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Saturday, March 30, 2013

to license or not to license. is there a question? or what is an empowering birth? who decides?

OK this is an opinion piece and i imagine it'll piss a few people off. 

but i've been in tears this last week and i don't want to keep quiet about it. i was ready to quit being a midwife. 

recently i found myself in the midst of a discussion on midwifery licensure. i don't know why i bated myself into this trap. i was premenstrual. we have a client who is going through a difficult time and a midwife who is reaching out to any and all resources that she can find to help this momma. reaching out in a way that would not be possible if she were working outside the system.

i'm back to believing i'm not a feminist because i'm not hating on the system which i guess is being equated to the "man" and therefore in order to be a good feminist, i'm supposed to hate. sigh. sorry i know that is filled with sarcasm and passive aggressiveness, but i'm still pretty upset about this. 

as most of us have heard there is a midwife in north carolina who is being charged with murder as a result of a fetal demise. tragic. for everyone. 

i've read some backlash that this case supports the flaws of seeking licensure. i'm not quite sure the logic, but i guess it is because in north carolina homebirth with a midwife is illegal. the state does have CNM's, but from my knowledge they work on the base and i'm not sure civillians have access to them, and they sure aren't doing homebirths. and this is where lets hate on the man comes in, why, because the obstetric community does not support OOH birth, CPM's much less "community midwives". 

*tangent* i've heard this word community midwife tossed around in this case. i prefer it over traditional midwife. and from now on will try and use this term, particularly speaking of unlicensed midwives.* though really, aren't we all community midwives if we are attending births out of hospital? so maybe i'll use it for all midwives that don't work in hospital, licensed or not. i don't know. i just hate traditional midwife and medwife. makes my skin crawl to have such division between us. 

there was a discussion that you can listen to here on progressive parenting. there is also a post which is allegedly the mothers side of the story. *the mothers story appears to have been taken down. sorry*

i said that this is an opinion piece and so here is my opinion. 

if the midwife were licensed she would not be charged with murder. this case would have gone through a review by her peers to deem whether she acted appropriately or not. she would have had a trial and held accountable by her peers. she may or may not have lost her license based on their findings. and the family would likely have recourse in a civil suit to recover any financial damages, though that will never bring their baby back. if it is a state in which midwives carry malpractice, well then there also would have been a system in place to provide the family with compensation, not force them to seek it on their own.

and the midwife, well she would be on board with any health care professional and would not be charged with murder. this is the case in hospitals right. the unfortunate nature of what we do will be the eventual bad outcome. it happens in hospitals and there is no media coverage about it. it is silently swept under the rug and dealt with in back rooms. when this happens at home with a midwife, particularly an unlicensed midwife, and in a state where midwifery is illegal. it devastates the community.

i'm not here to judge the midwife. i'm here to talk about how it would have looked if midwifery were legal and if she were licensed.

back to the discussion i was bated into earlier this week. the discussion that had me in tears. the discussion that caused me to pause and fear being a midwife. 

i'm not naming names. there is no point. but there definitely were some heavy hitters involved. and actually most of these people are friends with midwives i've worked with.

the slogan "midwives for families, not midwives for midwives" comes to mind. 

so in this discussion, these women were critical of licensure because of the restrictions that it puts on birthing mothers - namely, breech, twin and VBAC. in many states once midwives become licensed these criteria are out of their scope and midwives cannot serve these women out of hospital. the argument - they are higher risk. the unfortunate reality is that the obstetric community has seen these women as a obstetric emergency and will advocate for early elective c/s. so the mothers are really not in a good place. 

there is a positive side however, ACOG recently put out recommendations saying that vaginal twin birth was a safe as a c/s; in many countries such as canada breech birth is coming back and more practitioners are being trained in how to help manage them, and VBAC? well in WA state midwives can choose to care for women who are attempting VBAC's using a community standard protocol that is evidence based. so things are improving. options for birthing women are improving. it's not perfect. 

i don't completely get the argument that these restrictions say that women are not smart enough to make decisions regarding their own bodies. i think if that is the case then these women should birth unassisted, at least don't hire me. when you hire me, you are hiring me because i sought education in how to help mothers prenatally and throughout their birth and postpartum. you are hiring me because of my knowledge. 

so back to this discussion that i was in. i can see for the most part what these women want is for optional licensure, like what oregon and minnesota have (though oregon is possibly transitioning into mandatory licensure). they disagree with the CPM being the standard. which i can agree with, i think midwives could do with more rigorous training, but i also think that the CPM is an adequate baseline and that these are good midwives. and to streamline a system of licensure. it's a starting place.

what shocked me out of this discussion was the alleged belief that licensure impacted the care we give to mothers. that it put licensed midwives on par with OB's. and what got me to my core was a comment that licensed midwives were intervening in women's birth causing them to have postpartum depression and breastfeeding issues. that women were hiring a midwife expecting one thing and then not getting the birth experience they wanted because it was "managed" by the midwife rather than just allowing the mother to birth the way that she wanted. 

oh my, i could break down this in so many ways, but it got to me. so not only do i have the responsibility of two lives in my hands, i also have the responsibility of how my actions may impact the mother and baby (and negatively at that). one of the reasons that i became a midwife was to protect that postpartum period, now i'm being told that if i'm "managing" a birth and that if it isn't what the mother wants (but if in my educated opinion needs to happen) that i'm causing mothers to have negative birth experiences and postpartums. pressure. ok. i tap out. i don't want to be a midwife then. i can't handle that. seriously. it's too much. 

thankfully i was surrounded my amazing women who took me in their arms while i cried and replenished my strength to move forward. 

what this all makes me wonder is what are we as women putting on other women. all these expectations. we set each other up for failure, that you are never good enough. oh a midwife helped direct your pushing or reduced an anterior lip. you didn't birth on  your own. your body didn't do it itself. seriously? do we think that women who were attending other women in pictographs just sat back and let a mother birth on her own and didn't do anything to facilitate the process? that's pretty nieve. 

a doula at a birth the other night talked about her births. her second baby she had an anterior lip that the midwife eventually reduced after the mother recognised that her pushing efforts were being held up by something. in her next birth that sensation returned. she knew within herself that the lip was there and asked to have it reduced, and then the baby came. does this mean that the mothers body failed her? what right do we have to judge women and their birth experiences? 

if i'm "managing" a birth by protecting a mothers perineum, telling her to slow down as the head is crowning so she doesn't blow her bottom out, is that her body not working? if she is happy, but you are not because someone else had hands on her body as she pushed. who needs to take a step back? birth isn't just going to look one way. i've only attended 130+ births. they have all been different. i've watched mothers birth their own babies without anyone's hands on them, i've also helped a mother direct her pushing. one wasn't more empowering than the other. and if you judge a woman because she had help, who is the one disempowering her experience? who is the one causing her postpartum depression when she's been told her body failed her? that she could have had it better? 

why do we as women sabotage each other?

Monday, March 25, 2013


sharing just a small moment of last night with you.

a grandma meeting her grandson for the first time. she was downstairs while her daughter was birthing taking care of her other granddaughter. she comes upstairs to check on things to find mom and baby tucked into bed.

cries of joy in korean as she instantly fell in love with this new life. overjoyed. proud. shocked.

*scenes that bring tears to a midwives eyes*

Saturday, March 16, 2013

87 days

in 87 days i return to maine for homecoming. 

writing senior exams. two days of testing, case studies. review of all that we have done. and the graduation. 

there are only four from my class graduating this term, eleven total from what i can deduce. this is the average in which most midwifery programs graduate new candidates on a yearly basis. 


i need to start studying, but reviewing the last three years is daunting.

i at least tried to organize some of my course work yesterday so i have a guide. still more to do. 

this is a reality check though, because in this time period i'll also be packing up and moving. not really sure where. to a storage unit in regina? for the time being i guess. and then the plan is to drive across to maine. so there is a week lost there. 

umm...Ok maybe 75 days of studying. 

i think my blood pressure just spiked. 

send help. 

Wednesday, March 6, 2013

recognizing my white privilege

interesting conversions.

they really began for me more than a year ago at the CPM symposium and have slowly been more prevalent since then. i suppose i'm becoming more aware that these conversations actually need to be had and i'm really not competent to have them. but at least i'm in them. i'm trying.

i don't feel as though it's my obligation to speak up about white privilege and the racial disparity that is imbued in every nuance of this world. but i feel as though i'm being asked. the need is there. a shift has to be made.

it's my obligation to stand up when it could be so easy to sit down. to turn it off in the way that my white privilege allows.


a few weeks ago there was a post from midwifery today that compared the plight of midwives with the abolitionists and childbirth in america with that of african american slaves.

the response was heated and emotional. controversy arose. the post was removed and an apology given. and a letter to the editor written.

it was strange to be part of that. to know that there are people that think that is ok. and placing myself within the framework to defend that.

it's not comfortable to think about the fact that i have experienced and accomplished much in my life due simply to the fact that i am white. it's much more difficult to accept it.

but here i am. and this is what i am doing. starting a conversation.