Wednesday, October 3, 2012

Dear MANA Sisters: A Letter from a Midwife


Today's post comes from a midwife, who cares deeply about advancing the profession and improving safety.  Her identity is confidential.  We want to offer a safe space for midwives who are interested in talking about their concerns, and advocating for improved practices, to freely speak.  Here are her insightful thoughts: 


Dear MANA sisters,

I received my MANA Newsletter today and read it cover to cover, as I do, and have done, since becoming member of MANA nearly a decade ago.

I want to start off by saying I am one of you. “I am a midwife!” I go to trainings with you. I attend conferences all over the country. I stand in circles where we hold hands and sing and cry. I march public rallies in support of midwifery and home birth.

You, sisters, trust me. You call me at all hours of the day or night in confidence to review a difficult birth, to lament about a trying apprentice, or to decompress after a demeaning experience during a hospital transport.

When you look around a room full of midwives, my face is one of those among yours. I am not an anti-midwife, or an anti-homebirth crusader. Quite the opposite: I am a staunch supporter of midwives and home birth.

I have been humbled by the knowledge and compassion I’ve experienced among midwives and I am proud that I have been trained by so many wise and wonderful women. The sisterhood of midwifery has fundamentally influenced who I am - and for this I am grateful. But I did not enter midwifery to experience sisterhood. I entered midwifery to serve women, their babies and their families.

What I find so concerning lately from the midwifery community is a lack of acknowledgement that certain conditions exist which create higher risks for mothers and babies in home birth. And when a family suffers a loss, there appears to be a dismissive attitude toward that loss. Somewhere along the line home birth midwifery has been deemed “as safe, if not safer, than hospital birth,” and nothing will change that. Close the book. End of story.

This attitude causes suffering. And the statement in the MANA News about a piece of legislation introduced in Michigan being merely “knee-jerk” and the result of (euphemistically) an “unfortunate birth outcome” makes me wonder:

What the position of MANA is in the case of “unfortunate birth outcomes?”

What I know about the Michigan bill is that it was drafted quite thoughtfully by former midwifery clients and members of the public who want increased safety standards, public reporting of home birth outcomes, and more rigorous educational requirements than another licensing bill that was proposed.

Is it the position of MANA that asking for increased safety, more transparency and accountability, and higher level of education in licensing midwives is frivolous or undesirable?

What part of the Michigan bill, specifically, is “terrible?” Has anyone from MANA spoken with the state Senator or the advocacy organization who introduced the bill and tried to understand the rationale for the provisions in the bill?

Is it the position of MANA that “unfortunate birth outcomes” should play no part in drafting legislation to license midwives?

How many “unfortunate birth outcomes” are acceptable to MANA? At what point are these outcomes not aberrations or statistical outliers, but indications of the quality of care provided by midwives?

What is MANA’s position statement regarding families who have lost a baby with a midwife? Does the client’s perspective count in this circumstance? Or does MANA only care about clients whose babies lived? Are the voices and opinions of home birth loss mothers important to MANA? Or is it the position of MANA to minimize the death of their child (“unfortunate outcome”) and to ignore their perspectives?

As a midwife - as a woman called to serve women and babies - these voices are vitally important to me. I believe women. I believe these women when they tell me they were deceived into trusting a situation was safe that actually had increased risk. I believe women when they tell me they were deceived into believing the credentials bestowed on midwives conferred accountability and professionalism. I believe women when they say they were reassured that their home birth - in a risky circumstance - was safe.

What is the recourse when home birth proves to be unsafe? What is the response of the professional organization that purports the safety of home birth? Do you care about these mothers? Do you care about these babies? Does MANA admit there are circumstances when birth at home increases the risk to the baby and mother? Does MANA support, promote, encourage home birth with a midwife in ALL circumstances? Does MANA believe home birth deaths should be investigated? Does MANA believe that any death that occurs under the care of a home birth midwife was of no fault of the midwife? Does MANA believe that midwives are infallible?

How is MANA assuring that home birth midwifery is as safe as it says it is?

I want to belong to a professional organization that is mature enough to address these concerns and has enough integrity to address the weaknesses of midwifery as well as its strengths. If we want our profession to thrive, safety needs to be part of the discussion now, and it needs to be a part of the discussion always.

Turning a blind eye means these “unfortunate birth outcomes” will continue to happen. And some may truly be “unfortunate birth outcomes” but others may be due to negligence, carelessness and malpractice. In order for me to stand proudly in a sisterhood of midwives, I need this profession to be making diligent efforts to discern the difference. 


  1. I'm not a midwife, just a mother, and I find it very telling that not one midwife has responded to this letter.

    It's as if they know that there is no defense.

    1. Dear Karen,
      I couldn't agree more. It is telling. This letter is only the tip of the ice berg. So many midwives, ex-apprentices, and doulas have contacted us with concerns about practices they see within the profession. These are people that care deeply about midwifery, and even more about the women and babies they serve. They want things to change for the better. Every one of them wants to remain anonymous. They've seen others who speak up about change who are black balled in the profession, and threats made amongst one another. It's a bit like Fight Club. The sad reality in all of this, is that improving practices cannot happen in a dysfunctional system where midwives cannot freely discuss their concerns. I wish more of them could speak freely. Until then, we're happy to share any anonymous perspective on the subject. Thank you for your comment.