, be a doula at abortions and sit for hours with a woman having a miscarriage, why is it such a stretch for me to reach out to the UC community? Why does it sound like I want to punish the UCer for making her choice to birth alone? 

Why am I being so black & white about this issue when I can so easily see the gray in almost any other? 

I’m sure that part of it has to do with many UCer’s arrogance about their knowledge and abilities to avert complications or use wishful thinking to eliminate anything negative from happening at all. The puffed out chests, bragging that they don’t need anybody sours my desire to offer assistance – because I am “anybody.” So, if they don’t need anybody, don’t need anybody! 

Caveats abound. “I don’t need anybody until I need: to know my blood type/to see if I have a UTI/to get antibiotics/to order an ultrasound/to see if my water broke/to determine the baby’s position/to check that my 40-hour labor is still normal/to help me decide if I should go to the hospital/to come help with my not-nursing baby/to deliver my placenta/to sew up my torn vagina/to do the newborn screen/ad forever.” This isn’t not needing anybody. This is needing somebody; apparently, a midwife. 

I’ve been told it’s my ego that pushes me to be so hard-assed against UC. That I need to be needed, want to be wanted and revered as The Midwife. I’ve looked deeply, trying to make sure it isn’t an ego thing and, (perhaps egotistically), I just don’t see it. For me, it is wanting others to be true to their word, to accept the responsibility they swear they want and to live with the consequences they promise they are willing to live with. That UCers lure midwives into their worries and complications, dumping them over the midwife’s head and walking away squeaky clean annoys me terribly. 

I guess, in the end, I have a real hard time with taking advantage of a situation and a relationship, using it for a one-sided benefit and expecting the other person, the midwife, to welcome them with open arms and then being banished when she is no longer needed or wanted. But, when she’s needed again, she’s expected to smile and offer her skills and experience (and license). Over and over, I see a midwife’s exploitation, her very name being maligned, but her love and attention wanted… at the UCer’s beck and call. 

It's that dichotomy that bugs me the most. Be true to your word. Do what you say you're going to do. Walk in integrity, not half-truths. I promise to keep doing the same.

 

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Reader Comments (76)

Oooo, Jenny. You tried to jab me hard. That was pretty darned amusing. Considering the majoriity of midwives aren't lesbian and the majority of obstetricians are heterosexual males, your argument that that is why you choose to UC becomes almost laughable.

(And not that it's any concern of yours, but I *always* come out about my sexual orientation and my psychiatric issues before taking on a client. I won't even make an appointment with someone unless they've read my Bio.)

If you're a UCer to "protect" your marriage, then do it. Saying you UC because you don't want a dyke in your choo-chatch is an excuse.

April 14, 2010 | Registered CommenterNavelgazing Midwife

As a very straight woman, I have to say- Jenny Hatch, that had to be about the most ignorant and hateful thing I've ever read. How vile of you. What a tiny little hate filled creature you must be!

April 15, 2010 | Unregistered CommenterAsh Johnsdottir

So do we also stop seeking medical care if we break a leg? Because, obviously, we're taking advantage of doctors there.

I'm one of the UCers you're talking about. I had my second alone with my husband, after receiving prenatal care from a midwife who was on-call in case something happened. I'm going the same route now with my third.
My midwife has never indicated that she feels taken advantage of in any way, and yes, I do think that, in your post, we could easily substitute doctor/homebirther for midwife/UCer. Following your logic, "true" UCers are only people who do not seek outside help should it become necessary, and that's what I consider reckless.
We seek outside help all the time, in any situation in life. We don't drive around with a mechanic in the backseat because our car could break down. We don't have a plumber watch us bathe because a pipe could burst. Why should it be any different with midwives?

April 18, 2010 | Unregistered CommenterSara

"Substituting UC and midwife for midwife and doctor is very different because the UCer is claiming complete autonomy, no need for anyone in her birth -and, often, even in her pregnancy (UPing). A midwife, otoh, acknowledges that things can fall out of the realm of normal and might need a more experienced/skilled/able-to-do-surgery-or-write-a-prescription person involved."

"I am right there with Dewi above saying that Unassisted *means* UN-ASSISTED. No help. By *anyone*. If anyone helps, it is no longer UN-ASSISTED, no matter how benign or fleeting that "help" is."

You are playing on semantics. The "unassisted" means unassisted by any medical person, until she thinks it is needed. Would it change you if everyone called it UBAMPUSTIIN instead? Of course not. You want to be paid and worshipped. You want women to believe that if their birth is normal, you somehow caused it. That you were monitoring and would actually recognize problems before she did. You want women to believe that all the problems that you let get out of hand were unpreventable and the baby would have died anyway.

She is just like a midwife doesn't want any doctor interevention until she says so, which is often when it is painfully obvious there is a problem and far too late to help. No prophylactic people. And you have to focus on the sematics because you have no response to the content of the argument.

And it absolutely is the same as a midwife. Midwives want to be able to practice solo, without collaborative agreements, prescribe, etc. and have sole decision-making power over when she is in over her head, in which case she dumps on someone who knows something.

If a woman can birth at home, it means the baby came out on its own without complications. What difference would it make that a midwife was there catching?

National data shows that midwives have high death rates when breech and oxygen deprivation and bleeding come into play, so the purported monitoring and management is little more than a show.

And have you considered the main reason midwives "back" UCers? Most women don't fall for midwives' propaganda and therefore, they are desperate for patients.

The problem would be solved if moms had lobbies like midwives and had the power to prescribe and order ultrasound and the like by themselves.

You don't like UCers because it exposes midwifery for the sham that it is.

April 18, 2010 | Unregistered Commenteranon

@Anon - such a sour viewpoint you have about midwifery... that we are out for a buck or that we throw ourselves a party if the birth is normal. I sometimes wish we could sit face to face to talk about where those beliefs came from because it isn't anything I am remotely familiar with. Most midwives I know feel that if the mom thanks them, they were too involved in the birth - I am one who winces if someone thanks me. If I've done NNR or help mom avoid going to the hospital, a passing thanks is very kind, but still absolutely not necessary. I am hired to be her servant. I do what she hires me to do - serve her in the way that she understands I will serve her.

And, an aside about wanting clients and money, for glory or whatever, I don't know how many rich midwives you've ever met, but I don't know any... LM/CPM/CNM (although the CNMs *do* make much more than LMs/CPMs).

Anyway.

It does make me sad that your view of midwives is so negative, but I know we all come from such different experiences, those of us in this birth world. The past few days, I've been in a discussion about whether a midwife should get a license or not and whether that is selling out if she does. The (on-going) discussion is just as loud and just as passionate as the UC/midwife debate. There, the comment (that can barely be heard above the din) is, "Can't we all just get along?" It seems, all too often, the answer is no. (And I do acknowledge my own hand in that decision. I'm trying to do better.)

April 18, 2010 | Registered CommenterNavelgazing Midwife

You know what is frustrating me the most? I think it's educated individuals being labeled as a "sham" or as people who interrupt the process of birth instead of letting it happen. Midwifery is not a "sham", and I take offense to that. Granted, in the world of midwives, I have no doubts that there are certain individuals who may or may not be compatible with others. But to label the entire profession as a sham is taking it way too far.

You're right Barb, we can't all get along and that is why there is no easy answer to the question.

April 18, 2010 | Unregistered CommenterRHONDA RN

if a woman says she is having an unassisted birth and also works with a midwife, then isn't she? isn't this about being mother led? women are trying to tell us something here. we/they want the support, the love, the consideration. but we/they want to be completely self directed, witnessed, absolutely undisturbed. they want the still around them so they can bring forth all the power of the universe.

my idea of an unassisted birth is a midwife to love me and watch me grow. maybe singing songs outside my birth space. maybe coming in and telling me she loves me. maybe not. maybe being there to witness my placenta be born. maybe not. maybe to make sure their is food and drink. who knows. the ability to be in the flow and allow what will happen to happen is unassisted birth. a midwife's part in this is to be part of the flow. to be there or not. does it matter?

what i am hearing is that you can't believe a women can want to be left alone and also want the support of a spiritual midwife. why not?

i think you are just reacting to arrogant or extreme UCers whom you may feel are anti-midwife, but then this is just your reaction to them. can it be real? take that out of the equation and feel what women are asking for. this is about evolution. about man and women becoming totally empowered. YOU aren't the one who will be raising their child. And perhaps this is the first step in empowered parenting. Allowing the parents to be their own midwives. In the middle of the shift though, we need witnessing and support.

How will you "react" if something in a birth doesn't make sense to you? And why does this need to make sense?

I do appreciate your thoughtful post. I have been reading you for a long time.

We can't be scared to change. Everyone will always be needed. But perhaps the definition of midwife is just changing. I hope so.

many blessings,
marybeth
www.misplacedmama.blogsome.com

April 21, 2010 | Unregistered Commentermb

I would have used a midwife if there had been a good option locally. My UC went perfectly well at home though. But, something about it feels reckless in a way, and I think its that when you are actually birthing the baby, you don't have control of both your body and the environment around you. You could use an extra set of hands or two and guidance. For me choosing UC the first time was about empowerment and fear of someone else "messing it up" but now that I've done it once, I feel empowered and as if it wouldn't matter who was around, I could get the birth I desired because I knew what to expect and how to get it. It is an oxymoron that when I didn't know what I was truly in for, no matter how researched and prepared I was, I didn't want any help. Now that I know what I'm in for, I know what help I want. You'd think it might be reversed. I'm still considering how I feel about UC - I'm glad it can be done and is done and is successful. Our was awesome. Yet I don't know how I feel about it for sure.

I do respect your position about midwife involvement. If you trust someone to help on any level, you should trust them to help. If you let someone in on the journey, then you share the journey. I wasn't ready to do that the first time, but next time I want to.

April 23, 2010 | Unregistered CommenterAli

I wanted to share my point of view from my first UC. I lived in Nebraska, a state where there is law against not only Midwives attending home births, but also, specifically, fathers catching babies. Sad, but true. I had had a regular hospital birth, OB and all for my first delivery, but at every turn I was having to fight against them and figure out how I was to do what I believed was best for my baby. This time, in a different state, I wanted the opportunity to birth in a way that I believed in. I began going to a group of CNMs who delivered in the hospital 5 minutes from where I lived. As my pregnancy progressed, I realized I wanted and needed to birth at home. At about 7 months, I told one of the midwives that I knew they could not attend home births, but I planned to stay home. I wanted them to know in case I came in, if something wasn't right, and I told her that I had studied well and would not stay home if there were signs of trouble. She smiled and skirted around awknowledging what I was saying. I don't know that legally she felt comfortable with knowing, but I'm so thankful for her warm smile and support.

My due date came and went, and I gave birth to my son at home. I caught him myself (we didn't feel it was right to hire a midwife illegally or risk my husband being held accountable for doing what we knew the state had deemed wrong.)

When I came to my next appointment holding my son, the Midwives smiled and congratulated me and held him and were surprised at his size and wanted to weigh him. I can't tell you how thankful I was for the love and support of these midwives. My family didn't congratulate me. They were all mad at me... When I walked in with my 4 day old newborn, and was met with support...how wonderful. They weren't hurt that I didn't need them. I needed them in every way they assisted me through my pregnancy. I still stand by the fact, though: This was an Unassisted Birth.

April 27, 2010 | Unregistered CommenterK

"I think it's educated individuals being labeled as a "sham" or as people who interrupt the process of birth instead of letting it happen."

A low-risk pregnancy does as well or better alone than with a midwife at home. If that isn't a sham, I don't know what is. When midwives claim they monitor the baby during labor, but have extremely high rates of lack of oxygenation, given the population, that is a sham. When some claim they can handle breeches and shoulder dystocia, without all the c-sections and technology and then have extremely high rates of death and neurological damage that is a sham.

No one believes that convincing yourself of your unfounded beliefs about childbirth constitutes an "education".

I'm offended that midwives go around soliciting hospitals, insurers, government and the like to force women to use them instead of giving us our health benefits. Why can't midwives attract enough patients on their own, if they are so great?

April 30, 2010 | Unregistered Commenteranon

Hi Barb. It's been a very, very long time since I've commented here, but I've been reading faithfully just the same. Rixa has made two posts since this discussion so I thought I'd come over and see what this is all about.

What I find the most interesting about this understandable "nickers being in a twist" here, is that I've heard this *exact* debate somewhere else: the uc boards I've frequented over the last several years. Seriously, I think there are a lot of UCers who would agree with you! Thankfully, they are not as common in the group I've been moderating as they once were (the influx of midwives to our little group might have something to do with that, lol).

I think what you're running into, as Rixa pointed to, is this generalization of UC. You have to understand that not all UCers think the same way! They are as unique as well, as women can be, lol.

I am a freelance doula, an aspiring midwife (someday, oh yes, SOMEDAY) and the mother of three children. I don't know if you remember me so I'm just reminding you in case you don't. I have had a mw assisted hospital birth (#1, girl, 40wks, 6lbs 6.8oz, pit induction for suspected pre-e that I didn't have, 6.5hr labor), an unassisted birth (#2, girl, 36wks, 4lbs 10oz, footling breech, 7hr labor and perfect birth, if um, rather more intense than vertex presentation, lol) and a planned homebirth turned uc that I just um, don't know how to label, lol (#3, induced at home at 39wks6days for PIH, ridiculously short labor that resulted in the waterbirth of a 5lb15oz baby boy before my poor mw could get there! ). *panting* Whew! How's THAT for quick backround?

Anyway, when I first started reading you, I was very staunchly passionate about UC much the way Rixa was when she first had her daughter (probably because I had JUST had my first UC!). I can relate SO much to what she's been saying because I frequent a lot of the places she does and because our journeys, I guess you could say, have been so similar. I sought out a mw during my 3rd pregnancy because, while doing some routine "prenatals" on myself, I noticed I was measuring ahead. I have a friend who WAS a student mw so after two weeks of little jumps I went from amused to "hmmm". I know perfectly well it's normal to measure a little head, especially in multiparus women, but I think SIX cms is definitely eyebrow raising. So I called my friend over and made HER measure me to see if, in fact, I was getting the right numbers. I was. two weeks later I was measuring TEN cms ahead so I made her come back over and confirm for me (I think two measurements are a good idea). Fine, yes, ok, ten ahead! I knew it wasn't twins so I met with her preceptor and ended up having an ultrasound to check on the beebee (he was fine and very obviously a boy).

Anyway, this particular mw knew me a little bit by reputation as her student and I have been friends for a while. She knew that I had not only had my last baby uc but that I had caught her student's ubac baby also (that wasn't planned, incidentally, it just happened that way). So when I hired her, we had a very good understanding of what we needed from each other. I had a possible problem brewing and I wanted someone around to compare notes with, who had more experience than I did with potential problems and who had caught 1700 babies so would have a good chance of recognizing immediately a particular birth defect I was concerned about. I wanted that person to be someone I felt comfortable with, that I respected and that I could count on to respect ME and to be what I needed to her be for me. (ok so it just so happens that this is a local mw whose career I've been dogging for a few years and I almost fainted with fangirl *squee* when I met her). As mentioned above, all was well and actually, by the time I gave birth, the poly had resolved itself (no cause was ever determined though that babe is 8mo old and I'll tell you, he really, REALLY likes to pee). We opted for the home induction because my BP was just creeping up and up and up and if the home induction didn't work we'd have a few more days before transferring to a hospital.

I'm telling you all this to let you get a peek into the oxymoronic mind of a ucer that deeply respects the art of midwifery and can comfortably embrace freebirth AND midwifery without actually being a moron! :P In fact, I came to my appreciation for freebirth out of an introduction to the birth world by a midwife's novel (Sheila Kitzinger's book on pregnancy was the first book about birth I ever read...when I was 10yo). To me the two go hand in hand. If I, as a woman, approach all of my births from a standing point of inner power (a freebirther) then when it comes time to consult someone that's spent their lives to devoted to learning birth-lore and medicine it's not a transference of power at all. When I was dealing with my mw (who is becoming a friend of mine) I never felt like I was anything less than her equal. For *me* that is important and it's not something I'm likely to find just anywhere. The mw that assisted me birthing my first child is a fantastic mw and I've recommended her to many many women but I will never use her again. I never stopped feeling like an errant schoolgirl with her, lol.

Anyway, I'm a bit rambly as I'm very tired but I just wanted to give you a peek inside my head. Freebirth isn't about just trusting birth. I love Carla, I love her ideas and I love her heart but I don't think trusting birth is where it starts (though I do have faith in the process, as a general rule). No, I feel it's "Trust Myself" and from there. Does that mean that I trust that every birth I'm blessed to witness will go off perfectly if Mom just trusts herself? No! It means that if she's encouraged to really listen to inner self, she will know what she needs (be it help, more water or a bloody backrub). For some women, what she needs, apart from anything pathologic going on, might just be to birth in a hospital and for others, a mw coaching things along or maybe just sitting in a corner (or running a wonderful herbal bath for me...hmmm yes!)

Women, as I know you know, are incredible beings. The idea that giving birth in a normal situation without the help of someone watching isn't safe is ludicrous to me: my CAT gets more respect than that! At the same time, I would never tell any woman she SHOULD uc. There was a time when I might've but I've had some experiences along the way that have taught me how unfair that would be. IT's not always a wise choice. I think what we should be striving for is a community of birthers and birth helpers that understands that women need all sorts of things from complete autonomy to intense intervention and that all of this starts with trusting her enough to allow her to seek it out as she wills. It's a two way street and something that's difficult in society today because don't KNOW they are trustworthy! They've had it brainwashed out of them from the the time they were small. Women who serve others in the service of midwifery are not exempt from this! Not only do we have to deal with our own personal brainwashings with regards to this, but we also have to try to figure out if the woman sitting in the room with us has discovered her own inner voice enough and whether or not we can trust her when she says she has!

It's just not as simple, in some ways, as any of us would like it to be, is it?


To me, a mw who doesn't at least support the CHOICE of uc is a mw who fears birth in general. I know you don't agree with that and I promise I have loads of respect for you and I don't mean that as an attack. I'm not even saying that mw's who respect the choice should then make themselves available because that is a whole other set of issues that have nothing to do with the philosophy of birth. I'm just saying that freebirth and the art of midwifery go hand in hand, to me. I really don't understand why so many people just can't see that.

April 30, 2010 | Unregistered CommenterRebekah C

I wanted to respond to this separately. What I'm hearing here, Barb, is your feelings being hurt. Or rather, how you imagine you would feel if someone treated you this way.

I have to say that if my mw felt this way about our relationship, I'd be crushed. I don't know many women who would go about things like you're describing. I am sure there are some, people are people regardless of their birthing practices and jerks abound in just about every "category" of humanity.

Most of the women I know who choose freebirth and then have sought help have friendships, connections or working relationships with the mw's they are getting help from. In my case, I didn't just waltz in, get help, leave. I came seeking help. Shit, I couldn't even pay her immediately, she took me on entirely on faith I have paid her since then and I will be eternally grateful she extended that trust to me, even knowing I'm a "UCer". I visited with her many times before my sons birth, despite not even meeting her until I was 28wks pregnant. She visited with me several times after his birth, too. I speak to her on the phone from time to time (she's really busy so I try not to intrude TOO much). I also paid her fee AND sent her a gift as a thanks for her support (she went above and beyond for me but that's another story and has nothing to do with the birth).

I guess my point is that I think you're letting your imagination run away with you. You are definitely describing something awful that I wouldn't wish on anyone. I think you're seeing the worst-case scenario and it's just not what most of us are talking about when we talk about "getting help". I see that you recognize that your service includes your heart. And you don't want anyone taking advantage of you OR holding out on you (or any one else), so to speak. You want them to share the experience with you- and I think that's wonderful. I don't think that what you need as a mw and a what a UCer is looking for are necessarily mutually exclusive.

I actually feel for you, here. Almost 2 yrs ago, now, I offered my doula services to a woman who wanted, desperately, to have a VBA2C's. She wanted it very badly and after hearing her story, I realized this poor woman had zero support for her wishes. Not from her doctor, not any of the local mw's (not that there were so many of them) and certainly not from anyone in her family. So I offered to be her doula, free of charge, because she was just OH so lost.

She lived near me and we became friends. We still talk from time to time, in fact. But anyway, she did manage to find a mw that would take her on. The mw horrified me before I even met her. My "client" was 8wks pregnant when this woman was talking induction at 38wks to avoid the "big baby" that caused her first c-section (in the area we lived in, once a v-bac, always a v-bac and GOOD LUCK finding a doctor anywhere over there that will work with you otherwise). This woman had NO knowledge of any of my clients case history aside from the size of her first child at birth (10lbs) and at the time she proposed this, she hadn't even MET my client! (I, on the other hand, while trying to help my new friend find her way, went over her surgical records with her and all that jazz so I had actually knew more about her case-history than her mw ever did!) Anyway, I went to a prenatal with her because the mw wanted to meet me because we'd be "working together". I won't go into details, I'll only say that this woman scared the bejeesus out of me. She didn't share information with my client so much as tell her how it was going to be. When I gently inquired about some of her crazy ideas (seriously, you want to induce labor here, at your birth center, at 38 wks, with some cohosh and an AMNIO HOOK?!?!) she screamed at me that SHE was the mw and that SHE had 17yrs experience, etc etc etc.

Unfortunately, her very blunt nature, her kindness to my client (she was very soothing in her tones to her) and the fact that my client, bless her heart, wasn't um...how do I put this? Let's just say that she was one of the more poorly educated women I've worked with about her body, how birth works, etc etc. Anyway, this woman managed to gain my clients trust and well, ok, whatever, it's her birth. When she started having prodomalish contractions at 38wks, her mw wanted her to drive herself down there and get things going! So what she did was convince my client to just not call me and go down without me. Now I Mean, this woman was more than my client by then. She was my friend. In fact she was the Only friend I had in the area as I'd just moved there! we went shopping together. I watched her kids for her. We shared cloth diapers and traded clothes, I mean, the whole thing.

I was SO hurt when she just didn't call me. I mean, if I had been unprofessional, I could've understood. If we had met more than once and she had some reason to believe that I was a terrible doula, fine. But at the time, I had no idea what this mw's problem was with me, other than I had asked her a question about possible cord prolapse while inducing labor by amnio hook, lol. And I was polite about it, too, I mean, sheesh, I'm a doula! I could certainly be *wrong* about how dangerous that is....right? :P
Considering the crap that went on when she got down there and the fact that the poor girl wasn't even IN labor when she ended up with a c-section for "failure to progress" and "cpd" I was so ANGRY on her behalf. I don't mean to be harsh, but this woman, while the sweetest person I've ever met, just wasn't terribly swift. I really wanted to be in that role of a doula for her, I wanted to be her advocate and I wanted to kind of, you know, look out for her so that crazy woman wouldn't do something like declare her at failure to progress during an herbally induced labor (she was a very stretchy one cm dilated, never had regular contractions and oh, was only 38wks pregnant!). Hello 3rd c-section! In the end I just felt like my client was manipulated and in turn took inadvertant advantage of my friendship with her.

I worked SO hard with her for 6mo on preparing for this vbac and she just dropped me like a hot potato when she was convinced I wasn't needed.

I got over it. I did, because, in the end, it wasn't about me. I'm still angry FOR her, you understand, because what that woman did to her is just...don't even get me started. But the hurt went away and I had to humble myself and recognize that I chose to offer my services to her in whatever way she needed. I wasn't invalidated as a person because she decided she wanted something else in the end. It was HER birth. Her experience. I pledged to support her and that is what I did. But having that experience definitely taught me about what you are talking about up there. Oh yes. Midwives are people, too. Midwives pour their heart and soul into their work (if they're not crazy nutters, that is :P)

So I hear you. I don't think your concerns are invalid at all. I just hope you don't think we're all like that cuz we're not. :)

Ok, enough rambling, lol.

April 30, 2010 | Unregistered CommenterRebekah C

I'm just finding this old post somehow and have spent the past hour or so reading the comment thread. The attacks against the blog author and midwifery are inexcusable.

A midwife who is consulted by a UCer is not midwifing, she is consulting . Midwives shouldn't confuse their already frail existence by acting in this capacity. However, it makes for an interesting business model--distinguishes said midwife from other competitors...ie what does x midwife have that is different/better than y?

A UCer who wants a consultant should hire a birth consultant, one whose expertise is in interpreting and distributing information about birth, not a midwife. Anyone want to start another business?

If a UCer knows her body and suspects something awry, it would reason that she would contact an obstetrician, just as a midwife [legally] would. Contacting a midwife is scapegoating and nothing less, as the midwife [supposedly] is the expert in normal birth. What's with contacting a midwife to make sure the birth is still normal? It's done because an obstetrician would never be down for it.

If a UCer is admitting that she is not on equal *educational* ground (regarding prenatal care and/or birth) and that she needs assistance [from a midwife], then that midwife is *hired*, whether that UCer wants her in the room, hands touching, or whatever.

Does *educational* ground compare to maternal instinct/self awareness? You don't hire a midwife for maternal instinct...or do you?

Shall we call it a midwife-UC collaborative agreement? This has already been going on. As navelgazing midwife said, a midwife is a servant, there to create the birth you want and need. She is the expert because of her studies in midwifery and experience witnessing births. The more time in the more expertise gained.

UCers could stand to read about the history of traditional midwifery in the U.S., Canada, Australia and the U.K. to learn that midwifery is not the enemy. The battle has been long fought and continues.

May 12, 2010 | Unregistered Commenterabeni

I thought this was fitting with my previous comment:

Onwards and upwards: where now for consultant midwives?

Stephens L

RCM Midwives (RCM MIDWIVES), 2006 Jul; 9(7): 278-9 (10 ref)

The emergence of the consultant midwife role is surrounded by debate as to whether it is forging a clear career path. Liz Stephens presents preliminary findings describing the consultant experience.

May 14, 2010 | Unregistered Commenterabeni

Barb,

Why is it hateful to talk about an issue that no one ever openly talks about? I wasn't trying to "jab" you or make excuses for my choices. My feelings about vaginal exams are just what they are.

I also have psychiatric issues and have been working diligently to heal the damaged places in my soul. Birthing ALONE with my husband helped to heal some of the broken parts of my being.

Inviting a Lesbian into my bedroom to "help" would have added layers of confusion and feelings of defilement.

I would just like to openly address this issue, despite concerns about being labeled a homophobe for the rest of my life, simply because for sexual abuse survivors, who make up a big part of the UC community, and especially me personally, I don't want ANYONE touching my body. Male or Female Obstetrician, or Male or Female Midwife, no matter what their sexual orientation is.

Birth is a sexual event. A nine month journey/dance between me, my husband, and our baby culminating in the birth. I believe it is so sacred an event in a womans life that ideally only the angels accompanying the child from heaven should be present along with the husband and wife.

I know some midwives are frustrated by the UC'ers they interact with, and thats fine. But please know that we are just trying to do the best for our families and make the best choices for our children.

For me personally, any vaginal exam by any person stirs up feelings of defilement because of my sexual abuse background. A Lesbian doing the exam would just up that energy to a higher degree. Why is it hateful to say it out loud? It's a fact.

I have been sexually abused by medical workers and was raped in a hospital setting. I would never feel comfortable giving birth in a hospital.

That being said, if I felt that my childs life depended on me having a c-section or some intervention that would save his or her life, I would tuck aside my own issues and do what needed to be done.

I hope this clarifies things somewhat.

Jenny Hatch

May 25, 2010 | Unregistered CommenterJenny Hatch

I had a family practitioner who gave me prenatal care and encouragement, and was available for phone consultation during the births. When I had birth attendants, illegal and not extremely experienced, he made a point of talking to them ahead of time and offering his support and asking them if there was anything they needed that he could give them. He always gave us sterile scissors for instance. ( At one point he gave us something for cutting and clamping a cord before the baby was born, I guess in case it was around the neck and too short, which we didn't use, and I told him that I was afraid what would happen if we did that and then the shoulders didn't come. ) He interacted with these women like colleagues. When my husband and I had babies with no help, he continued to give me prenatal care, to talk to us on the phone during the birth if we had a question, and to come afterwards to examine me and the baby, take the cord blood we had saved to the lab, wait for the crossmatch, and bring me the rho-gam shot. I didn't have many questions to ask him during birth. But once I called when a cord just went on pulsing and pulsing and pulsing for 45 minutes. I was used to cutting it when it stopped pumping. He said to tie it well and go ahead and cut it and the back pressure would make the placenta separate, and that is what happened.

So it seems to me that he was filling a role like what the midwife you talk about is filling for these "UC" mothers. At first, we were only doing this because he was stopped from attending home births because the chief of OB said he would lose his privileges if he attended any more home births. I would have gladly have had him at my births. However I have to admit that when I called him up after my 8th was born and apologized for forgetting to tell him I was in labor, and he laughed and said 'no problem, when do you want me to come over?" I did feel sort of proud that I knew how to give birth and was not dependent on him. I was also grateful that he was coming over to examine me and the baby, and especially that he brought the rho gam to me, as leaving home to go get that would have been a real drag.

Back then I suppose I didn't realize that he was taking a risk doing this for me.
Maybe he felt he knew me well enough. I am so glad he was willing to do this.
If a midwife feels OK doing this for people, I think it is wonderful. If one doesn't, she shouldn't.

I feel a little bit uncomfortable about there being a movement for "UC" because I don't think someone should do this because it is trendy. Some people have little other choice, as you know, and some might have valid personal, emotional, psychological reasons for not being able to tolerate someone outside the family at their birth. I had a CNM, a fine person and midwife, at the birth of my ninth child, after I had moved away from my family practitioner.
I wasn't used to having someone outside the family there, and my labor stopped when she showed up. She and her assistant left for a while and my labor started up again, and this time it did go on when they got back. But I was still trying to play hostess to an extent, and my husband retreated to the kitchen and started cooking, his reaction when he is nervous around people.
I would have rather have had him with me. It was an easy birth, and no big deal, and not at all terrible or traumatic to have them there, and I thought that it was a reasonable safety measure since we now lived 45 minutes from a hospital. I still think that. If she hadn't been willing to come, I would still have had the baby at home, of course, and I might have been a little more relaxed during the labor. I might have interacted with my other kids more. I might have decided to have the baby outside, which I had always fantasized about doing, especially earlier in the labor when I was picking beans to finish out a canner batch, having contractions between the bean rows. I think the baby would have been born an hour or two sooner, for sure, if these people I didn't know well hadn't shown up at my house. (I didn't know the assistant at all.)
So I think I understand the impulse to privacy at a birth. And I don't think it is wrong for people to want privacy, but want to have someone available to consult with if they are needed. It is only the heavy liability climate that makes that problematic.

Susan Peterson

August 13, 2010 | Unregistered CommenterSusan Peterson

I know this is old, but I can't let this go without a response.

Its an amazing world where some folks want labor in a hospital with monitoring, some want labor in a birth center with a midwife, some want labor at home with a midwife, and some just want everybody to leave them alone. Fortunately everybody can have their way.

Would that it were true, Doctor.

November 5, 2010 | Unregistered CommenterDreamy

Great reminder! Thanks for that.

November 5, 2010 | Registered CommenterNavelgazing Midwife

I've been gearing up to write a post about UC for a while now, but I've been putting it off because of how my readership may react.

My personal belief is that unassisted childbirth is irresponsible. Sure, some women and babies are less at risk than others, but I can't help but inwardly recoil when I read birth stories of high-risk UC's (breech, twins, VBAC etc). I will always, always defend a womans right to choose how and where she delivers her baby but that doesn't mean to say I have to agree with it.

The Trust Birth thing really bothers me. I am so glad to read that somebody who is pro-midwife, pro-women and pro-birth choices feels the same. Whenever I have touched on the fact that birth CANNOT be trusted 100% of the time, I have found myself attacked for that mentality and accused of being anti-midwife and anti-informed choice. You are absolutely 100% bang on the money when you say birth should be respected rather than wholly trusted - which is why I just can't get on board with UC.

To each their own. There was a time that I even considered UC'ing so I can totally understand why some would choose it.

Imogen: Are you listening? Let me know you heard this, please.

As a blogger, you have GOT to stop worrying about what others say about you or your writing. I don't mean don't *think* about your readers, but if you have beliefs that you want to talk about, you canNOT let the loud criticizers drown your voice into silence. What kind of writer does that?!? STOP IT! WRITE, for goodness sake, woman... WRITE.

I've written about this very topic several times and as you cruise through my blog (I'm watching you!), I hope you come across the posts that speak to this very issue. I've gotten loud, quiet, louder, quiet and now I am in a LOUD place and *pray* I won't quit, get scared, feel beat down by those that disagree.

Blogging is YOUR voice. SPEAK UP! You are NOT alone, even when you feel you are.

And I'm watching you apologize for people "misunderstanding" you and what you wrote, and criticizing yourself for not being more clear. YOU. ARE. PERFECTLY. CLEAR. People are going to take your words and hear them through their own filters. It is NOT your responsibility to make sure every person hears what you say through YOUR filter! You write. You see how people heard it. See if *anyone* heard it the way you meant it. And if no one seems to "get it," then you tweak your words next time. Try to NEVER apologize for people's misunderstanding your words and your intentions. Apologies ARE appropriate when you *are* sorry for <fill in the blank>... I've written public and private apologies, pulled offensive posts (NEVER DELETE A POST... E-VER!) and found myself feeling great humility as I continue learning.

Most of all, Imogen... write, write, write... put the judgement filter away and just write! Write as if you were going to die in a week and you wanted those close to you to know your thoughts and beliefs.

Please, please write. You have very valuable thoughts many of us want and need to hear.

May 23, 2011 | Registered CommenterNavelgazing Midwife

:) NGM, you are a legend. Thank you. x

(and a side note... I would absolutely LOVE it if you would consider doing a guest post for me... let me know if that's something you'd be interested in)

Email me. :)

May 24, 2011 | Registered CommenterNavelgazing Midwife

My only comment would really be to point out that your reasoning is why there has been a bit of a shift towards calling UC FreeBirth instead. So that you don't get all hung up on the idea that it somehow disallows you to ask for help. My understanding of freebirth is that it means to give a woman freedom to have her birth as she wants. This can be never consulting with another person, or book, or website throughout her pregnancy and childbirth. Some may want prenatal care to be "reassured" that they are fit and healthy, as is their baby leading up to birth, but then birthing alone. Some women consider it to mean truly alone, others think it means only with their husband and other children present. I don't think there is anything wrong with wanting a midwife to talk with before birth but still wanting a private, family birth, and if you can be open with your midwife about that, isn't it better to let each midwife decide for herself if she is okay with that specific situation? I suppose the idea of having a freebirth and then deciding you need a midwife to come attend partway through seems the same to me as having a homebirth and deciding you needed to go to the hospital. You started with one, and ended with another. And there isn't anything wrong with that. The last thing women need is to feel more restrictions being placed on them, i.e. "once you commit to a freebirth, there's no turning back". That to me is the point of freebirth; to be free to do what you feel is right in the moment. To have your space protected, and to give your baby to this world in the most stress free environment manageable, regardless of where your birth experience takes you, and who joins in your journey along the way.

September 15, 2011 | Unregistered CommenterSimone

"Why is a midwife smart enough, skilled enough and experienced enough to consult with, but not cool enough to have at the birth? How come “trusting birth” comes with the parentheses 'unless I need a midwife to pull me out of danger or fear.'"

~ Birth is very private, individual experience. Trust, in any care provider, is a huge deal. Some women don't have access to someone they fully trust to attend their birth. So they consult with a midwife during pregnancy, and handle the birth alone. I see how hard you are trying to understand this, and I hope you find success.


"I guess, in the end, I have a real hard time with taking advantage of a situation and a relationship, using it for a one-sided benefit and expecting the other person, the midwife, to welcome them with open arms and then being banished when she is no longer needed or wanted. But, when she’s needed again, she’s expected to smile and offer her skills and experience (and license)."

~ You can either fully support the way every woman chooses to birth or not. I have had two birth experiences, one involving midwives and the other an OB. I will never have my child in the hospital again, and I highly doubt I'll find a midwife I am comfortable having in the room. Why should a informed, educated, intelligent woman trust a midwife's instincts about something going wrong more than her own? when I was pregnant with my daughter, I knew something was different, or 'off'. Despite the fact that I had seen my midwife the day before and she'd said everything was fine, I went to the hospital. My daughter had turned around in the night. She was fine, just in a new position. But I was in touch enough to know something was different, and check it out.

October 21, 2011 | Unregistered CommenterRevel

Why do you call Meghan's birth a UC then? Am I remembering that story wrong because I thought you had a lot of (again if I'm remembering correctly) rather bossy ladies there with you.

April 18, 2012 | Unregistered CommenterLisa

Bossy ladies are a world apart from a trained provider. The birth was a UC because there was no midwife/trained care provider in attendance.

April 18, 2012 | Registered CommenterNavelgazing Midwife

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