So, the Honest Midwife, Leigh Fransen, wrote a post entitled "Cytotec Tea" and it has been making the rounds, the truth of the post being questioned, Leigh's motivations being questioned... (is she a Dr. Amy minion?!) and it is time to share, publicly, what I also have seen at the hands of CPMs/LMs.
I was also an LM/CPM like Leigh, but was an apprentice/student when I saw much of what I did that was unethical and illegal.
I was at Casa de Nacimiento for three months in 1993 and then during most of a year from 2002-2003.
In 1993, I was nearly totally midwifery green, having attended maybe 75 hospital births by that time. I knew not what was legal and what wasn't; I trusted my senior midwives for guidance and education. But, there were clearly things being done to the women that weren't right. I didn't have the presence of mind to 1) say anything or 2) to leave. Sometimes women would stall near the end of their labor and a midwife would give a clandestine shot of pitocin into the vaginal vault (the floor of the vagina), shooting the baby out almost immediately. The women never knew it was given to them. Other times, the midwives would use something called a "ghost," a gauze tampon soaked in pitocin, placed inside the vagina or rectum, again, without their consent. The ghosts worked slower than the shot, so was less dramatic on the baby (and, most certainly, mom).
Charting, too, was often a stretch (understatement). Any glimmer of changing dates (a mom had a longer cycle? *wink wink*), lying about when women's membranes ruptured and not beginning to count second stage until you could see the baby's head were all common occurences.
After I left Casa, I moved to Orlando and worked at Special Beginnings Birth & Gynecology Center with CNMs. It was an amazing place where we charted what we saw, women were risked out according to the law and there was never, ever, lack of consent. I was startled at the difference.
Why did I volunteer... no, PAY... to go back to Casa in 2002? And stay for almost a year? It was midwifery boot camp. I learned so much there, including tips and tricks I could have in my arsenal should I ever need them. By the time I got back there, the pit in the vault and the ghosts were gone, but pretty much everything else was still there.
And so were the cameras.
Cameras had been installed to watch the students in the birth rooms. The women did not know about them. As far as I know, there was no taping going on, but the lack of privacy was terrible. I heard that later they put the cameras on the consent (buried?), but they were not there when I was at Casa.
Somewhere near the end of my time there, I learned that some of the women were being given Cytotec without consent. I was horrified. I thought back to all those post-dates women who miraculously went into labor with the Blue & Black Cohosh (that never worked when I gave it to them!) and realized they had probably gotten Cytotec. The only time I was asked to give it to a woman, it was in Gatorade, melted; I refused to give it to her. The midwife shrugged and went and gave it to her herself. I went back and looked at my charts and saw, "Mom sipping Gatorade" in several places... almost always with post-dates women ready to be risked out. I don't know if they used Cytotec to augment labors; I never saw that occur.
So, when I've disclosed this in midwifery groups (usually in defense of Leigh), other Casa graduates have said I was not telling the truth, that they never saw any of these things happen. I say to them that the students were usually sheltered from the information, yet they still can't believe the midwives would ever use Cytotec. Blessedly, another midwife, a trusted midwife in the community, finally said she learned of the Cytotec in the herbs while she was there with some of the women who were disbelieving. Validation is a wonderful thing.
I left Casa behind to become a CPM/LM in San Diego, CA. There, most of the midwives were good and above board, but there were still the fudging on charts, the taking on of high-risk clients and, in my experience, the manipulation of consent. (I often said, "How informed IS informed consent?!" My IC form was extremely long and demanded the women explore a wide variety of providers and studies before making their decisions. I did not want to be the only piece of information they received.)
One midwife in particular was less than stellar. I learned, from her clients that transferred to me, that if she didn't have gas money, she would call the client and have her measure her own belly. Not that self-care is a bad thing, but if you're paying for a midwife to do a visit, then she damn well better pay a visit.
Did I ever do anything wrong? You bet. I fudged charts, lied about ROM to care providers when we transferred, allowed women to keep pushing far, far beyond what the law stated we should and took on high-risk clients (the most egregious was taking a client with a history of three shoulder dystocias... who had a helacious one again). I took a woman with a history of a massive PPH... waving away its seriousness as "probably" the doctor pulled on the placenta and caused it himself. Wrong. Blessedly, she transferred care mid-labor and then had a torrential PPH in the hospital; she almost lost her uterus to save her life. I would have killed her at home.
What was in my head?!? I wanted to help women... help them have a great birth experience... to help them love giving birth... to show them there can be respect in birth... and, now that I look back, that I wanted to SAVE them from the medical establishment. How fucking arrogant of me. I am incredibly ashamed of my behavior and actions during those years. I have apologized to the women who will talk to me (and have psychically apologized to those that won't/don't). All I can do now is speak out.
Why? Why now when so much is past? Because I have been saying these things for years and no one listened until Leigh started her wonderful blog. While there are a few things I question about her experiences, enough resonate that I know she isn't lying about most things. (I don't think she lies, per se, but is a tad hyperbolic at times.) I get messaged and told of all kinds of things midwives arre doing around the country, hear the stories of the damaged babies and the physically used women. Yes, even midwives damage clients.
If home birth midwifery is going to have any sort of quality reputation in the US, we really need to reign in the rogue midwives. We need to stop the lying, the operating outside the scope of practice. It's true, the hospital/medical system doesn't allow for a lot of leeway with autonomy and a low cesarean rate like midwives can offer and when there is IC, women should be permitted to determine their own course of care. However, far too often, the midwife isn't skilled enough, doesn't have enough education, to facilitate such complicated births. Until midwives acknowledge their limitations, we are doomed.
I encourage others to speak out, but realize they may have to wait until they are no longer licensed either. Even still, I hear those that tell their stories, in public, about the midwives who shouldn't be practicing anymore. What's so hard, is there is no one governing body to report these wrongdoings to. Where is the accoountability? Oh, that's right... there is none.
Let's fix that.