Should my midwife be my friend?

There is an interesting dynamic between an expectant mother and her midwife.  Those of us who have experienced this relationship know how binding and powerful it can be. Of all the aspects of this relationship, there are two that stand out to me as being problematic. One is the false sense of empowerment and control that is cultivated in the mother as she prepares for birth. And the second is, quite simply, the the highly intimate nature of the midwife/client relationship. These things can complicate the relationship to the point of compromising care, leaving women vulnerable and targeted for unbalanced influence that could put them and their babies in harm's way.

First, let's consider the issue of empowerment and control. If I had to paint a portrait of the kind of women who seek the care of midwives, one of the defining characteristics would be their tendency to carefully analyze every decision they make.  Mothers interested in midwifery care are reflective, educated, well read, and thoughtful. They don't make any choice without asking questions and they don't do things just because it is considered the norm.  They search long and hard until they feel completely reassured that they're making the best choices for their baby. Ironically, this is the type of woman who seems particularly vulnerable to being swept up in the arms of midwifery.  

In fact, these women who think they are "educating" themselves about birth (doing all their homework, so to speak), are the same mothers being seduced by imagery and manipulated data from the NCB community. They are assured that home birth is safe - safer than hospital birth.  They are told that hospitals use too many unnecessary interventions.  They are told that what would normally be considered a high risk factor is "just a variation of normal".  They are told that our culture has lost the ability to birth naturally, robbing us of the opportunity to "experience" birth and keeping us from being the women we were born to be. But the midwife's sales pitch for natural birth is often one-sided, with a stark and deliberate absence of information offered about the inherent risks of out-of-hospital birth. As the midwife builds up the appealing (and false) image of the gentle and safe nature of birth, the mother develops a sense of pseudo-empowerment and a false sense of understanding. The image of a perfect natural birth starts to take shape and the mother's determination to achieve it settles in.   

Essentially, through very carefully crafted and presented propaganda, women are offered an important motivator in deciding to birth outside a hospital - the illusion of control.  In out-of-hospital birth, the woman is taught to control her thoughts, to "trust birth" and to listen to her intuition to guide her through labor.  Her cervix isn’t checked unless requested. She isn’t told when to push. She relies only on her own instincts.  These mothers feel as though they are making a conscious decision about everything from environment to having the freedom to birth the way they choose . . . as if it's as simple as picking out what to wear for the day.  Midwives cultivate this notion by assuring moms that, simply by being women, they are experts on labor and birth and will therefore be able to make the best choices for their babies. As the big day approaches, women develop a false sense of control and unrealistic expectations for their birth experience, including the charming idea that they will somehow be "empowered" if they are able to accomplish this feat "naturally". 

In reality, we must all admit that birth is not something that can be controlled - not by mothers, not by babies, not by doctors, and certainly not by midwives. At best, a doctor or midwife can attempt to guide us through the experience, watching to keep us safe and taking action when things aren't going right.  We cannot control birth and being led to believe that we should is deceiving. 

Another element of the dynamic between the expectant mother and the midwife that proves problematic is the idea that your midwife should not only be your caregiver, but also one of your closest friends.  Midwives sell themselves on the fact that they spend hours of personal time getting to know you and your family intimately. But consider for a moment how creating that kind of close, personal relationship with your care provider can backfire. Establishing an intimate relationship with your care provider can establish a false sense of security and build unfounded trust. Personal relationships involve emotion and those emotions directly affect your ability to make clear and balanced decisions.  This is where the “midwife spell” comes into play.  When a midwife has taken the time to get to know you and bond with you, their influence upon your decisions becomes quite powerful.  “But with great power (and friendship!) comes great responsibility” and, sadly, in some cases the nature of this power becomes unbalanced and potentially manipulative.  This is why we hear stories of women trusting their midwives far beyond what a rationally thinking woman would do.  (Examples: extremely prolonged labor, using garlic to treat Strep B, attempting high risk births outside a hospital such as breech babies, multiples, and VBACs, etc).  In these cases, trust and personal relationships become a liability and can prove detrimental to overall care.

These dynamics between mother and midwife are key components to "advancing the cause" and many women don't realize they are buying right into it.  As she seeks control over her experience and a competent friend/midwife to guide her through it, a woman leaves herself vulnerable to manipulation and influence. She is lulled into a false sense of control and subject to making poor decisions based upon emotional ties.  Then, when things go wrong, the responsibility immediately falls upon the woman and family for having made the choice of out-of-hospital birth.  Never mind that a true “choice” cannot be made if all facets of risks and benefits aren’t presented for evaluation. For many women who believe in making educated choices, and even those who defend their right to have a choice in where/how they give birth, they don't realize that choices are being made for them all along the way. 

When it's all said and done, who would you rather employ? A competent doctor who lacks bedside manner but who keeps your baby safe, even if it means having to make tough decisions that you might not like? Or a midwife who is your friend and encourages you no matter what, but puts you baby's life at risk? I think the answer is obvious.