After reading the inspired anthology edited by Geradine Simkins, entitled "Into These Hands, Wisdom From Midwives", I feel like my call to midwifery has been reborn, and my purpose for recently taking a diversion from the sole title "midwife" to pursue a second degree in social work is being brought back fullcircle to the added repertoire and purpose of the vocation and calling I was born with, that of a midwife.
I have spent time loving and hating my passion, but in the end it is still my passion. Something draws me back. I have spent hours complaining that I can never quite, that women won't quit calling me, asking me to be the honored one of "wise woman" and attend them at their birth. Despite my endless hours of complaining, and when questioned or challenged by those empathetic and listening ears "well, then why don't you just tell them no!" I reply, because I can not! I panic at the thought of abandoning those precious women, and families, those precious children who excitedly proclaim "our midwife is here!"
I have never once felt burdened or unsatisfied while I am spending time in a woman's home or my office talking about the stresses of her life, nutrition, considers about parenting, breastfeeding, fears about birth, excitement about her bodies changes. I feel connected and magical when I am with woman. There are times I have experienced much anxiety waiting for the impending call. For most of my adult life, since the age of 21, I have been connected to my phone 24/7, with few breaks. Sometimes this causes much anxiety as I have missed birthdays, holidays, weddings of friends, recognition of extended family. But when I receive the call, no matter how "inconvenient" it is like a much waited relief, to finally be "in labor"! We are in labor! We are having a baby! This is what I always say. The truth is, I am doing very little of the work. I have been in labor on three separate occasions. Each one unique, and each special, but the rest of the hundreds of labors I have been in, I have been a watcher, a waiter, a support, a guardian, a reinforcement of the powerful woman who has selected and honored me to be her midwife.
The burden of sometimes wanting to quit has come through society not really understanding or knowing what I actually do, being devalued over and over again by "real" professionals who know nothing of the personal and family sacrifices I have made to become an expert of the normal, to recognize the limits of normal, and to be able to appropriately resolve or transfer care when the normal becomes complicated.
I have sat with the fear of being arrested as a felon, watched the reality of one of our midwives arrested, charged, and facing 20 years in prison when there was no bad outcome, the parents were satisfied, and she had taken appropriate steps within the scope of her practice. I have watched the struggles and realities of brazen midwives across the United States, who are never endowed in wealth- no one gets rich in money and status being a midwife- have to come up with mounting legal defense cost, often supported by her protesting clients who do not want to lose their community midwife, but in the end, she is at the mercy of the legal system, while her supporting clients will go on to have normal lives with no repercussion of the United States unique stance on criminalizing midwifes.
I have sat through years in my state, as a result of the arrest of midwife Elizabeth Camp-Smith, in 1999, of the impending fight for legalization of midwives. Those years caused fights not only from the medical association who did not want to see midwives legitimized, but also within the midwifery community. Sisters who had differing opinions about licensing of midwives, and the preservation of the right to practice traditional midwifery freely. That fight still continues today, although the efforts of the pioneering women who spent many hours of their own uncompensated time, money, and heart to draft a bill that was inclusive of the desires of all midwives in the state. Because of their efforts, and the supporting grassroots consumer movement consisting of doulas, childbirth educators, and parents who wanted to preserve the right to have their cherished midwife attend their births, and the births of their daughters and granddaughters, the hard fought effort was won on a thread of one vote 15 minutes before the end of the legislative session in 2005.
I remember well that whole year, and that fearful night. We had been working tirelessly since 1999 to bring midwives together, and pass a bill that would allow licensing of midwives for midwives who wished to legally carry pitocin for hemorrhage, freely order labs and ultrasounds, administer Rhogram, provide IV antibiotics for group B positive women, and collaborate more complete care for their women. At the same time, there was a desire to ensure midwifery, licensed or non licensed was not a felony, and that women would have the right to preserve their choice in how, whom, and where they birthed their children.
Midwifery is not about homebirth, it is about autonomy, choice, and self-determination of women. It is about empowering women through their birth experience so that they may bond with their babies, feel powerful, and know that they can get through any difficult situation and make the choices in their care about their setting, choice of provider, and interventions available to them. So often women are scared into interventions, and disempowered and mistakenly believe "my doctor saved me" when it is often the intervention, and fear induced model that escalated the need for more intervention, and the message the woman received that reinforced that her body is not capable, that birth is a catastrophe waiting to happen, and that if she is able to have no intervention she was lucky, masochistic, not caring for her child, and she is downplayed.
Women reinforce this with each other by invalidating each others experiences either by one-upping each other with traumatic birth stories, or by patronizing, or downplaying the rare mother who did succeed in a "normal" birth by saying "yes, but you are strong, I could not do that!"
As a midwife, this attitude, and defining and defending what I do over and over again to those that do not understand or really don't want to becomes tiresome, and often times I succumb to the tiresome task of how long and sometimes futile it is to defend myself. Many times, I do not offer the information of what I really do, how my life really is, and let people think I am the radical midwife, who knows nothing, and end up hearing the story of how they new someone who had a fast, uncomplicated labor and ended up birthing at home and calling the EMT for a non-emergency childbirth. It ends up being a sensational story, that discounts the normalcy of birth, and the woman's trust in her body to just allow birth to occur, even if it meant she did not have time to travel to her intended location. This is not an emergency, this is normal! Yet we call this emergency childbirth, and the attending EMT often feels like a hero, for using his/her minimal training skills to be present with a woman's normal process, in which she is actually doing the work, their is no pathology.
How many times have I laughed when I hear a sensational news story, of an unfortunate mother who had the audacity to trust her bodies urges, and allow her baby to come in a car, or on the side of a road while en-route to a facility. The EMT's called, the news crew notified, and then the headline of the occurrence of.... a birth outside of a hospital!..... as if it was something to talk about as abnormal, and a circus exhibit. The unfortunate reality, is there is a reason for this sensationalism. Most resident physicians never see a truly normal delivery from start to finish, most labor and delivery nurses see largely induced, medicated, and surgical births that follow an assembly line protocol, and expected course determined by the policies of the hospital, and the convenience of a physician practice which is often over booked due to the need to care for enough women to cover the outrageous fees associated with the burden of $100,000 annual malpractice policies.
And to some extend, how can we blame the obstetricians, birth it the most risky and litigious areas of medicine that a physician can get into. Can we fully blame them for a cesarean rate reaching 32% in 2007, and as high as 50-60% in some hospitals? While the evidence clearly shows the significant risk in mortality, morbidity, prematurity, post-traumatic stress disorder due to birth trauma, postpartum depression, and long term health and mental health issues for mom, an obstetrician is still less likely to be sued for a poor outcome of an unnecessary surgical birth, then he is for a bad outcome for a vaginal delivery.
Also the financial benefits in both time and billing of insurance for the birth to the institution and the doc, leaves surgical delivery on the rise, and elective cesarean chosen more and more by women who are not given all of the information, or understanding of the risk involved with these interventions.
We have normalized pathological birth, and have made one of the most basic rights of women into a big capitalistic business. And if you do not believe that birth in the hospital is about business, guess again! Birth is still the number one reason for hospitalization in the united states, and 1 in 5 women who enter the hospital for a normal delivery will end up with hospital based infection. One in 3 women will end up with a cesarean section, while the World-Health Organization (WHO) states that a c-section rate of 8-10% is what an institution should aim for. Furthermore, while we temporarily made gains with encouraging women with 1 or 2 previous cesarean sections to attempt vaginal birth after a cesarean for the next birth (VBAC), around 2000, a non-evidence based opinion by the president of the American College of Obstetricians and Gynecologist (ACOG) ended the nationwide support of VBAC, and women who had successfully already had 1 or more VBAC deliveries were being denied the choice in hospitals as more and more hospitals and physicians refused the choice to women.
Recently women have started becoming informed and demanding this choice be offered to them, as they have the right to refuse unnecessary repeated surgical deliveries, and evidence shows that the risk for multiple cesarean deliveries to both mother and baby increase substantially with each subsequent surgical birth. The risk of a ruptured uterus from an attempted VBAC is much lower than the repeated cutting open and scarring of the uterus. After one successful VBAC delivery the risk for subsequent pregnancies ending in uterine rupture become lower, and near the rates of never having had a cesarean section. Even in unsuccessful VBAC attempts the benefits of having a trail of labor to the baby lower the rates of respiratory distress and mortality. Something about the hormonal exchange and natural stress occurring with each contraction causes physiological changes which prepare the baby for his/her life on the Earth-side.
In most of the world babies (75%) are delivered in the hands of a midwife. In most developed countries midwives have been integrated into the health-care system as a valued and honored profession which is separate from the practice of medicine or nursing. In all of these developed nations which incorporate midwifery as the primary birth attendant, and obstetrics as the experts in high-risk management, and collaborators with midwives who recognize by education, touch, and intuition when normal has become complicated, these countries have much better and accurately documented outcomes.
In the United States our poorly tracked and often manipulated statistical data (due to the capitalistic nature of health care) still ranks us below some third-world countries in both infant and maternal mortality. Furthermore, anthropological data suggest the health of a women and birth indicate the health of men and the whole society. Women who experience powerlessness and indignity during their vulnerable moments of birth, experience more stress and long term medical and mental health effects. Women are already at a disadvantage due to wage and access to care disparities.
While the initial look at our statistics show alarming numbers, if we add in disparities, and separate out the rates of maternal and infant mortality among race and socioeconomic status, we see an alarming difference among Black and Hispanic women. Regardless of education, class, or location, the prematurity, low-birth weight, and birth outcomes are much higher for these groups than for Euro American women. The numbers are saying something! The rates of maternal mortality have not gone down since 1982, despite advances in technology, fetal monitoring capabilities, ultrasound, and laboratory testing.
Despite statistics that show hospital practices incorporating midwifery care lowers complications, mortality, and length of stay in a hospital midwifery practices are being cut over and over again due to capitalistic administrators who can make more money by having more women streamlined, and less one-on-one time spent with each women. Obstetricians having to pay high fees already for malpractice, are often made to pay more when having agreements with midwives in their practice, even though evidence shows having midwives in practice lowers the cost of maternity care, and improves outcomes.
Midwives, both CNMs and CPMs face increasing cost of the inability to find affordable liability insurance, and the risk of lawsuits increasing, as well as the risk of legal action. Midwives, despite showing over and over again in well documented data collecting and statistical analysis that midwives improve the health and safety of mothers and babies across the board, are under much more scrutiny than obstetricians. When an obstetrician has a poor outcome it is not scrutinized as severely as with a midwife. And if the birth occurred outside of the hospital, often the parents are mocked and blamed for choosing a midwife, and putting their baby at risk, even if the problem was congenital or beyond anyone's control.
Therefore, being a midwife is sometimes discouraging under the pressure and risks we take everyday to defend what we believe in. Most of us make little money for our demanding, and risky job title. Most of us are ignored and discounted for our hands-on abilities and expertise.
I have learned how to interact with other professionals, and am blessed to live in a state that is legal. I do not have to fear going into a hospital that I will be prosecuted for practicing medicine without a license, as I once did when I first started practicing. But it has not come without a cost. When I first received the "call" to be a midwife, I was 5 months pregnant with my first child. I was electrified by the energy and power of birth, and pregnant women. I was enthralled with what my body was doing as I watched my belly grow, and felt my daughter move inside of me. My first birth was long and difficult, but transforming. It taught me how to work through fear and pain at a new level. Had I been in a hospital, I likely would have ended up with pitocin, an epidural, and possibly a c-section. My baby was never in danger, but my birth process was unusual, on-and-off, and was literally a 5 day process!
I believe now, there were many unconscious fears and past experiences that I had to work through during those 5 days before I was able to surrender to the natural flow and energy of birth. I did not understand it all then, but it was not a text book labor. It was difficult for me, and for everyone involved in attending me. I had some people in panic, believing I should go to the hospital, fearing that once my membranes were ruptured, and I stopped having contractions for over 24 hours, that I was taking a risk.
I am sure my midwife was tired, possibly annoyed, and did not understand how I was reacting to labor. But through it all she supported my right to stay home, she monitored me for infection, helped me take preventative measures for infection, gave me Bach Flower remedies to address the unconscious fears I was experiencing that were blocking my baby from coming. And finally, after having two previous nights of transition like contractions, and never progressing pass three centimeters, after having my contractions stop, my water spontaneously braking, and then a night of no labor, after a full day of monitoring, finally 26 hours post rupture, caster oil, and much needed space from well-intended but fearful or distracting people in my space, I started contracting again.
This time the energy felt different, and this time, I decided to not call my doula who was totting her 15-month old daughter, or anyone else. I needed space, I needed to not be on display. For an hour or so I did not even wake up my husband. I didn't want the contractions to stop, and I noticed whenever there were a lot of people around they became more painful and ineffective, and eventually stopped. I first called my midwife before I even woke my husband. He awoke a few minutes before she arrived, and she checked me. I was afraid of hearing that I was the same... 3 cm and 50% effaced.... but this time she had a smile on her face as she said "4cm and 100% effaced!" The effacement meant I was not going to stop, and the contractions were finally effective.
I was at my mothers house for my first birth, not feeling comfortable birthing in a basement apartment in a sub-divided home with two other apartments and thin walls. So for most of the night my mother, my husband, and my midwife supported me. Near the end she called her assistant whom I had never met, but who brought the most loving an comforting energy to the birth. My midwife, who was pregnant, and besides my long ordeal, had 2 other women trying to birth that week was tired, and her assistant took over. I did not even know her name at first, but her face was like an angel! I connected immediately with Roxanna, as she pushed on my knees, and spoke to me softly as the dawning light started to fill the room. I was tired, and wanted to sleep, and she helped me relax as much as I could between the contractions which gave me little rest.
Finally Melody came back to the room, and said I was 7 cm. I was discouraged thinking that the text book birth meant for my first baby I had at least 3 more hours of labor, and I wanted to cry and quite, but Melody reassured me that my body was changing fast, and 30 minutes later I was ready to push. After only 20 minutes of pushing, on a birthing stool, my daughter slide out at 6 lbs and 12 inches, and 17 days before her due date.
That was a difficult experience for me, as well as my birth attendants. In fact that whole pregnancy was difficult psychologically, which translated into me being a "needy" client as I needed a lot of reassurance that I was not going to have my baby at 28 weeks, that nothing was wrong. But it was also a healing time, a time that made me realize my body itself was not an impending psychological disaster. It made me trust the process, trust birth, and trust that I could work through pain and hard things, no matter how impossible they seemed.
I am grateful for that difficult birth being my first birth, because it installed patience and respect for the birth process. I was overwhelmingly grateful for the patience and reassurance my midwife showed me through the whole experience, and I did not fully understand what I had done at that time, but as I have become more mature and seasoned both as a person and a midwife, the depth of my understanding and gratitude for that experience and support has shaped my practice as a midwife, and my commitment to be "with women". d
I believe as midwives, we are also individuals, and develop naturally into the areas of "specialty" of the women we work with. There is a midwife for every women. Most women choose me because they connect with me, even over my experience, licensure, or training, most women who choose me connect with me.
Many of the women I have worked with over the years have had traumatic life or birth experiences with their bodies they have needed to heal from. I have been able to offer understanding, support, and help them to identify and process these things prenatally because I feel like, had I known how to do that when I was pregnant the first time, I would have likely had a shorter and easier labor. But I am not sad for the experience I had, I believe I needed that experience to be a good midwife, to understand how our emotional experience with our bodies effects the birth process.
I had decided to be a midwife when I was 5 months pregnant, but I did not tell anyone, including my husband until I had signed up for the midwifery program at the Utah College of Midwifery (now Midwives' College of Utah) started by a modern pioneering midwife Dianne Bjarnson, in the 1980s. Dianne attended 6 of my mother's 8 births, before I even thought of becoming a midwife.
I didn't really know what I was getting into, even when I signed up for the program. I didn't know how to go about being a midwife, so it just seemed like the thing to do. I just knew I had been called to be a midwife, and so I went on faith that I would be led to the right path. After a year of book study, and toting my nursing baby to class, or leaving her for a couple of hours with my mother to watch while I studied herbology, anatomy and physiology, management of postpartum care, and prenatal care I approached a couple of different midwives about apprenticing. Back then, the college was run by the midwives who wanted to ensure a new generation of well trained midwives. The office was in the home of a supportive secretary, and the classes were in the homes of the midwives who taught them. Three days a week 7 students, 5 of whom graduated with me, when to different homes of midwives across the valley to take in whatever we could in knowledge and wisdom from these seasoned midwives.
We had to find our own preceptorships, and so after having to learn to assert myself and beg, and after being scrutinized by a midwife to ensure I was truly understanding and committed to the difficult life-style of a midwife, I was honored to spend a couple of years under the apprenticeship of Cathy O'Bryant. I believe my experience with Cathy shaped me into understanding how to combine the traditional values of herbology and natural medicine, with the appropriate application of using life saving medication, prophylactic antibiotics, and seeking appropriate medical care when appropriate. Cathy was both hands off, but a natural at combining both worlds with evidence-based practice. She did not subscribe to folk-medicine without first investigating it and finding the evidence and validity behind it, nor did she discount it when it actually did work. She also showed me the appropriate use and knowledge of using medical interventions to prevent a hemorrhage, or emergency.
I was also privileged to attend many births with Dianne, who was more traditional, and learned that different practice styles worked, and birth works regardless of midwifery style, and both midwives had good outcomes. Training with different styles helped me to be open to developing my own style that was personalized and to not get stuck in idolizing the ways of my preceptors as the only way. Midwifery is a living profession, and should be molded to the style that fits the provider. I encourage my students to attend births with other midwives, and when possible attend as a doula in different settings while they are learning so that they get to know all they ways of birthing.
I have learned that midwifery is not about me, it is about being with woman, with the woman I serve, and supporting her choices no matter what they are. If she decides half-way through her labor that she wants to go to the hospital and have an epidural, I support her, I go with her, and encourage her in her choices. I give her dignity and respect in whatever way she is choosing to birth.
I have a very low c-section rate, even when I transport about 2%, I have been blessed to have never lost a baby or mother. I know that some babies die, and likely someday I will have a death, but I am grateful for the many lives I have seen born into the world, and even when they start out rough a few puffs of air, they pink up, and are rigorous and strong.
I have made some mistakes along they way, I have had periods of burn out, I have had to learn to midwife myself, and not let the constant threat of being called rule my everyday life. I am a boxer, ultramarathon runner, and a midwife. I have run long races when I had clients due, and during those races have never been called to a birth. My clients know when I am racing, and seem to respect that I need some time to regroup so that I can be with them when they really need me.
I have, in 12 years, missed only one delivery when I had too clients in labor at once. I have mostly had satisfied and happy women. Every midwife, no matter how good or well intended, will have some clients who do not like them, or project something negative onto their midwife. I have had a few of those, but no more than I can count on one hand. It is difficult when you have given of yourself, and spent many hours protecting and supporting a woman through a tough situation to decide you are to blame for her experience that did not turn out "perfect". I have to remind myself that I am not in control of birth, or any individuals experience, and all that I can do is offer what I have as a lifegaurd, and my dedication to being present fully at every birth. But any provider must be prepared to have someone who is not happy no matter what.
The fear of someone not being happy and legal ramifications resulting is a constant fear of all birth providers. There needs to be change in the legal system to protect providers, lower malpractice cost, and ultimately improve services for women and families. I am not saying we should not be accountable, but providers who have deep pockets are at risk, regardless of their involvement or ability to control the outcome.
Four years ago, I started back on an educational journey that I thought would end with me being a nurse-practitioner and CPM. I had felt lead to go back to school, but I didn't know exactly what the reason was. I assumed to obtain prescriptive rights and expand my scope of providing basic health care to the women and families I serve.
Even though I graduated from a MEAC (Midwives Education Accreditation Council) accredited school, which is officially recognized by the US Department of Accredited Education, and passed the NARM (North American Registry of Midwives') exam, becoming a Certified Professional Midwife (CPM) which has been developed as the "gold" standard for certifying direct-entry midwives, no other publicly funded university would recognize my accredited degree. Even though I officially obtained a Bachelor of Science in Midwifery in 2004, accompanied by over 1400 clinical hours as a student, and additional years of practice as a CPM, and autonomous provider, I was forced to enroll as an undergraduate student in a local University. After two years of taking prerequisite nursing classes in organic chemistry, and officially majoring in Behavioral Sciences, I had a very clear moment that nursing was not what I was supposed to go into, and instead to apply to a Social Work program.
This was a shock to me and met with internal resistance. With less than 30 days to gather letters of recommendation, write biographical sketches, and find an undergraduate practicum site, and having to enroll in 19-20 credits of college courses, I applied to programs at Brigham Young University and the University of Utah. I had to restructure my education route in order to obtain the needed prerequisite courses to graduate before the admission period of the next fall. I felt very strongly that I was to be a part of the University of Utah program starting in fall of 2009.
I was not devastated when I received my first rejection letter from BYU. This was at the height of the recession, and that year both schools received more than twice the normal applications they normally receive, and it reduced my chance of being selected from 50% to about 20%. I believed I was a shoe in because of my diverse background and experience in midwifery, legislation and policy making, and the research and teaching assistant experience I obtained during my two year period at UVU in my undergraduate program.
But among the high number of applicants, and the general lack of appreciation and knowledge of the field of midwifery, I also received a rejection letter from the U of U. I was at first angry, because I had not wanted to apply to this program, and I felt led to do so, fighting an internal battle the whole way. But the skills I gained in lobbying and successfully passing midwifery legislation proved to be useful, when at the suggestion of a Masters Level Intern at the undergraduate site I was at, I lobbied for months to be admitted, and finally in July of 2009 was admitted.
It ended up being a blessing to be a late admission. Most of the first year students had already been placed at a practicum, and so I obtained special permission to stay on at the site of my undergraduate site. This added to my skills and connections that are playing into my future in midwifery as I now go on.
I still did not understand why I was in a social work program, which I considered more modeled under the medical model, and as a midwife, have difficulty believing and accepting power differentials as an "OK" and acknowledged norm in practice. I believe this is a fallacy created by the medical model, and should not be a part of the social work vocabulary. I believe social work practice should be more integrative, and more community based, even in direct practice. I found some social workers who were practicing this way and labeled it as "feminist theory" and practice. But they really were just reflecting the midwifery model of care. They were non-birth midwives.
When I found the only feminist theory training site in Utah through the Womens' Resource Center, and badly wanting to be placed in that highly competitive internship for my second year placement. I was first devastated by being the 1st alternate. I had done well on my interview, but it was highly competitive, and had I included more of my experience of working with undocumented immigrants, and less on midwifery, I probably would have been in, and not the 1st alternate. But God has a plan, and his plan was not for that site.
I was devastated, because the feminist model reflected my beliefs that the need to control dual-relationships that is not seen as harmful, but instead part of the community integrative model of midwifery care, an empowering when done in the right way, the false belief that power-differentials are inevitable, has never sit well with me. But it is so hammered into students over and over again, I found it best to keep my disagreement to myself through classes, in which teachers didn't really care to hear about my experience as a midwife.
But in my heart I was disheartened by the level of which social work practice generally is not connected to the persons environment. In reality, I see this changing in actual practice. I see the feminist model of social work, which is really the midwifery model of care taking hold, and evidence suggesting that community integrated, and holistic practice is indeed more effective, and instead of increasing dependence on the provider, it decreases because the client is empowered as the expert.
My second year placement ended up in a residential setting. While I greatly enjoyed working with the teens I had the privilege of serving, and I believe the setting and understanding the multi-disciplinary team approach is valuable experience in knowing how to bring different types of midwives together, and bridging the gap of understanding of midwifery care with other birth professionals, it felt unnatural, and I felt like I was doing well, but never felt like I totally fit. I was like a homebirth midwife, working in a labor and delivery unit.
I still am grateful and respectful of the skilled providers who allowed me to learn and work under them in the last year. They do many wonderful things with youth. But I know my destiny is not to work in an institutionalized setting. I am a community midwife, and an activist, and I relish in working within my clients own environment, and changing views and perceptions on a wide scale level.
During my first two years back at school, I maintained a medium busy practice. I thought I would stop doing births for at least the two years of my graduate program, but that proved to not be the case. I could not turn down repeat clients, and a few special new clients. I turned down many, but still attended enough births to have anxiety around the end of semesters. But those births were refreshing as I was able to be with women in a nonmedicalized way, and focus on their power and energy, and transformance, instead of pathology and social injustice. I am grateful that i was able to have those few births, as my connection to midwifery was limited during those years, and I was often discouraged and lost when the style of the program did not mesh with my lifestyle and beliefs as a midwife.
I was not sure what the future of midwifery held for me. Having two licenses, it was tempting to think about transforming my practice to education, counseling, and to not have to be available for 24/7. But the day after my last class of graduate school, a local and master, and young midwife was tragically killed. That was 8 days ago, and since then I have been immersed back into the midwifery community from all angles.
At first I was annoyed to not even have a week off before deciding how to move forward, but then I realized God was telling me, it is time to start midwifing again. As I read "Into These Hands" I was reaffirmed that social work is a part of midwifery. As midwives we are birth attendants, social workers, advocates, policy makers, and support women and families through transitions in all areas of life.
We are what social work started out as, but the field of social work has been conformed and standardized to reflect the flawed medical model, and is not always integrative. There are political and professional reasons this had occurred both to find legitimacy as a profession, and to prevent harm because with the model of power differences, there is a risk to a client. But changes are happening in social work , to get rid of the idea that the client can not be an equal power player, or even have more power than the social worker. I see this on-the-fringe, feminist model becoming more mainstream, and believe the complementary background of midwifery is what social work needs. I also believe the communication and professional ethics of social work can greatly benefit the survival and unite the midwifery front.
So after many jolting moments this week, and emotional, and spiritually deep reflections I have realized, I am really still a midwife. Even if I have too degrees and licenses, it is all about midwifing women, and letting them do the work while i support and watch and encourage. As a midwife, I do not claim the glory of a birth, and I fight for the rights for every women to have a midwife attend her birth.
I fight for the preservation of traditional midwifery values and vision, and the interfacing and collaboration of life saving medical interventions in birth when they are necessary. I fight for women to recognize their potential and power, the beauty and importance and right to have full knowledge of their choices in birth, and to take the pathology and fear out of the most basic and crowning right of a woman! I believe with all my heart that if we healed birth, and took care and honored our pregnant women. If we gave her dignity and listened to her story prenatally, during birth, and after birth, If we supported her in breastfeeding and honored her place and importance in mothering... many societal problems that create mental health issues, health disparities, marital problems, and even youth drugs and violence would go away.
Peace on earth, and healing birth, is the fundamental step in reforming health care. More community midwives, and the midwifery model of care is the first step in fixing our system.
I am on fire, and no longer a student, and have the freedom and time to raise awareness, and continue to teach students, and provide care to the women I am honored to serve. It is time to take back birth, and heal our earth mother and our mothers of the human race!
I have spent time loving and hating my passion, but in the end it is still my passion. Something draws me back. I have spent hours complaining that I can never quite, that women won't quit calling me, asking me to be the honored one of "wise woman" and attend them at their birth. Despite my endless hours of complaining, and when questioned or challenged by those empathetic and listening ears "well, then why don't you just tell them no!" I reply, because I can not! I panic at the thought of abandoning those precious women, and families, those precious children who excitedly proclaim "our midwife is here!"
I have never once felt burdened or unsatisfied while I am spending time in a woman's home or my office talking about the stresses of her life, nutrition, considers about parenting, breastfeeding, fears about birth, excitement about her bodies changes. I feel connected and magical when I am with woman. There are times I have experienced much anxiety waiting for the impending call. For most of my adult life, since the age of 21, I have been connected to my phone 24/7, with few breaks. Sometimes this causes much anxiety as I have missed birthdays, holidays, weddings of friends, recognition of extended family. But when I receive the call, no matter how "inconvenient" it is like a much waited relief, to finally be "in labor"! We are in labor! We are having a baby! This is what I always say. The truth is, I am doing very little of the work. I have been in labor on three separate occasions. Each one unique, and each special, but the rest of the hundreds of labors I have been in, I have been a watcher, a waiter, a support, a guardian, a reinforcement of the powerful woman who has selected and honored me to be her midwife.
The burden of sometimes wanting to quit has come through society not really understanding or knowing what I actually do, being devalued over and over again by "real" professionals who know nothing of the personal and family sacrifices I have made to become an expert of the normal, to recognize the limits of normal, and to be able to appropriately resolve or transfer care when the normal becomes complicated.
I have sat with the fear of being arrested as a felon, watched the reality of one of our midwives arrested, charged, and facing 20 years in prison when there was no bad outcome, the parents were satisfied, and she had taken appropriate steps within the scope of her practice. I have watched the struggles and realities of brazen midwives across the United States, who are never endowed in wealth- no one gets rich in money and status being a midwife- have to come up with mounting legal defense cost, often supported by her protesting clients who do not want to lose their community midwife, but in the end, she is at the mercy of the legal system, while her supporting clients will go on to have normal lives with no repercussion of the United States unique stance on criminalizing midwifes.
I have sat through years in my state, as a result of the arrest of midwife Elizabeth Camp-Smith, in 1999, of the impending fight for legalization of midwives. Those years caused fights not only from the medical association who did not want to see midwives legitimized, but also within the midwifery community. Sisters who had differing opinions about licensing of midwives, and the preservation of the right to practice traditional midwifery freely. That fight still continues today, although the efforts of the pioneering women who spent many hours of their own uncompensated time, money, and heart to draft a bill that was inclusive of the desires of all midwives in the state. Because of their efforts, and the supporting grassroots consumer movement consisting of doulas, childbirth educators, and parents who wanted to preserve the right to have their cherished midwife attend their births, and the births of their daughters and granddaughters, the hard fought effort was won on a thread of one vote 15 minutes before the end of the legislative session in 2005.
I remember well that whole year, and that fearful night. We had been working tirelessly since 1999 to bring midwives together, and pass a bill that would allow licensing of midwives for midwives who wished to legally carry pitocin for hemorrhage, freely order labs and ultrasounds, administer Rhogram, provide IV antibiotics for group B positive women, and collaborate more complete care for their women. At the same time, there was a desire to ensure midwifery, licensed or non licensed was not a felony, and that women would have the right to preserve their choice in how, whom, and where they birthed their children.
Midwifery is not about homebirth, it is about autonomy, choice, and self-determination of women. It is about empowering women through their birth experience so that they may bond with their babies, feel powerful, and know that they can get through any difficult situation and make the choices in their care about their setting, choice of provider, and interventions available to them. So often women are scared into interventions, and disempowered and mistakenly believe "my doctor saved me" when it is often the intervention, and fear induced model that escalated the need for more intervention, and the message the woman received that reinforced that her body is not capable, that birth is a catastrophe waiting to happen, and that if she is able to have no intervention she was lucky, masochistic, not caring for her child, and she is downplayed.
Women reinforce this with each other by invalidating each others experiences either by one-upping each other with traumatic birth stories, or by patronizing, or downplaying the rare mother who did succeed in a "normal" birth by saying "yes, but you are strong, I could not do that!"
As a midwife, this attitude, and defining and defending what I do over and over again to those that do not understand or really don't want to becomes tiresome, and often times I succumb to the tiresome task of how long and sometimes futile it is to defend myself. Many times, I do not offer the information of what I really do, how my life really is, and let people think I am the radical midwife, who knows nothing, and end up hearing the story of how they new someone who had a fast, uncomplicated labor and ended up birthing at home and calling the EMT for a non-emergency childbirth. It ends up being a sensational story, that discounts the normalcy of birth, and the woman's trust in her body to just allow birth to occur, even if it meant she did not have time to travel to her intended location. This is not an emergency, this is normal! Yet we call this emergency childbirth, and the attending EMT often feels like a hero, for using his/her minimal training skills to be present with a woman's normal process, in which she is actually doing the work, their is no pathology.
How many times have I laughed when I hear a sensational news story, of an unfortunate mother who had the audacity to trust her bodies urges, and allow her baby to come in a car, or on the side of a road while en-route to a facility. The EMT's called, the news crew notified, and then the headline of the occurrence of.... a birth outside of a hospital!..... as if it was something to talk about as abnormal, and a circus exhibit. The unfortunate reality, is there is a reason for this sensationalism. Most resident physicians never see a truly normal delivery from start to finish, most labor and delivery nurses see largely induced, medicated, and surgical births that follow an assembly line protocol, and expected course determined by the policies of the hospital, and the convenience of a physician practice which is often over booked due to the need to care for enough women to cover the outrageous fees associated with the burden of $100,000 annual malpractice policies.
And to some extend, how can we blame the obstetricians, birth it the most risky and litigious areas of medicine that a physician can get into. Can we fully blame them for a cesarean rate reaching 32% in 2007, and as high as 50-60% in some hospitals? While the evidence clearly shows the significant risk in mortality, morbidity, prematurity, post-traumatic stress disorder due to birth trauma, postpartum depression, and long term health and mental health issues for mom, an obstetrician is still less likely to be sued for a poor outcome of an unnecessary surgical birth, then he is for a bad outcome for a vaginal delivery.
Also the financial benefits in both time and billing of insurance for the birth to the institution and the doc, leaves surgical delivery on the rise, and elective cesarean chosen more and more by women who are not given all of the information, or understanding of the risk involved with these interventions.
We have normalized pathological birth, and have made one of the most basic rights of women into a big capitalistic business. And if you do not believe that birth in the hospital is about business, guess again! Birth is still the number one reason for hospitalization in the united states, and 1 in 5 women who enter the hospital for a normal delivery will end up with hospital based infection. One in 3 women will end up with a cesarean section, while the World-Health Organization (WHO) states that a c-section rate of 8-10% is what an institution should aim for. Furthermore, while we temporarily made gains with encouraging women with 1 or 2 previous cesarean sections to attempt vaginal birth after a cesarean for the next birth (VBAC), around 2000, a non-evidence based opinion by the president of the American College of Obstetricians and Gynecologist (ACOG) ended the nationwide support of VBAC, and women who had successfully already had 1 or more VBAC deliveries were being denied the choice in hospitals as more and more hospitals and physicians refused the choice to women.
Recently women have started becoming informed and demanding this choice be offered to them, as they have the right to refuse unnecessary repeated surgical deliveries, and evidence shows that the risk for multiple cesarean deliveries to both mother and baby increase substantially with each subsequent surgical birth. The risk of a ruptured uterus from an attempted VBAC is much lower than the repeated cutting open and scarring of the uterus. After one successful VBAC delivery the risk for subsequent pregnancies ending in uterine rupture become lower, and near the rates of never having had a cesarean section. Even in unsuccessful VBAC attempts the benefits of having a trail of labor to the baby lower the rates of respiratory distress and mortality. Something about the hormonal exchange and natural stress occurring with each contraction causes physiological changes which prepare the baby for his/her life on the Earth-side.
In most of the world babies (75%) are delivered in the hands of a midwife. In most developed countries midwives have been integrated into the health-care system as a valued and honored profession which is separate from the practice of medicine or nursing. In all of these developed nations which incorporate midwifery as the primary birth attendant, and obstetrics as the experts in high-risk management, and collaborators with midwives who recognize by education, touch, and intuition when normal has become complicated, these countries have much better and accurately documented outcomes.
In the United States our poorly tracked and often manipulated statistical data (due to the capitalistic nature of health care) still ranks us below some third-world countries in both infant and maternal mortality. Furthermore, anthropological data suggest the health of a women and birth indicate the health of men and the whole society. Women who experience powerlessness and indignity during their vulnerable moments of birth, experience more stress and long term medical and mental health effects. Women are already at a disadvantage due to wage and access to care disparities.
While the initial look at our statistics show alarming numbers, if we add in disparities, and separate out the rates of maternal and infant mortality among race and socioeconomic status, we see an alarming difference among Black and Hispanic women. Regardless of education, class, or location, the prematurity, low-birth weight, and birth outcomes are much higher for these groups than for Euro American women. The numbers are saying something! The rates of maternal mortality have not gone down since 1982, despite advances in technology, fetal monitoring capabilities, ultrasound, and laboratory testing.
Despite statistics that show hospital practices incorporating midwifery care lowers complications, mortality, and length of stay in a hospital midwifery practices are being cut over and over again due to capitalistic administrators who can make more money by having more women streamlined, and less one-on-one time spent with each women. Obstetricians having to pay high fees already for malpractice, are often made to pay more when having agreements with midwives in their practice, even though evidence shows having midwives in practice lowers the cost of maternity care, and improves outcomes.
Midwives, both CNMs and CPMs face increasing cost of the inability to find affordable liability insurance, and the risk of lawsuits increasing, as well as the risk of legal action. Midwives, despite showing over and over again in well documented data collecting and statistical analysis that midwives improve the health and safety of mothers and babies across the board, are under much more scrutiny than obstetricians. When an obstetrician has a poor outcome it is not scrutinized as severely as with a midwife. And if the birth occurred outside of the hospital, often the parents are mocked and blamed for choosing a midwife, and putting their baby at risk, even if the problem was congenital or beyond anyone's control.
Therefore, being a midwife is sometimes discouraging under the pressure and risks we take everyday to defend what we believe in. Most of us make little money for our demanding, and risky job title. Most of us are ignored and discounted for our hands-on abilities and expertise.
I have learned how to interact with other professionals, and am blessed to live in a state that is legal. I do not have to fear going into a hospital that I will be prosecuted for practicing medicine without a license, as I once did when I first started practicing. But it has not come without a cost. When I first received the "call" to be a midwife, I was 5 months pregnant with my first child. I was electrified by the energy and power of birth, and pregnant women. I was enthralled with what my body was doing as I watched my belly grow, and felt my daughter move inside of me. My first birth was long and difficult, but transforming. It taught me how to work through fear and pain at a new level. Had I been in a hospital, I likely would have ended up with pitocin, an epidural, and possibly a c-section. My baby was never in danger, but my birth process was unusual, on-and-off, and was literally a 5 day process!
I believe now, there were many unconscious fears and past experiences that I had to work through during those 5 days before I was able to surrender to the natural flow and energy of birth. I did not understand it all then, but it was not a text book labor. It was difficult for me, and for everyone involved in attending me. I had some people in panic, believing I should go to the hospital, fearing that once my membranes were ruptured, and I stopped having contractions for over 24 hours, that I was taking a risk.
I am sure my midwife was tired, possibly annoyed, and did not understand how I was reacting to labor. But through it all she supported my right to stay home, she monitored me for infection, helped me take preventative measures for infection, gave me Bach Flower remedies to address the unconscious fears I was experiencing that were blocking my baby from coming. And finally, after having two previous nights of transition like contractions, and never progressing pass three centimeters, after having my contractions stop, my water spontaneously braking, and then a night of no labor, after a full day of monitoring, finally 26 hours post rupture, caster oil, and much needed space from well-intended but fearful or distracting people in my space, I started contracting again.
This time the energy felt different, and this time, I decided to not call my doula who was totting her 15-month old daughter, or anyone else. I needed space, I needed to not be on display. For an hour or so I did not even wake up my husband. I didn't want the contractions to stop, and I noticed whenever there were a lot of people around they became more painful and ineffective, and eventually stopped. I first called my midwife before I even woke my husband. He awoke a few minutes before she arrived, and she checked me. I was afraid of hearing that I was the same... 3 cm and 50% effaced.... but this time she had a smile on her face as she said "4cm and 100% effaced!" The effacement meant I was not going to stop, and the contractions were finally effective.
I was at my mothers house for my first birth, not feeling comfortable birthing in a basement apartment in a sub-divided home with two other apartments and thin walls. So for most of the night my mother, my husband, and my midwife supported me. Near the end she called her assistant whom I had never met, but who brought the most loving an comforting energy to the birth. My midwife, who was pregnant, and besides my long ordeal, had 2 other women trying to birth that week was tired, and her assistant took over. I did not even know her name at first, but her face was like an angel! I connected immediately with Roxanna, as she pushed on my knees, and spoke to me softly as the dawning light started to fill the room. I was tired, and wanted to sleep, and she helped me relax as much as I could between the contractions which gave me little rest.
Finally Melody came back to the room, and said I was 7 cm. I was discouraged thinking that the text book birth meant for my first baby I had at least 3 more hours of labor, and I wanted to cry and quite, but Melody reassured me that my body was changing fast, and 30 minutes later I was ready to push. After only 20 minutes of pushing, on a birthing stool, my daughter slide out at 6 lbs and 12 inches, and 17 days before her due date.
That was a difficult experience for me, as well as my birth attendants. In fact that whole pregnancy was difficult psychologically, which translated into me being a "needy" client as I needed a lot of reassurance that I was not going to have my baby at 28 weeks, that nothing was wrong. But it was also a healing time, a time that made me realize my body itself was not an impending psychological disaster. It made me trust the process, trust birth, and trust that I could work through pain and hard things, no matter how impossible they seemed.
I am grateful for that difficult birth being my first birth, because it installed patience and respect for the birth process. I was overwhelmingly grateful for the patience and reassurance my midwife showed me through the whole experience, and I did not fully understand what I had done at that time, but as I have become more mature and seasoned both as a person and a midwife, the depth of my understanding and gratitude for that experience and support has shaped my practice as a midwife, and my commitment to be "with women". d
I believe as midwives, we are also individuals, and develop naturally into the areas of "specialty" of the women we work with. There is a midwife for every women. Most women choose me because they connect with me, even over my experience, licensure, or training, most women who choose me connect with me.
Many of the women I have worked with over the years have had traumatic life or birth experiences with their bodies they have needed to heal from. I have been able to offer understanding, support, and help them to identify and process these things prenatally because I feel like, had I known how to do that when I was pregnant the first time, I would have likely had a shorter and easier labor. But I am not sad for the experience I had, I believe I needed that experience to be a good midwife, to understand how our emotional experience with our bodies effects the birth process.
I had decided to be a midwife when I was 5 months pregnant, but I did not tell anyone, including my husband until I had signed up for the midwifery program at the Utah College of Midwifery (now Midwives' College of Utah) started by a modern pioneering midwife Dianne Bjarnson, in the 1980s. Dianne attended 6 of my mother's 8 births, before I even thought of becoming a midwife.
I didn't really know what I was getting into, even when I signed up for the program. I didn't know how to go about being a midwife, so it just seemed like the thing to do. I just knew I had been called to be a midwife, and so I went on faith that I would be led to the right path. After a year of book study, and toting my nursing baby to class, or leaving her for a couple of hours with my mother to watch while I studied herbology, anatomy and physiology, management of postpartum care, and prenatal care I approached a couple of different midwives about apprenticing. Back then, the college was run by the midwives who wanted to ensure a new generation of well trained midwives. The office was in the home of a supportive secretary, and the classes were in the homes of the midwives who taught them. Three days a week 7 students, 5 of whom graduated with me, when to different homes of midwives across the valley to take in whatever we could in knowledge and wisdom from these seasoned midwives.
We had to find our own preceptorships, and so after having to learn to assert myself and beg, and after being scrutinized by a midwife to ensure I was truly understanding and committed to the difficult life-style of a midwife, I was honored to spend a couple of years under the apprenticeship of Cathy O'Bryant. I believe my experience with Cathy shaped me into understanding how to combine the traditional values of herbology and natural medicine, with the appropriate application of using life saving medication, prophylactic antibiotics, and seeking appropriate medical care when appropriate. Cathy was both hands off, but a natural at combining both worlds with evidence-based practice. She did not subscribe to folk-medicine without first investigating it and finding the evidence and validity behind it, nor did she discount it when it actually did work. She also showed me the appropriate use and knowledge of using medical interventions to prevent a hemorrhage, or emergency.
I was also privileged to attend many births with Dianne, who was more traditional, and learned that different practice styles worked, and birth works regardless of midwifery style, and both midwives had good outcomes. Training with different styles helped me to be open to developing my own style that was personalized and to not get stuck in idolizing the ways of my preceptors as the only way. Midwifery is a living profession, and should be molded to the style that fits the provider. I encourage my students to attend births with other midwives, and when possible attend as a doula in different settings while they are learning so that they get to know all they ways of birthing.
I have learned that midwifery is not about me, it is about being with woman, with the woman I serve, and supporting her choices no matter what they are. If she decides half-way through her labor that she wants to go to the hospital and have an epidural, I support her, I go with her, and encourage her in her choices. I give her dignity and respect in whatever way she is choosing to birth.
I have a very low c-section rate, even when I transport about 2%, I have been blessed to have never lost a baby or mother. I know that some babies die, and likely someday I will have a death, but I am grateful for the many lives I have seen born into the world, and even when they start out rough a few puffs of air, they pink up, and are rigorous and strong.
I have made some mistakes along they way, I have had periods of burn out, I have had to learn to midwife myself, and not let the constant threat of being called rule my everyday life. I am a boxer, ultramarathon runner, and a midwife. I have run long races when I had clients due, and during those races have never been called to a birth. My clients know when I am racing, and seem to respect that I need some time to regroup so that I can be with them when they really need me.
I have, in 12 years, missed only one delivery when I had too clients in labor at once. I have mostly had satisfied and happy women. Every midwife, no matter how good or well intended, will have some clients who do not like them, or project something negative onto their midwife. I have had a few of those, but no more than I can count on one hand. It is difficult when you have given of yourself, and spent many hours protecting and supporting a woman through a tough situation to decide you are to blame for her experience that did not turn out "perfect". I have to remind myself that I am not in control of birth, or any individuals experience, and all that I can do is offer what I have as a lifegaurd, and my dedication to being present fully at every birth. But any provider must be prepared to have someone who is not happy no matter what.
The fear of someone not being happy and legal ramifications resulting is a constant fear of all birth providers. There needs to be change in the legal system to protect providers, lower malpractice cost, and ultimately improve services for women and families. I am not saying we should not be accountable, but providers who have deep pockets are at risk, regardless of their involvement or ability to control the outcome.
Four years ago, I started back on an educational journey that I thought would end with me being a nurse-practitioner and CPM. I had felt lead to go back to school, but I didn't know exactly what the reason was. I assumed to obtain prescriptive rights and expand my scope of providing basic health care to the women and families I serve.
Even though I graduated from a MEAC (Midwives Education Accreditation Council) accredited school, which is officially recognized by the US Department of Accredited Education, and passed the NARM (North American Registry of Midwives') exam, becoming a Certified Professional Midwife (CPM) which has been developed as the "gold" standard for certifying direct-entry midwives, no other publicly funded university would recognize my accredited degree. Even though I officially obtained a Bachelor of Science in Midwifery in 2004, accompanied by over 1400 clinical hours as a student, and additional years of practice as a CPM, and autonomous provider, I was forced to enroll as an undergraduate student in a local University. After two years of taking prerequisite nursing classes in organic chemistry, and officially majoring in Behavioral Sciences, I had a very clear moment that nursing was not what I was supposed to go into, and instead to apply to a Social Work program.
This was a shock to me and met with internal resistance. With less than 30 days to gather letters of recommendation, write biographical sketches, and find an undergraduate practicum site, and having to enroll in 19-20 credits of college courses, I applied to programs at Brigham Young University and the University of Utah. I had to restructure my education route in order to obtain the needed prerequisite courses to graduate before the admission period of the next fall. I felt very strongly that I was to be a part of the University of Utah program starting in fall of 2009.
I was not devastated when I received my first rejection letter from BYU. This was at the height of the recession, and that year both schools received more than twice the normal applications they normally receive, and it reduced my chance of being selected from 50% to about 20%. I believed I was a shoe in because of my diverse background and experience in midwifery, legislation and policy making, and the research and teaching assistant experience I obtained during my two year period at UVU in my undergraduate program.
But among the high number of applicants, and the general lack of appreciation and knowledge of the field of midwifery, I also received a rejection letter from the U of U. I was at first angry, because I had not wanted to apply to this program, and I felt led to do so, fighting an internal battle the whole way. But the skills I gained in lobbying and successfully passing midwifery legislation proved to be useful, when at the suggestion of a Masters Level Intern at the undergraduate site I was at, I lobbied for months to be admitted, and finally in July of 2009 was admitted.
It ended up being a blessing to be a late admission. Most of the first year students had already been placed at a practicum, and so I obtained special permission to stay on at the site of my undergraduate site. This added to my skills and connections that are playing into my future in midwifery as I now go on.
I still did not understand why I was in a social work program, which I considered more modeled under the medical model, and as a midwife, have difficulty believing and accepting power differentials as an "OK" and acknowledged norm in practice. I believe this is a fallacy created by the medical model, and should not be a part of the social work vocabulary. I believe social work practice should be more integrative, and more community based, even in direct practice. I found some social workers who were practicing this way and labeled it as "feminist theory" and practice. But they really were just reflecting the midwifery model of care. They were non-birth midwives.
When I found the only feminist theory training site in Utah through the Womens' Resource Center, and badly wanting to be placed in that highly competitive internship for my second year placement. I was first devastated by being the 1st alternate. I had done well on my interview, but it was highly competitive, and had I included more of my experience of working with undocumented immigrants, and less on midwifery, I probably would have been in, and not the 1st alternate. But God has a plan, and his plan was not for that site.
I was devastated, because the feminist model reflected my beliefs that the need to control dual-relationships that is not seen as harmful, but instead part of the community integrative model of midwifery care, an empowering when done in the right way, the false belief that power-differentials are inevitable, has never sit well with me. But it is so hammered into students over and over again, I found it best to keep my disagreement to myself through classes, in which teachers didn't really care to hear about my experience as a midwife.
But in my heart I was disheartened by the level of which social work practice generally is not connected to the persons environment. In reality, I see this changing in actual practice. I see the feminist model of social work, which is really the midwifery model of care taking hold, and evidence suggesting that community integrated, and holistic practice is indeed more effective, and instead of increasing dependence on the provider, it decreases because the client is empowered as the expert.
My second year placement ended up in a residential setting. While I greatly enjoyed working with the teens I had the privilege of serving, and I believe the setting and understanding the multi-disciplinary team approach is valuable experience in knowing how to bring different types of midwives together, and bridging the gap of understanding of midwifery care with other birth professionals, it felt unnatural, and I felt like I was doing well, but never felt like I totally fit. I was like a homebirth midwife, working in a labor and delivery unit.
I still am grateful and respectful of the skilled providers who allowed me to learn and work under them in the last year. They do many wonderful things with youth. But I know my destiny is not to work in an institutionalized setting. I am a community midwife, and an activist, and I relish in working within my clients own environment, and changing views and perceptions on a wide scale level.
During my first two years back at school, I maintained a medium busy practice. I thought I would stop doing births for at least the two years of my graduate program, but that proved to not be the case. I could not turn down repeat clients, and a few special new clients. I turned down many, but still attended enough births to have anxiety around the end of semesters. But those births were refreshing as I was able to be with women in a nonmedicalized way, and focus on their power and energy, and transformance, instead of pathology and social injustice. I am grateful that i was able to have those few births, as my connection to midwifery was limited during those years, and I was often discouraged and lost when the style of the program did not mesh with my lifestyle and beliefs as a midwife.
I was not sure what the future of midwifery held for me. Having two licenses, it was tempting to think about transforming my practice to education, counseling, and to not have to be available for 24/7. But the day after my last class of graduate school, a local and master, and young midwife was tragically killed. That was 8 days ago, and since then I have been immersed back into the midwifery community from all angles.
At first I was annoyed to not even have a week off before deciding how to move forward, but then I realized God was telling me, it is time to start midwifing again. As I read "Into These Hands" I was reaffirmed that social work is a part of midwifery. As midwives we are birth attendants, social workers, advocates, policy makers, and support women and families through transitions in all areas of life.
We are what social work started out as, but the field of social work has been conformed and standardized to reflect the flawed medical model, and is not always integrative. There are political and professional reasons this had occurred both to find legitimacy as a profession, and to prevent harm because with the model of power differences, there is a risk to a client. But changes are happening in social work , to get rid of the idea that the client can not be an equal power player, or even have more power than the social worker. I see this on-the-fringe, feminist model becoming more mainstream, and believe the complementary background of midwifery is what social work needs. I also believe the communication and professional ethics of social work can greatly benefit the survival and unite the midwifery front.
So after many jolting moments this week, and emotional, and spiritually deep reflections I have realized, I am really still a midwife. Even if I have too degrees and licenses, it is all about midwifing women, and letting them do the work while i support and watch and encourage. As a midwife, I do not claim the glory of a birth, and I fight for the rights for every women to have a midwife attend her birth.
I fight for the preservation of traditional midwifery values and vision, and the interfacing and collaboration of life saving medical interventions in birth when they are necessary. I fight for women to recognize their potential and power, the beauty and importance and right to have full knowledge of their choices in birth, and to take the pathology and fear out of the most basic and crowning right of a woman! I believe with all my heart that if we healed birth, and took care and honored our pregnant women. If we gave her dignity and listened to her story prenatally, during birth, and after birth, If we supported her in breastfeeding and honored her place and importance in mothering... many societal problems that create mental health issues, health disparities, marital problems, and even youth drugs and violence would go away.
Peace on earth, and healing birth, is the fundamental step in reforming health care. More community midwives, and the midwifery model of care is the first step in fixing our system.
I am on fire, and no longer a student, and have the freedom and time to raise awareness, and continue to teach students, and provide care to the women I am honored to serve. It is time to take back birth, and heal our earth mother and our mothers of the human race!
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