Week 18: A midwife’s nature, or the scorpion and the frog

I started a discussion at my prenatal appointment about tearing and perineal support, with the intention of asking my midwife how she does it. I ended up rambling about a birth I attended as a doula, and how instinctive everything was as long as the woman felt that no one was watching or managing her, but as soon as ten people streamed into the room and started manhandling her, touching her, and telling her what to do, things changed. She ended up with a big tear that I believe could have been prevented, not by anything having to do with physics, position, perineal support, etc but by not feeling observed and ordered around.

My midwife rambled a little too, talking about how studies have shown that if the mother supports her own perineum instinctively, tearing is less likely, and other things. At a certain point she stopped herself. She said, “I hear your questions, but I’m not really hearing fear. Are you afraid of tearing? What is your intention in asking these questions?”

It was an amazing observation. The fact is, I’m not afraid of tearing from the birth. I’m not afraid of pain and I’m not afraid of pushing a baby out. I’m afraid of what other people might do to me WHILE I’m giving birth. That could cause untold damage. I said, “I guess my real question is, what do you do during a birth? Particularly at the end? What kinds of things can I expect from you?” I admitted that it isn’t tearing I am afraid of, but her, and what she might do. I said I wanted information about how she would practice and behave so that I could ask her to do different things if I wanted to. I said I have been thinking more and more that I want to be completely unobserved, especially at the critical moment when the baby is emerging.

“Well, I’m not the unassisted birth midwife,” she said. She said she wants to be in the room, although she might be sitting on her hands and making her own energy relaxed. She said she usually touches the perineum, to see how it reacts, and if it tightens then she’ll know she isn’t supposed to be touching. Sometimes it will relax with a sigh and she knows that her touch is helpful. She likes for the mother to support herself although she won’t guide her hand there intentionally, or put her in a position she doesn’t choose.

I loved her for her honesty. And I have already promised in myself to give her the same.

On the way home I started thinking about the fable about the scorpion and the frog, where the frog agrees to give the scorpion a ride across the stream and the scorpion stings the frog halfway across. As they both sink and drown, the frog asks “Why?” and the scorpion says, “I can’t help it, it’s my nature.”

What’s a midwife’s nature? You can make all the distinctions you want between licensed and unlicensed, medwife and midwife, traditional birth attendant, and the alphabet soup of qualifications. But at the end of the day, a midwife’s nature is to OBSERVE. Because licensed or unlicensed, she is responsible for seeing whether there is danger or abnormality. She wants to protect the safety of the mother and baby, and no matter whether her methods include invasive and unnecessary procedures, or a physiologic model of care, either way she needs to know what is happening. The act of observation is good and right and something we should expect and want a midwife to do.

Michel Odent has said that the midwife can be in the next room and listen. But that is still observation. And if observation makes the laboring woman feel unsafe – because it could lead to intervention – it won’t matter that the person is in the next room if you know that they are listening to and interpreting your sounds, especially if you know that they are nervous and would rather be in the room and able to see you. It won’t matter that the person in the room with you or in the next room is full of love and support and is extremely skilled. It won’t matter that you’ve hired her for safety and protection and that you know she knows your wishes. The fact of being observed while in labor, and KNOWING that you are being observed, is inescapable.

When I imagine myself being in labor and being observed, I see myself, at best, not having the kind of ecstatic birth I think I am capable of. At worst, I see myself having a long, painful and perhaps abnormal labor.

Sadly, I don’t think it would have bothered me, had I not had my first birth experience, because until I was assaulted I believed observation was benign. I knew the doula was observing me, I was hooked up to a monitor once we got to the hospital, and I didn’t really care – I was fearless and lost in laborland. But this time I know how much harm and meddling observation can cause. I don’t even want to think about my husband looking at me and trying to do something, trying to comfort me, or wondering about how my labor is progressing.

I am practicing following my gut feeling and my heart. Once I am in labor, if I know unequivocally that I need to be unobserved, I will remember what is in the nature of a midwife. And I will think about whether or when to call her.

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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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