Whose Blog Is This?
Log onto Squarespace

Entries in UC (3)


Defining Mid/Medwife

While the term “Medwife” is volleyed around birth circles on the Net and in real life world, I’ve wondered, for a long time, what the definition of each would be if we were to create/give them one. Sure, I’ve read numerous descriptions of what the differences are between the two, but never in a thread such as this (that I’ve seen).

I do know the strong feelings people have about these terms and really do want to continue the discussion, but ask everyone to please remain civil. (Isn’t it kind of sad that I even have to mention it?)

So here is how the thread went down on my Navelgazing Midwife Facebook  page. My comments/thoughts are interspersed through the piece in bold italics. 

DH1: MIDwives: Trust birth and do not interfere in the birth process unless absolutely necessary. They are highly educated and use that to their advantage in knowing when to or, more often, when not to interfere. They understand there is a wide variety of normal and that being "with woman" does not mean to control them.

MEDwives: Use the medical model of obstetric management to control birth using medicine, herbs, expectations, etc. for all kinds of ways to start, augment and speed the birth process. This variety is found more often than not working in the hospital setting although there are some still controlling birth in home settings as well.

KB: So do MIDwives convert to MEDwives and cancel out their trust in birth when the shit hits the fan on a perfectly unintervened birth and they need to resort to medicine and herbs?

JW: DH1 hit it with the control factor.

DH1: No. Midwives intervene as well but only when absolutely necessary... which is not very often. Medwives seem to intervene on a regular basis as "protocol". That is the different in my eyes.

KB: MEDwives are not as "highly educated" as MIDwives? Please explain that one.

RP: I have seen some "medwives" who you could not even tell the difference between them and an OB. In fact, my OB is more open to alternatives and has a lower rate of intervention than they do. I guess it was fairly obvious to me that there were what many would deem "medwives".

DH1: No, they have different training. Medwives are trained that the birth process is broken and needs to be tampered with in order to function properly. Midwives are trained to trust the birth process with a very thorough understanding of the physiology of birth, female anatomy and most importantly patience.

That you said “…trained that the birth process is broken and needs to be tampered with in order to function properly,” I really am baffled where that comes from. While I admit there are plenty of midwives who’ve been quick on the intervention draw (and I’m sure I’ve done that myself), having seen the curricula for midwifery schools (CPM & CNM), I have a hard time believing any midwife is trained or believes the birth process is broken. Maybe it would be easier if you could share some examples of what you mean.

I do think there are midwives who use technology for convenience’s sake, similar to OBs, but that’s different than believing the process is broken.

Also, if you’re looking at who has the more thorough understanding of the physiology of birth and the female anatomy from an educational standpoint, that is most certainly a CNM. CPMs get a fraction of A&P compared to CNMs.

RNK: With DH1 100%.

NgM: clapping hands Can't wait to get into this one later! grinning You all are wonderful! Thank you so much for your candor. This will be a hot button topic and already there's lively interaction. I think this topic is soooo worthy of discussion. Thank you, in advance, all of you willing to share your thoughts, even if they seem not to be the popular one.

KB: I wonder how you've been able to thoroughly assess the training modalities of "medwives" and "midwives" to come to that conclusion, DH1. And who are you talking about exactly. I've known many a "medwife" DEM and probably more "midwife" CNMs in my 10+ year career. I think it's a pretty faulty blanket statement to make and there is a lot of magical thinking going into the whole "midwife" vs "medwife" discussion.

AL: The difference is in the eye of the beholder.


VM: I think it all depends on the perspective of the person using the term. Where I live, there aren't many midwives who aren't CNMs. The CNMs are controlled via their practice agreements and must be "medwives" in many cases: intervening when it is questionable, whether it is necessary, bullying moms into tests and ultrasounds that aren't supported by evidence and not supporting VBAC. Supporting women in this environment, it would be very hard to call any midwife who attends a homebirth a medwife. Because at least she trusts the process so far that she is willing to attend in a home.

What does bullying a mom into tests and ultrasounds look/sound like?

JWP: I don't think training has anything to do with it in most cases. Experiences can shape people after their training, things they've seen can make them change. I'm doulaing for a mom anytime now who is using the known medwives of the area. They are highly watched and controlled by their backup Drs. So while maybe they believe this is the right way to handle a pregnancy, maybe they don't and they don't have many choices. It's either quit and leave even fewer midwives here, switch places of employment to the other MW office in town or just deal with it ‘til we can get laws changed for autonomous practice.

SGM: I think midwives are comfortable being "with women" and trust the process, their own skills and instincts. I think medwives are well meaning, but have been jaded by the OBs that "oversee" them, and the medical model of care in general. By attending to women in the hospital, some midwives simply acquiesce to the status quo, and unfortunately become medwives. They lost their passion along the way, and it has become just a job.

I think this comment alone confuses me more than any other. That a midwife in the hospital who adheres to protocols –that she believes to be true- because she does, you feel she’s lost her passion? That it’s just a job? How did you come to that conclusion? Because she doesn’t buck the system, she doesn’t have passion? Because she works with a degree within institutional walls, her entire practice is discounted?

I rarely see the acknowledgement that not all midwives enter the profession to Change the World of Obstetrics. Not all midwives, especially CNMs, believe homebirth is the safest place to birth. And, just because she doesn’t agree with you (global you), doesn’t mean she’s a shit midwife. She’s just not the midwife for you. And not all women who choose midwives are looking for the “enlightened, spiritual” birth experience. Many women do want the kindness and care CNMs offer, the respect for choices, the time with listening and the patience with interactions. A midwife who adheres to and honors protocols, in my opinion, is not the definition of medwife; it’s the definition of a midwife who feels the protocols and rules help keep mom and baby safe. Just as you might disagree with that definition, she, too, might very well disagree that not using protocols is the safest route for both mother and baby.

KC: Medwife - manages birth for her convenience (or fear), causes herself to be "needed" yet still, usually does so with the best but misguided intentions.

Midwife - keeps her hands to herself unless nature requires it, even when it’s hard not to meddle, she addresses her own fears internally and not externally on mom or baby. She lovingly "life guards". You know if a lifeguard tried to rescue a strong swimmer it would cause drowning, hence a need to be rescued because of the "rescuing'. My midwife crotchets baby hats to keep her hands busy when the urge to "help" gets strong. I am so grateful I can trust her to be a guardian not a manager.

How does a midwife manage birth for her convenience (or fear)? Examples would be great here.

And just as a point of arguing (more), a lifeguard who tries to save a strong swimmer would not, at all, cause a drowning. Bad analogy. (I’m a lifelong swimmer and a retired lifeguard.)

DB-H: K, a DEM (Direct-Entry Midwife) can still practice obstetrics-based care. It’s more of an attitude and approach than credentials.

There are DEMs who encourage augmentation of labor with natural means because mom's tired, baby is big, etc., that check dilation way more than even high risk OBs do. This to me is a medwife.

A midwife encourages the tired mom, telling her how important these last few days/weeks inside are for her baby. She watches the labor, only assisting when medically needed and not for the convenience of herself or others.

Where are all these midwives who encourage inducing or augmenting labor because the mom is tired or because the baby’s too big? Do you mean CNMs? I’ve known a lot of midwives (and have disagreed with puh-LENTY of them in how they practice), but cannot even think of one who practiced this way.

EM: Medwife is a boorish, annoying term made up by some midwives to criticize a colleague.

JD: I am in agreement with DH1, aside from the training... two women can have the same exact training, but come out the other end with different ideas.

K, I'm not seeing where anyone says midwife=DEM (or CPM) and medwife=CNM. I think we all know that isn't the case. However, it is known that CNMs (in the hospital) have more rules to follow.

RC: Where I live there is only one kind of midwife in terms of training and where they do births (both home and hospital). But the distinction stands. Medwives work from a place of fear. They transmit that fear to their clients. Fear breeds a need to control.

Describe the fear. How do they transmit that to clients? Please tell a story that shows a midwife feeding fear to the client.

KB: J, I know that no one has stated whether someone is a CPM or CNM, however DH1 did mention training so that is why I asked for clarification.

DD: To me, I thought I knew the definition of MEDwife. Then my cousin had her baby at the hospital with the "midwife" staff.

They are REALLY not midwives there, so now my definition of MEDwife is

MEDwife: Woman doctor who is called a midwife by the hospital so that they can pay her less. Due to being paid less, she develops a complex and must prove that she is more qualified and better than the attending doctor by performing more interventions and "saving" more babies than him.

Be wary the surgeon in midwive’s clothing Just because they're female doesn’t mean they are a midwife, no matter what the hospital says.

DH2: On paper, they are no doubt equally educated. In practice, some might be more willing (hopefully all good MIDwives) to use patient-oriented, mother-friendly techniques to help a mother get the birth she wants. A medwife, in my experience, is just an extension of the OB - who might not be interested in anything other than getting the baby out at any cost, usually at your expense, and call it a "good outcome." Grr.

MNK: Midwife describes a professional credential, which typically entails a set of knowledge, values, attitudes, skills and abilities. MEDwife is a stereotype that is often used by people who are labeling a group based on assumptions. Stereotyping fails to take into consideration the unique complexities of individuals.

Here, here!

KP: I've jokingly said that a "medwife" is anyone who is "too medically minded," based on the opinion of the person defining the midwife's practice style; and a "madwife" is anyone who is less medically minded than the person wishes.

To me, a "medwife" would include those who have a high induction and/or Cesarean Section rate, and who basically manage pregnancy as if they were the stereotypical high-intervention obstetrician.

BP shares a post she wrote on this subject.

MC: If a midwife can legally use medications in labor/birth as well as other medically minded interventions and she resorts to using the meds/interventions FIRST then she is a medwife. Midwife means with woman. Bringing her fears into the birth place with her makes her unable to truly be with the laboring woman. I agree with M, too- it is a stereotype we commonly use for CNMs.

Question: So if a midwife isn’t to use medications and interventions first, what is she to use? What situations are you specifically speaking about? Is there any situation where medications or interventions are acceptable as a first line of defense?

NgM: Very interesting, all of you.

I've heard the terms compared for many years now, have been called each myself. I've asked for definitions several times, but have rarely heard an answer. This is very helpful as well as enlightening.

I've even heard such a tight definition as any midwife who carries medications is considered a "medwife." I guess if a midwife carries meds, she doesn't Trust Birth enough? I absolutely do not understand that mindset.

My experience only: I don't think I've ever met a midwife (CPM/CNM) who pushed for unnecessary inductions or epidurals. Perhaps within protocols, but not just because a mom's tired of being pregnant or because it's convenient.

It confuses me that people get all cranky about protocols. We all operate in this culture within many different sets of protocols... rules of the road, the handling of money, the education system, our legal system and more. With some, there are accepted ways around/through them and there are certainly unacceptable ways to deal/cope with them.

How can women think there won't be protocols/parameters with something as crucial as the life and death of a baby? How can women think anarchy is acceptable in birth? I don't mean the pushing of constraints or questioning authority... not at all... but complete anarchy? (Is UC complete anarchy?) Are we to just leave birth 100% alone to do its thing without touching a woman at all? Ever?

The comments above speak about a midwife knowing when to touch a mom, when to interfere (hear the tone of that word?) to save a life, but the issue arises... WHO judges whether the midwife acted "appropriately" or was meddlesome? Is it the mom? The Medical Board? Grandma sitting in the room? The doula? Where does this judgment come from and why is someone entitled to confer the epithet of "medwife" on a midwife?

And, as I ready myself to leave homebirth midwifery, am I cranky about this topic because I've been called a medwife a lot? Does being a medwife have any part in my leaving midwifery? Leaving the practice of midwifery to women who don't think about the complications as deeply as I do?

Still listening and pondering.

MNK: Can you say dogma? I highly suspect that most of the folks touting this 'Medwife' dogma have probably never held the hand of a husband witnessing his wife suffering from DIC, having her uterus removed, and dozens upon dozens of blood transfusions after the 'Midwife' delayed transporting with a PPH, because she wanted to try to get the baby latched! (I'm an IBCLC, by the way) Part of being a MIDwife is recognizing when intervention is warranted and relying on your training and wisdom to guide your reactions (and certainly this doesn't happen by consulting with the 'family, and doula' (yep, I'm a doula, too) in the room!

Barb, this is your career, sorry to sound bossy here but don't allow other people to define your parameters. You have a solid head on your shoulders, skilled hands, and a generous heart. You, Barbara, are the epitome of a MIDwife in every sense of the word. As to who decides, well you have a scope of practice to adhere to and your training. I don't think you are giving yourself enough credit but that's my .02 worth. Trust Birth, , it usually works well, and when it all goes to shit, because it does on occasion, -and it will- trust your ability to recognize it and get the pair to a freakin' qualified Perinatologist. Don't let other people bully you either. Do what you need to and know is right. If it's not right for you now, take a hiatus, but if you want to persist in practice, go girl!

I appreciate that. As you know, the decision is made.

DH1: I think this matter is complicated as you so aptly wrote NgM. You are right, there is a lot of judgment in these words. I think it comes down to "Who's birth is it?" Is it the midwife's birth because she has protocols to follow and a practice to protect? Or is it the Mom's birth because she is the one birthing and this is her baby? Who is in charge here? One of them? Both of them? Who is MORE in charge? What about the baby or the partner? I'm not sure any of us have the answers to these questions as anyone deeply impacted and involved by birth would know there are no answers to these questions because every birth is different AND dependent on at least ONE person (mama, midwife and/or baby) trusting the birth process. If the "one in charge" does not trust the birth process, it is very likely the others won't either and this is where meddling comes in.

This birth trust does not come from credentials or training. I never said anything about CNMs or DEMs. It especially does not come from fear based on a few experiences gone wrong. We have to trust that women know what they want, they know how to give birth and their babies know how to be born - even after her birth attendant has had an adverse outcome with another woman. This does not mean she has to change her protocols for everyone thereafter. Every woman/baby is unique and every woman/baby deserves the chance to prove that interventions are not necessary without protocols being pushed on her because the "protocols, practice, law" says so. We all know right from wrong and can make educated choices that make sense for each situation.

I also agree that the distinction of medwife and midwife is painful to both parties (not to mention Mamas and babies). If we are to be honest with each other though there is a difference. It comes down to control. Who do you think is in control of this birth? Not responsible for, but in control of. Getting out of your own way to allow the birth process to unfold is what being a midwife "with woman" is all about.

After reading this comment, I started a post (that I haven’t finished yet) about how a bad outcome changes one’s practice. The short analogy is: if you sped through the intersection 1000 times without incident, but sped through once and had an accident that killed your child, how will that accident affect your driving forevermore, especially as you cross the intersection?

Watching a mother or baby die in birth cannot NOT affect you.

We are all products of our experiences. Women choose to UC based on previous experiences. Asking a midwife to not incorporate her experiences in birth, asking her to leave her accumulated knowledge at the door is absurd. We learn with each birth! Each experience builds on the one before, creating a block for the one that will come after. It is the midwives with many births under their belts, with many years of experience, that are most honored.

Regarding the control aspect, in the perfect midwifery/client relationship, each woman uses her strengths and leads her Self. The laboring woman is in control of her labor and birth. The midwife is in control of making sure the mother and baby stay alive… in fact, she was hired by the woman to do just that. And then, ultimately, the baby is in control… the baby guides the actions of the others around him/her. To me, this is symbiosis at its best.

SM: ‎"Blind maternalism is just as dangerous as blind paternalism" if I may quote one of my favorite OB/GYN buddies. I agree.

KB: ‎"Birth trust/Trust Birth" is a sales pitch and just as polarizing to this profession as the circular midwife versus medwife argument. It's interesting that not many midwives have contributed their two cents to this thread but lots of others have. I'd like to know when those of you who are the most critical plan to start your midwifery practice and if 5 years later you have a different opinion.

AHH: I agree with E and think that we midwives have enough resistance and criticism from the medical community in general and the last thing we need to do is echo their thoughts about us.

DH2: I'm just basing my ideas on the care I've received from midwives, versus what I read from very different midwives like Barbara and others. Very different care than what I received.

AKS: Honestly? I think it's a dumb distinction to make. There are good midwives and there are "bad" (unskilled, or controlling, or unkind, or a bad fit for a particular woman) midwives. I would guess there are DEMS, CPMs, and CNMs in both groups --and I would guess there are medically-minded midwives (who follow current standard medical practices, whether or not they are supported by evidence) and "alternative"-minded midwives (who also follow practices that may or may not be supported by evidence) in both categories.

NgM: It's been a hard day, so I'll try to keep my tone at a civil level.

1. We are all a product of our experiences. Anyone who thinks otherwise... or who thinks the experiences don't affect us every single day... is in serious denial.

2. There ...is NO WAY one (me) can watch a birthing woman die, right in front of her (me), and not have it affect her (my) practice as a midwife. The experience doesn't control my right hand and force it to rupture women's membranes or wrap itself like a boa constrictor around my head, controlling my brainwaves, but it most definitely colors my reality that women can -and DO- die in birth.

It (the memory) doesn't mean I sit wringing my hands, just waiting for my clients to have an AFE, but it does give me a gift (a GIFT)... the woman who died gave me a gift... of the deepest respect for life and its precariousness, even in birth.

I know there's so much more to say about this, but it's late.

And yes, #3 is it is so, so, SO easy for non-midwives to speak about what a midwife should or should not be doing at birth. I defy any critic to stand in my shoes... in any midwife's shoes... and then tell me what a midwife should or should not be doing.

My job is to keep two people alive. With that statement comes an endless list of scenarios and what-if's that cannot be rattled off in a Facebook (or blog) discussion.

DH2: Given what I know just from reading your blog and hearing you talk so passionately about birth, Barbara, I would not call you a "medwife." You respect birth, and do not a take a cavalier approach to it - with good reason (as you just stated). If someone hires you to help deliver their child and then calls you a medwife, then it sounds like what they want is perhaps an unassisted birth. Because you already sound pretty hands-off unless there is a reason not to be.

MG: I agree that the label is harmful. So often those who are labeled "medwives" are only following protocols they wish they didn't have to follow... so why are they hospital midwives? Because they believe they can make a difference in women's births by offering them hospital-based midwifery care even with those protocols as opposed to giving birth entirely over to OB's. And from what I've seen, they are right, and do not deserve to be insulted for going to the front lines for women who for whatever reason aren't having a home birth. They work hard for the benefit of women. And there are midwives who are disrespectful of women with any or no letters after their name and who work both in and out of hospital.

On another note, using medication to save lives and interventions to avoid larger interventions is prudence, not over-medicalization. 

One thing is clear: Medwife is an epithet, hurled at a midwife who, for whatever reason, isn’t aligned with the woman spitting out the word. As KB says, this is one of those circular discussions and I’ve been watching it go ‘round and ‘round like a playground ride for years. I don’t expect it to stop anytime soon.

Wonderful midwife Pamela Hines is more diplomatic than I am (as usual). She says:

"There are midwives for every family. If you have specific expectations, only communication help you decide if that midwife is right for you. While I do hear of midwives with a bit of a 'bait and switch' persona in labor versus prenatally, this is not the norm. I hate that people decide that their idea of care should be the norm for every other woman in the world."


    Me doing a vaginal exam on a mama who was pushing for quite awhile with no forward movement. We eventually transferred to the hospital where she did deliver vaginally; baby'd been quite acynclitic. Anecdotally, this was the one baby I caught in the hospital.    


Separatism: conflict amongst the ranks

We recently celebrated Pride here in San Diego, PrideFest, aka HomoFest. I went to the parade and stood with 150,000 others, cheering for our freedoms (and demanding even more), our hard-won self-esteem and for the sheer joy of hanging out with friends. When I marched with the kids in 1990, the parade was all of forty-five minutes long. This one went on for a couple of hours. 

Sarah and I had broken up for awhile in 1988. I was a crazed mess, so went into therapy and immersed myself into the lesbian community here in San Diego. I went to several lesbian support groups, but the one on Thursday nights turned out to be the most interesting of them all. 

Those weekly meetings at the (then) Gay & Lesbian Center, took me from the myopic, white, heterosexual, middle class mindset and introduced me to… nay, challenged me… to see from various vantage points and acknowledge that I was really just a self-centered, ego-driven, hypnotized woman who thought she knew what was going on in the world. I sat, spellbound, listening to women talk about oppressions I never knew existed. I grew up in the Deep South, so had an inkling of racial oppression, but sitting face to face with women of color was stunning. I endured finger pointing, enumerating the ways I, too, was oppressing women of color… saying things like “I don’t see color; I see people,” and not knowing the PC (politically correct) terms for the nuanced cultures of the women right around me. 

I learned about other marginalized cultures (“marginalized” was a word I heard many times in those days)… the bdsm (bondage/discipline/sadism/masochism) folks, the butch (more “masculine” energied) dykes, teens coming out, lesbian mothers (my people! …who were few and far between back then), migrant lesbians, etc. and the subcultures of each of the marginalized people. Those nights at Group opened my eyes to worlds I’d never imagined. It was there I realized that every topic, every person had their own subtext within them. And those subtexts were never-ending. None of that even begins to examine the “isms” of the day, including classism and sizeism (another group I embodied). 

It’s like this in birth, too, isn’t it? Under the umbrella of human procreation, there exist an infinite number of choices women can make (or are forced to endure). Depending on where you live and even the political atmosphere of the day, the choices are rounded up like a huge net grabbing fish in the ocean. Whoever does the throwing can alter the birth’s path and outcome. Birth in the hospital? At home? With a midwife? Alone? Or, if we live in a Third World Country, does the mother feel safer with her family or the local Traditional Birth Attendant (TBA)? Do we risk losing our safe hiding place to transfer to the hospital because of a hemorrhage? (And, please know, this is an area I do not have much information about… the different choices women have in other, less mechanized, cultures. I welcome the education.) 

And then we move down the flow chart, each choice above having an infinite number of options, or, if not options, an outcome that is different for every single woman… maybe not in the live baby/live mother, live baby/dead mother, dead baby/live mother or dead baby/dead mother, but each woman carries her own experience, some in the body, others in the heart and some even deep in their souls. 

At the Festival, I ran into a couple of women from those long-ago rap groups and the flood of memories prompted me to write this. The analogy was so striking, the things that are going on in birth; I just couldn’t ignore the beckoning sirens. I hope I don’t crash amongst the rocks. 

When Sarah (who was in the Army) and I were in Germany, we’d found an underground group of gay men and women (Friends of Dorothy) and one of those women called herself a Separatist. Not having the Internet, I learned through context what that meant. 

Kathy Belge describes Separatism like this: 

“Lesbian separatism is the feminist political act of choosing to be around only lesbians or only women. In the early years of the Feminist Movement, some lesbians chose to avoid interacting with men as a way to remove themselves from male-dominated society. Their belief was that even well-meaning men were sexist and influenced by the patriarchy. They chose to be around only women in order to understand what womanhood and sisterhood is really all about. Some women moved to the country, bought land and created women-only societies. Avoiding all men was impossible, but they chose to have all of their significant relationships with women. The idea was that women could never truly understand themselves as powerful beings if they were immersed in the dominant, sexist culture. From lesbian separatism the idea of women-only space came into being at concerts, conferences and festivals.” 

This particular woman we met in Germany was so much of a Separatist, she gave her son to his father because she couldn’t abide by having a penis in the house. 

Historically, it’s important to note the connection between the Black Separatist movements of the sixties, acting as models for the women who came after in the seventies. Other societies have also chosen to remove themselves from the mainstream, too; the Amish and the Shakers, for instance. 

Any of us who’ve been in the birth world for any length of time have watched the same happen. Doctor? Obstetrician? Doctor of Osteopathy? Family Practice MD? Registered Nurse? RN with or without a BSN? Certified Nurse Midwife? Certified Midwife? Licensed Midwife? Certified Professional Midwife? Unlicensed/Direct-Entry Midwife? Religious Midwife? Overseeing organizations are created, a board elected, rules written (and continuously debated); exclusivity is a hallmark of any patriarchally-oriented organization.

Again, under each of the above monikers, factions develop, pulling together and, at the same time, pulling apart, oftentimes creating a whole new category. 

In the late 1970’s, the Michigan Womyn’s Music Festival was born. Note the spelling of “womyn” (alternately spelled “wimmin”) – any derivative of the word “men” in it was changed to a different, “womon”-centered word. (We find this same mindset in birth with the renaming of the vagina to yoni or contractions to surges.) While I didn’t come out until late 1986, the Music Festival, and many others like it were still going strong, this one in particular continuing today. 

 If you poke around, Googling MWMF, you’ll see an on-going discussion, years long, about whether to allow transgender folks to attend. Lisa Vogel, one of the founders of the yearly event says: 

“Since 1976, the Michigan Womyn’s Music Festival has been created by and for womyn-born womyn, that is, womyn who were born as and have lived their entire life experience as womyn. Despite claims to the contrary by Camp Trans organizers, the Festival remains a rare and precious space intended for womyn-born womyn.” 

Interestingly, this wasn’t a concern back in the mid-late 80’s. Instead, then, it was the battle between allowing male children to attend or not. Some didn’t want any males there… no penises at all. Others were okay with nurslings and there were women who said kids under five. They picked five years old because they were still heavily influenced by their mothers, but after that they were in school and being influenced by the patriarchy. I see now, they’ve got two delineations: five and ten. They are segregated, but still permitted to attend. Why the five to ten-year olds? They were in school, but before puberty hit, when they would be considered real men. 

To some of us, this might sound absurd. People are people! How are men supposed to change without women around to show them the way? My eleven-year/fourteen-year/seventeen-year old son is not a man yet. But, I promise, to these women, Separatism was a grave and intensely crucial topic that required an opinion, one way or the other; black or white – choose or you were dismissed (physically and emotionally). Gray simply did not exist. Whole groups (and clubs) revolved around defining the word “Separatism” and who “qualified” as a real Separatist. In a fantastic article in the New Yorker, Ariel Levy says: 

“Different groups had different definitions of separatism, ranging from a refusal to associate with men to a refusal to associate with straight women to a refusal to associate with gay women who weren’t separatists.” 

The most idealistic/dogmatic womyn transformed their lives into a world where they rarely, if ever, had any contact with men. Some moved to womyn-owned land, allowing only womyn to live or visit there, excluding even male-born children; meaning mothers were required to divorce themselves from their sons. 

Does any of this sound familiar? 

Looking around, can we see parallels in the birth community? Groups form and morph depending on the cause célèbre. Should fathers be present at births? (Interestingly, while this was a big issue in the seventies and eighties, it’s come around again with Dr. Michel Odent’s belief that men should not be at births after all.) Which childbirth classes should women take? Bradley? Lamaze? None? Of course, the gulf widens as we add in Natural Birth, Normal Birth, Cesarean Birth and Unassisted Births. 

We also see this in the politics of birth even as I speak. Whether it is women who schedule a cesarean, get an early epidural or have an Unassisted (child)Birth (UC), proponents and detractors tend to be rabid about their choices. It’s very hard to find some gray. Sometimes I wonder if it even exists. 

John MacAdams of the Marquette Warrior, says “It’s a chronic problem in the rarefied world of political correctness -- and that world has spread out of academia into the mainstream media. Members of designated victim groups are allowed to be offended at the barest slight, but feel perfectly free to express rank bigotry toward those who disagree with them, or even merely adopt a different lifestyle.” 

We see any discussion deteriorate, almost as they begin, into accusations, hurt feelings and an absolute insistence on the rightness of the speaker. Isn’t there something, anything, we have in common? How do we find it amongst the sludge we all seem to be slogging in?

 Occasionally, the thought rises to the top, “What is this doing to benefit women?” On-lookers turn their heads back and forth as if they were at a tennis match; but where’s the ball? Is all this in-fighting hurting our causes (if you will)? Or is this the normal push and pull of a larger entity, clamoring to break off and live on its own. 

The latter stages of (the larger) Separatism movement found the lesbians raging against the heterosexual women, each “side” having ghastly epithets to heave at each other. “Breeder” came from that time. 

Jill Johnston says, in “Lesbian Nation,”: (emphasis mine) 

“Women wanted to remove their support from men, the ‘enemy’ in a movement for reform, power, and self-determination. A revolutionary prototype existed in their midst. But the prejudice against women within the ranks of women, much less loving women at the intimate level, was so great (still is, of course) that feminists could only act against their own best interests and trash the women who modeled their beliefs. The split between straight feminists and lesbian feminists was extremely damaging, and will no doubt continue to be in any future wave, to the cause of women’s liberation. The internal damage within the lesbian feminist ranks was also lethal.” 

I worry the same thing will happen in birth. Will the in-fighting be so intense we will only appeal to the most radical of those interested? Will women who are simply curious be so disgusted with our polarized beliefs, they couldn’t care less if we had the answer to the riddles of the Universe because it’s impossible to hear over the roar of anger? 

In those rap group days, I worked on the San Diego Lesbian Press, the local magazine/newspaper, obviously geared towards dykes who live here in San Diego. Working on SDLP was my first experience 1. working with only women and 2. using consensus to problem solve. Working with women is a whole blog post on its own. (Sarah should write it; she has extremely strong feelings about it.) But, can I tell you now how much I HATE consensus?! I mean, seriously. Could there be anything more time-consuming and more manipulative than trying to come to a consensus? Blech. I will no longer participate in groups that use consensus as their method for problem solving. (And I know others love consensus, think it’s the only way to come to “fair” answers, but that is not the way I see it. At. All.) 

I was ignorant then, a joiner and a newly self-discovered writer, so I became a part of the SDLP Collective

The defining moment came when there was a discussion about accepting an ad from a company owned by a man. There wouldn’t be any man in the ad, no penis would subliminally peek through, but this discussion turned into a humongous, weeks-long “discussion” (and I use the term loosely). You see, SDLP needed money something fierce; could they/we afford to turn away money… even though it did come from a man? The separatist side vociferously refused to even consider accepting money from The Enemy; the ad was absolutely not to be in the paper. Just as emphatically, less rigid, though still feminist, women could see the benefit of taking the money. Wouldn’t it be using a man’s money for a good cause? Wouldn’t we be bettering our women’s lives by being able to put out a paper? (Something we very likely would not be able to do otherwise.) When using consensus, everyone has to agree, no dissenters at all. I remember occasionally making a comment, but it was obvious I was a neophyte and no one cared what I said. I was probably asking basic questions like, “What are we fighting about again? I can’t even remember anymore!” 

I ended up leaving the SDLP to fight themselves to death; and they did, too. SDLP died shortly thereafter. I snarkily say dogma killed them. 

Is this our fate as well? Are the two extremes going to kill themselves off, leaving nothing but the center? 

Thinking about myself personally, I participate in this Us vs. Them as much as the next gal… maybe more sometimes. I’ve been implored to keep my mouth shut about certain issues, to try and make peace with all the birth sisters around me, no matter how much I disagree. But, you see, I wasn’t mature enough to ask the right questions back in early 1990. However, today, with many years of birth work under my belt, I feel qualified to defend my position and to speak, if not somewhat eloquently, at least pretty darn clearly about what I see and why. I’m an old crone of a midwife now (even though my midwife years are nothing compared to many of my peers), sharing the stories of those around me. Most are gloriously beautiful, wondrous births. But, too many of the stories aren’t fabulously perfect births; they have ended in tragedy and pain. I tell those stories, too. If it angers some women, then so be it. Their stories piss me off, too, so I guess, in some alternate-universe way, we’re even. 

When I stand back and see the parallels between the two Separatist movements, I know they are but two of a billion other arguments/discussions/opinions going on simultaneously. From husband vs. wife, Catholic vs. Protestant and the United States vs. everyone else to Wall Street vs. stockholders, Unions vs. employers and organic vs. commercially grown food… thinking there are just two sides is absurd. The same way couples go to therapy, employers go to mediation and we get to choose our food by which ones we buy, there have to be other ways of bridging the gaps we have in birth besides blowing each other up with bombs. 

I think about the song “From a Distance” that Bette Midler sings. 

“From a distance you look like my friend,
even though we are at war.
From a distance I just cannot comprehend
what all this fighting is for.

From a distance there is harmony,
and it echoes through the land.
And it's the hope of hopes, it's the love of loves,
it's the heart of every man.” 

I promise to remind myself, in the heat of those moments when I am standing toe to toe with another woman, that even as I speak my mind and tell my stories, I will remember she is a sister, she does have valuable things to say and I will keep an open heart and mind to what she is saying. I would only wish the same from her.


Me (and my big butt) marching in the LGBT Parade in the early 90's. Look! Polarized views even about marching with kids!



Unassisted Birth Buzz

I'm sure most of you in Blog World have already read the Washington Post article on Unassisted Birth, but if you haven't, there it is for you. I encourage you to also read the after-chat between Laura Shanley and Mairi Breen-Rothman, CNM found here.

I wish wish wish I could stick my nose in all the places the articles and their comments are occuring because of my own experience with Meghann, but because I can't, I will remind you all here, in a shortened synopsis, what it was.

After Tristan's (hospital) birth, which I thought was fabulous and terrific, I moved to Tacoma, Washington and went to an exercise class that was run by a Bradley teacher and La Leche League leader and was slowly un-brainwashed/brainwashed (as the case may be) into understanding natural childbirth and its perfection.

I was introduced to the work of Marilyn Moran, who is the TRUE mother of the Unassisted Childbirth movement, NOT Laura Shanley as she likes to profess herself to be. Anyway. I read Marilyn's book Birth and the Dialogue of Love and was highly encouraged to have a DiTY Birth (as they were called then). I actually called several midwives in the Seattle area but could not find one to take me on at my late gestation, my extreme weight and my deep poverty level.

(I hear myself on the other end of the phone often and it definitely influences my decision to help a woman in need.)

Because I couldn't find a midwife, I chose to have an unassisted birth - not called a UC back then, but we'll call it that now for ease's sake and to use the terminology of today.

I continued getting prenatal care at Madigan Army Regional Medical Center and also gathered things to prepare for a homebirth. I was going to have my Bradley/La Leche League leader as my doula ("Doula" also being a word not yet invented back in 1984) along with another 2 girlfriends, one a former L&D nurse and another Bradley teacher. My own Bradley teacher's 16-year old daughter was also attending to be my photographer. The two ancillary women's nursing babies were also attending.

After a birth-assaultive stripping at Madigan, I began labor and all the players finally came to the house (except my Bradley teacher who was camping as it was Memorial Day weekend) where I ended up laboring a total of 39 hours.

I pushed for 2 hours and Meggie was born, a gnarly shoulder dystocia that required quite a bit of resuscitation. Someone called the ambulance (no 911 at that time) and far too slowly, the fire department, police department and finally an ambulance descended onto our tiny house where, by the time they arrived, Meghann was breathing and doing okay. Eight men stood around staring at naked me sitting on the floor with my placenta still attached, their wanting to take me to the hospital. My former husband had to argue with the ambulance driver that I was fine and he would take me in himself. Someone put a glove on and tried to pull my placenta out by the cord. No one else was paying attention but me and I yelled at them to stop it and go away.

If I'd have had a midwife there, none of that scenario would have happened. The shoulder dystocia would have been taken care of appropriately. The resuscitation would have been deftly handled and I wouldn't have had the rude interruption of those gawking men, the arguments, the self-protection - the absolute massive intrusion of negative, cruel energy - all because I didn't have a midwife there.

Granted, my reasons for not having a midwife there were very different than many women's reasons. I had a UC because I was not going to go to a hospital with a 50% cesarean rate (and I would have absolutely had a cesarean) and my choices were limited to one: a UC - because no midwife would take me on.

I've read and listened to the multitude of other reasons for UCs including privacy with one's spouse, the belief in the perfection of birth if left alone and the pain of birth trauma/birthrape and the need to be removed from The System (including midwives) in order to birth with any sense of power. Of all the reasons to UC, the birth trauma issue is the one that I can wrap my head around as the most viable. Of course, "YOUR" reason for choosing is the most correct, but that's pretty normal.

In real life, I've known one UC death. In cyber world, I've known another. I've never seen a fetal death because of the disgusting crap foisted upon women and babies in the hospital. I'm sure I will get a lot of flack for saying that, but it's my truth. I don't deny the amazing amounts of abuse, trauma, assault and even rape that happens in the hospital, but I do believe the survival of babies is higher in the hospital than when left in the hands of UCers. I believe I am trained well enough to know when to transfer so babies and mothers are kept safe and when the unexpected happens, I am prepared to keep a mom and baby in a place of safety until help arrives and we can get them to where further help is available.

I can hear the arguments. Why not avoid the possibilities of transfer at all? Why not just be in the hospital in the first place? This quote from my post Oh, the homebirth debate blog... (is more annoying than words) describes why that isn't an emotional possibility for so many women:

It would be wonderful to demonstrate a completely natural birth in the hospital (NOT a homebirth in the hospital as many would want to call it) and watch all the care providers squirm with discomfort as their jobs became almost useless "just" sitting and observing. It would take an incredibly strong woman to be able to withstand the intense tension brewing, but it would be a great lesson for hospital personnel to witness. I believe it could never be done - and that's just so sad. It's sad that not only could we not even demonstrate a normal birth, but that nothing like it would ever occur in the hospital setting. The closest I have seen is in in-hospital birth centers, but even that is difficult to compare to a homebirth.

(end quote)

So much fear operates around birth with doctors and nurses (and many CNMs and even midwives), I do understand the drive for UCers to birth alone, to maintain the stance of strength and autonomy.

But, I believe a re-education of those that are birth workers is what is necessary. It seems absurd and daunting, sure. I know it seems crazy to think we can re-train that horribly evil doctor that slices open every woman's perineum and has a 45% cesarean rate. I don't have the exact answer HOW to do it, I just believe in the answer that we have to do it. Maybe it is in "seeing" that we need to do it. Aren't we all mad enough at The System? Don't we want it to change yet? Don't we want birth abuse/birth assault/birth rape to stop yet? Don't we want the reasons for women to have to choose UC to stop being created? Until we end the trauma, UCs will multiply.

In the commentaries and blogs, don't the masses hear themselves? Don't they hear how they sound saying it doesn't matter how the baby comes out, that the misery a mom and baby experience doesn't matter, just that they both are alive in the end? Isn't that horrible? How can people who whimsically subject themselves to plastic surgery for beauty or schedule cesareans because they don't want to feel the pain say it doesn't matter how a woman FEELS when it comes to her own birth experience? How can that 95% or more who gets an epidural say that? It's absurd!

Still, even though women are "made" to have babies, women don't traditionally birth alone. Many mammals don't birth alone, some even having "midwives" with them as they bring their offspring forth. A midwife is merely someone who knows a little more than you do about a subject. It doesn't mean you are stupid or wrong or ignorant or less than. It just means she has more experience because she has studied more on the subject and/or been around it more. Myself, I've been to right around 900 births. While you do know your Self best, I still have quite a bit of experience around birth and bet I can share a thing or two with you.

A hairdresser knows a bit about hair... even though it's yours. She doesn't know ALL about hair. She doesn't know all about YOUR hair. But, she can cut your hair in a nice way given guidance from you.

A brain surgeon doesn't ask your opinion at all, yet has a damn good idea what to do inside your skull if she's inside there.

Ah, but those aren't "natural" things. I gotcha.

What if you are hemorrhaging between periods. What if you are hemorrhaging postpartum. What if you have a breast lump.

You get the picture.

Where does "natural" end and "un-natural" begin? Who decides? Laura Shanley?

I think one of the most offensive aspects of the UC movement is the rabid Us vs. Them (Black/White) and the true inability for any discussion regarding UC and the possibility of finding a midwife who might actually support a woman's need and desire for autonomy - which, they (the UCers) profess, is their true desire. It is only in the past few months that I have seen any discussion that has included outsiders and, surprisingly, the interviews have been coherent and inoffensive. Good for Shanley.

Perhaps it will take the UC movement to wake up The System to the birth assault that's occurring and affect the change that's necessary for women to get their needs met - so they are able to have a birth worthy of themselves. Birth should be gentle, beautiful, loving and respected - no matter where it happens. There is so, so much to do to make change happen. I keep writing about this and there doesn't seem to be any change (except with finding Dr. Wonderful!). I wonder what more I can do.

What are YOU doing to affect change? How best can each of us use our talents to bring forth change? Ponder on it. Use your energies to imagine a world where respect for women is a given. Let's stop putting energy towards the negative crap they foist upon us, eh? Let's "see" what we want and create it... even if it takes small steps.

We can do it.