Friday, May 4, 2012

Midwife Masquerade: Denial

Yesterday we talked about the wide range of birth philosophies that influence midwifery. This range of beliefs creates an enormous disparity in quality of care that is not always apparent to mothers and families searching for a caregiver. While it might be easy for a family to assess a midwife's credentials, it is more difficult to evaluate her philosophy of practice.

In the past here on the blog, we've also noted the phenomenon of the NCB (Natural Child Birth) community throwing support behind midwives instead of families when "unfortunate outcomes" come to light. Those families who dare come forward to share their horrifying experiences of loss and grief, find themselves against a defensive community of NCB supporters, claiming that the family is on a "witch hunt" instead of seeking accountability. I think there are three reasons why this is happening.

One of the biggest reasons is simply because the majority of these supporters are women who have had only good experiences with a midwife. They instantaneously feel as if something they hold dear is threatened. Some of these women do not yet fully understand the vast differences among midwives, nor do they understand why it matters because they have only had positive interactions.  In essence, they still are living within their bubble of beliefs, in an echo chamber - not understanding how midwifery could stand for anything but the best birth experience imaginable.

The issue of misplaced support and understanding in the NCB community is perhaps further explained by the notion of denial. It is very difficult for people to feel like something they researched, believed in, and trusted could be misguided.  How would that reflect upon our own choices?  It would make us look foolish for believing in it in the first place, let alone recommending it to our friends.  The first instinct then is to defend their choice, to protect their midwives, to tout their good experience, to cry "don't take our choice away just because you had a bad experience."  

The last reason I believe the NBC is quick to shun mothers and families who have experienced loss is deeply personal and has to do with the relationship between a woman and her midwife. When a woman hires a midwife, it's because she believes in birth being natural and she appreciates the personal care a midwife can offer.  Women seeking a midwife often are looking for more.  They want to feel like they are being educated, empowered and valued. They want to feel like they are part of a community (one that can extend past birth and into the child-rearing years) that appreciates birth for all its beauty. The point here is that many women consider midwives to be their friends, sisters, or mothers.  And when the buzz starts to rise about things going wrong, it is nearly impossible to admit that your friend, sister, or mother-midwife would do wrong, even if it is unintentional.   

The truth is that a midwife's beliefs vary widely.  These beliefs significantly impact the care they provide, especially during emergency situations.  If you have a picture perfect birth, without complications, of course your midwife is great.  It is the moments when things aren't going right that you need your midwife to take decisive action to keep you and your baby safe. When the NCB community blindly supports midwives just because they are midwives, they are fostering the downfall of the profession.  If we cannot look at this profession analytically, acknowledging the failures in and effort to improve them, eventually it will fall.  Living in denial and ignoring families who speak out in order to protect something that is false, or at best misunderstood, cannot lead to improved practices.

To "masquerade" is to pretend to be something one is not.  I believe some midwives are pretending to practice safely, claiming they attend low risk births when in reality they are not, claiming that "birth works" for everyone and at all costs, and creating a false image of birth as being inherently safe.  Their followers are creating a space of denial in which these midwives reside, protected by the practices of the midwives acting responsibly and the confounding variability that is implicit in the term "midwife". 


  1. I find the close relationship that a midwife might have with her client to be a little troubling. Is there the objectivity needed in quality care when things go awry? What about when the pregnancy ends? I assume many midwives have clients as their friends after and this scenario probably works for many midwife/client relationships. But when something goes wrong, it might be harder for the parents to be objective in pursuing a legitimate case against the midwife for accountability when she has become a friend. I think that's what makes the HB midwife different than a hospital-based midwife; the relationship with the former is more clinical, but overall healthier in the big picture. I appreciate the doctor that can be friendly and kind, but ultimately focused on my medical needs first and foremost. How can this happen with such a close friendship between women?

    1. Laura, you nailed the message I was aiming for. I plan to write a post soon that examines the relationship between midwife and mother in greater detail. I agree that the relationship can be dangerous in terms of having the ability to make good judgments and decisions. More to come, thank you for your insightful thoughts!

  2. Thanks so much for this post!

  3. I can understand why women choose midwifery as a model of care during birth. Of course a woman wants a beautiful birthing experience, of course a woman would want to feel some kind of emotional connection to the person who is there to help her through the birthing process. Birth is so intimate, so emotional, so precious.

    The problem is that the midwife's primary role is not one of friendship. You do not pay your friends to love and support you. Your midwife is there to provide prenatal care and assist you during childbirth, as well as during the postpartum period. When you tell a friend a personal detail about your sexual history, they aren't required by HIPAA to keep mum. Your midwife is.

    If midwives are going to be taken seriously as professionals, then they need to establish a standard of ethics regarding client/midwife relationships. Something similar to what therapists and clients have. You can tell your therapist your problems, but your therapist can't call you up at 2 a.m. because her boyfriend broke up with her.