Week 12: Midwives

Interviewing midwives, but I don’t trust anyone. This one’s too quiet, that one’s too strong, that one’s too talkative, this one’s too young, that one’s too busy… By now I have met nearly every midwife in this area.

Some of those interviews took place before I was pregnant and I think my desires have coalesced a lot since then. Before I was pregnant, I didn’t quite understand that in order to get the information I wanted instead of just hearing a pitch, I really had to take control of my part of the conversation instead of sitting back and letting the midwife lead. It’s a good lesson because I will have to do the same in prenatals.

I met one practice, a pair of midwives, that I liked at first – but they ended up making me very nervous. I don’t know how well I would be able to discuss with them if there was a difference of opinion or if I decided not to follow a recommendation they might make. When I asked a question about informed consent/refusal, they brushed it off with the assumption that the decision would have been made for me already (by them).

I also made contact with a midwife who berated me over email for asking what was involved in her pricey consult/interview appointment, and how I might describe it to my insurance company so they’d cover it. She gave me a condescending lecture about how home birth midwives are underpaid and overworked, and insurance companies don’t value their services, and if I was that much of a penny-pincher well then I should probably just take myself to a conventional doctor in a hospital. I puzzled for a few minutes over why this was a sign I shouldn’t interview her – after all, I do understand what home birth midwives do, and I am happy to pay what my insurance won’t cover, and she came with high recommendations and might be a perfectly good midwife. I didn’t want to reject her without a specific reason, and an abrasive personality just didn’t seem strong enough.

However, I read her bitterness as a red flag. Everyone in this country must operate within the US health care system – home birthers, hospital birthers, even freebirthers – and not only can we not avoid it, but we may find ourselves depending on it in our most vulnerable moments and moments of danger. Unfortunately the common assertion that “we don’t need the institution” is wrong. Some of us will need it, and we might not know who we are until that very moment. A midwife who harbors bad feelings toward hospitals will not be helpful in the hospital, and may even be the type to abandon clients who need to go there.

One came and met me at my house, and I felt like she talked to me as my own person – maybe the difference was that she was in my space. Everyone else I felt like I was interviewing them, but not even as a customer – almost like I was interviewing a prospective boss. None of them seemed to leave any openings for variations in risk tolerance, variations in life choices, variations in desires beyond the superficial. It was like “here is how we do things…” But she wasn’t like that, she was very sweet.

A conversation with a friend helped me clarify what I want in a midwife. She asked me what are the two things I want, and I answered – someone who won’t abandon me; and someone who believes with her whole being that I am the decision maker.

On abandonment, it is something sadly common in the home birth world. A client could encounter a medical situation during pregnancy that warrants transfer to an OB and the midwife says “oh well, not my problem, see ya” – and in a hospital transfer, the midwife could leave, or she could mentally check out. But if she stays to help advise and shepherd the person into a new and scary relationship, and maintains her relationship, the connection, the love and compassion and holds the space that has been created through the entire pregnancy, then she hasn’t abandoned. On the other hand, a midwife could have a family emergency. As long as she has a backup who is well trained, briefed and willing to practice similarly, it’s still not the best situation for the client, but she hasn’t abandoned her.

The second item is contained within the institutional concept of “informed consent and refusal” but goes further.  Informed consent and refusal is relatively one dimensional, with information given, and consent either obtained or not. It’s a shallow abstraction of the true decision making conversation that should happen between two equals, one with greater knowledge, the other with greater care and concern for herself and her fetus. If a hospital client goes against the recommendation of the caregiver, the caregiver need only note the informing process and the refusal. If it is a serious situation, they may call on help from others in the hospital, which may take the form of convincing or coercing the client, additional expertise in case of something going wrong, and preparing in case something changes or there is an emergency. The midwife has only herself and her assistant. I believe that the independence (and exposure) of the midwife, along with her relationship with the client, should lead to a deeper and more complex conversation, especially in the case of refusal of a recommendation.

Then I met a midwife who I almost discounted without meeting, because I knew she had practiced in hospitals for many years. But I thought, why not just meet her.

I told her about my thoughts and desires for my birth, I told her about the concept of “Safety Fourth,” I talked to her about my lack of trust in caregivers, my plans to find a backup hospital provider, the hard work I have done to heal, the part of me that is not yet healed. I told her the two things I am looking for in a midwife. She took notes while we talked. Her notes were divided on one page by angled lines, some radiating diagonally from the middle, mandala-like. In one section was a spiral; in one section were the two characteristics I had described; in one section was the word “HEALING” in all caps; in one section were the words “love” and “compassion.”

I told her that while I had worked hard with myself to heal the physical and emotional wounds of the first birth, part of me still wasn’t healed – the spiritual, trusting part. I’ve come to believe that only some healing can be done alone, while some healing needs community and relationship. I said I wanted to consider my midwife to be part of my community, and that I wanted to be totally honest so that if anything made her uncomfortable she could say so, and even if she did not become my midwife we could preserve our community connection. I said that if I went into labor tomorrow, I would do it all alone, but that I would like to develop a relationship with someone over time, to the point that I would want them, and invite them to share the experience with me. I told her I want to trust someone but I don’t know if I can. Developing that relationship is my singular goal for my prenatal care.

I was crying by this point, and didn’t hold back. I looked over, and her beautiful eyes were twinkling with tears, she was looking partly at me and partly into the distance, and nodding her head, and crying. My husband was crying too. She held the space for all three of us, and we looked at each other’s eyes, and cried a little more, and breathed together. It was one of the most healing moments I have experienced.

She was the first to grab a tissue out of the big box on the table – “That’s why I keep a big box here!” she joked.

Before we left, I told her that I wanted to build a relationship with her. I was telling her that I wanted her to be my midwife, but all she said was, “we already are building a relationship.”

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About investigatingbirth

My investigations of birth began in 2009 when I was trained as a doula. I helped women consider the evidence on common interventions, and helped them prepare for the physical and emotional challenge of giving birth. After some time it became clear to me that there was another type of challenge that I was unable to adequately prepare them for, the challenge of the maternity system. But it was only after my own traumatic birth in 2013 that I realized how little I had understood. I began to ask questions that few around me - doulas, nurses, midwives, doctors - were comfortable hearing. Questions like: Under what circumstances, and for what reasons, do doctors not practice informed consent? How do hospitals deal with other patient populations vulnerable to abuse? How does loss of professional autonomy, for obstetricians, and professional authority, for midwives, impact the quality of care they are capable of providing - regardless of their training? This blog will collect noteworthy information that attempts to answer these and other questions. Most of what you see here will be aggregated from other sources and analyzed. You will also see original interviews, and the occasional opinion piece or personal story, as I try to piece together a clear picture of the system in which American women give birth.
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