Finding Fault in "Limited Choices"

Change is difficult, no doubt about it.  When one door closes, an opportunity arises for something new...dare I say something better?  It is possible.  Sometimes when we don't understand change, it's easy to find someone to blame.  Especially when that change seemingly takes something from us. 

The Greenhouse Birth Center is closing next week...for some a devastating loss, and for others a long overdue wave of relief.  An advocacy group has formed asking for higher standards and safer midwifery practices.  The safety of out-of-hospital birth is under the microscope.  Politicians are talking.  Safer options are coming to town.  Babies have died, babies have thrived, and everything in between.  Media is concerned, as is the State regulatory body.  Resources with accurate information are being developed.  There is no more hiding from the public, the lurking shadows of midwives practicing in unsafe ways.  Women want choice, but they also want those choices to be as safe as they can possibly be.  So what is a community to do? 

There are several things to consider.  First, we should think about why changes are happening in the first place.  Changes are happening because babies are dying that don't have to, plain and simple.  Changes are happening because the foundation of midwifery is cracked, and patched with unethical practices.  It's a bit like erosion, with midwifery as the cliff at seaside that stands tall and proud.  After years of the wind and waves eating away at the surface, slowly cracks penetrate.  Chunks of rock go crashing into the sea.  The mountain from which the cliff emerged, still stands, as do those midwives practicing responsibly.  There is no doubt that the structure is continuously wounded.  The erosion in this analogy refers to is ego, the inability to define risk, and further the inability to admit responsibility.  In many cases, the cracks spread far and wide because of incompetence and fear.   When midwives lie and deceive to skirt accountability, enormous boulders crash into the tumultuous waters below.  A profession cannot stand tall upon these principles and practices.  It simply cannot.  Midwifery, specifically those working in the out of hospital setting, must find a better way to serve women and babies.  It must hold itself to higher standards of education, understanding, perspective, practice, and ethics if women are to rely on it. 

Another question we must wrestle with is considering where fault lies?  Can one person, one family really cause such an uproar?  Some like to think so.  Some like to say it's our fault that changes are on the horizon.  Blame can only be attributed to one family speaking out if  you believe the notion that they are deluded cult leaders who hate midwives and want revenge.  That they are so overcome by grief that they want to take away the rights of others.   Some reason, "They must not see the other side, they must not see that they're taking away our choices."    

Folks, we have seen the darkest side.  A side we wouldn't wish upon anyone, and that is why we speak.  

I have yet to meet a loss or injury family who makes up a story for sympathy.  I've also yet to meet a grieving family who steps into the media to be scrutinized, attacked, and shunned just for the fun of it.  I have yet to meet a loss family who is at fault for taking away the choices of others because they told the truth. 

I have met many families though, who care about people, who care about right & wrong, and who don't want to see what happened to them, happen to others.  I have met many who feel used, manipulated, and duped...whose "choices" were taken advantage of.  Families who share their stories are not persecuting midwives, we are telling a truth that could just have easily have happened to any family.  In making the decision to share our stories publicly, fault is immediately bestowed upon us. It's another burden, along with grief, that we must bear. 

If someone must bear this burden of fault for instigating change, I accept it proudly.  If it is my fault for telling the community what happened to our family, for asking for higher standards, for advocating for safer practices, for suggesting things could be done better, then I accept.  If holding negligently practicing, individual midwives accountable for their actions, means that other mothers in this community have less of a chance of being served by them, and more accurate information about the reality of what is happening in their care, I accept that blame too.  If pointing out to the community, misleading associations between our own state and community, and loss of freedom makes me somehow to blame for misplaced anger, then I accept that.  Only so many babies in our state could be injured or die before someone started to talk about it.  For too long, we thought we were the only family.  Alarmingly, we learned we are not.   If someone or some group of people is to blame, consider the midwives who are practicing dangerously, those responsible for preventable deaths.  

I do understand loss, and I can see that with Greenhouse closing, some are mourning a loss in something they believed in.  What I hope this community one day understands, is that I want something better for all of you than what my family had, and I know it can be done without taking away choices.  It may seem that our choices are limited in the immediate moment, but by raising standards for education and practice, the end result will mean better care, better options, and establishment of accountability in a profession where there is none.  

Change is difficult.  It is especially difficult when it involves people you have trusted intimately, people you think are friends, people who have loved your family and delivered your babies without issue.  The fact is, no matter how great your care was, it wasn't that way for all of us.  It took the most traumatic event of my life to see past the illusion of trust and friendship I had leaned upon for so long.  Something had to change before more lives were lost, and there is more work to be done.  

Instead of misplacing blame because something so many of us thought was real, turned out to be an illusion, we should be asking ourselves: What do these changes mean, and how can we move forward in a way that will simultaneously improve the profession of midwifery for the safety of those who choose it?  Saying women are smart enough to choose isn't enough.  Ignoring the reality of unnecessary deaths and injuries is unacceptable.   Pretending these families are the villains, and midwives are somehow victims is distorted beyond my comprehension.  A shift in focus needs to occur, and it should be about working toward something better for all of us.  Time to talk about solutions. 

Are freestanding birth centers "safer" than hospitals?

Expectant Mother: I've been hearing rumors of several infant deaths in your care over the past couple of years and a baby who is currently in the RNICU fighting for its life.  Should I be worried? 

Local Freestanding Birth Center: Here is an updated stat sheet (shows "data" through 2010, even though it's half-way through 2012).  Having your baby at our birth center is still safer than the hospital.  

Expectant Mother:  Really, safer than the hospital?  

Local Freestanding Birth Center: "Freestanding birth centers have demonstrated superior safety.  Safe and satisfying outcomes include significantly lower cesarean rates than the nation-wide average of 32%."  "Birth is as safe as life gets."  

I feel compelled to address some of the myths women are being told in our own community.  The first is noting that safety should be defined as much, much more than whether or not you have a cesarean.  The way your baby is born has nothing to do with whether the labor & delivery was "safe".  What matters most is whether you both come through the experience alive.  

Safety is defined by Merriam-Webster dictionary as, "the condition of being protected from, or unlikely to cause danger, risk, or injury."  Ignoring risk factors, inviting clients to opt out of assessments that would determine risk,  and pretending that risks don't exist during childbirth, is not what I would consider safe.  Implying that having a cesarean is the enemy, a danger to be avoided, or that having one is "un-safe" creates a fear in expectant mothers that shouldn't be perpetuated.  Consider for example a mother who ends up needing a cesarean for reasons that couldn't be avoided in order to keep her baby safe.  Her first thoughts would be about how dangerous it is for her and baby instead of understanding its necessity.  A planned, pre-term cesarean without medical conditions is one thing, a cesarean that saves lives is another.  Using statistics as scare tactics and without context is unethical.    

I would also note that having a "satisfying" birth has nothing to do with safety.  Approaching birth with the priority being about the "experience" instead of the safety of babies and mothers is absurd.  While I believe that everything should be done that possibly can be done to ensure the experience is positive, ultimately the safety of the baby matters more.  It is not acceptable to sacrifice safety for a satisfying experience, rather the two should work together with an understanding that sometimes safety takes the driver's seat.  The mother I mentioned in the previous paragraph who had to have a cesarean, deserves to know her baby was born just the way he or she needed to be and to be no less satisfied because of it.  When cesareans are made out to be the standard by which we measure safety, we have a real conflict of interest on our hands.   

While I appreciate that no major surgery, cesareans included, come without risks, there are many more immediately dangerous circumstances that can come during labor that could cost your baby his life, put him at risk, and place him in a situation that is ultimately not safe at all in a freestanding birth center setting. ACOG President Kenneth L. Noller, MD, MS, states, “Even a normal pregnancy can become high-risk with little or no warning, and serious, sometimes life-threatening complications may arise for the woman and her fetus.”  He noted that shoulder dystocia occurs in one in every 200 births and listed the frequency of other complications:

• prolapsed umbilical cord: 1 in every 200 births
• life-threatening maternal hemorrhage: 1 in 250
• eclamptic seizures: 1 in 500
• uterine inversion: 1 in 700
• Apgar score of 0–3 at 5 minutes: 1 in 100 to 200.

These situations should be considered far more dangerous for your baby than a cesarean, and furthermore should be the foundation for discussions about the safety of out-of-hospital birth and it's relative "safety".  Instead, the birth center in this example is referencing cesarean rates and not addressing the real complications mothers need to be aware of if they are going to be truly "informed" about the risks they are embarking upon by choosing a freestanding birth center.  Neglecting to share the real risks that would define measures by which safety could be adequately assessed is not informed consent, nor is it honest, nor is it honoring the rights of women to make choices for their own well being.  No one can argue that based on proximity alone and immediate access to medical technology, hospital birth has to be considered safer than having a baby farther away...even if it's "only 12 minutes from the hospital".     

I need to state the obvious, of course a freestanding birth center with no medical equipment or medical personnel, is going to have a lower cesarean rate when compared to a hospital.  They are comparing apples to oranges here.  A freestanding birth center doesn't do surgery and would have a cesarean rate of 0%.  A hospital, taking on all kinds of high risk births including breech and delivery of multiples, etc, would of course have a higher cesarean rate in comparison.  Does this mean they are somehow not as safe in overall practices?  The claim doesn't even make sense.  Nothing about the rate of cesarean in either birth center or hospital addresses why a birth center would be safer.  Wouldn't the outcome, a baby and mother who are alive, be a better determining factor of safety, regardless of how the baby is born?  The statement about cesarean rates is nothing more than a distraction, a way to avoid answering the question, a way to influence a woman's feelings about cesarean delivery in a subtle way. 

Mothers also need to understand that a freestanding birth center in Michigan is not a licensed facility and does not report their outcomes to the state or anyone else.  There is no data to support the claim that giving birth outside the hospital is somehow safer than giving birth in the hospital. In fact, when babies who die are transferred to the hospital in an effort to save their lives, they are counted as the hospital's loss, as we learned from personal experience.  There is no body of oversight, no third party checking the "data" on the handouts a birth center distributes, and nothing that gives what is printed on that paper any kind of credibility.  There cannot be evidence to prove the birth center's safety if there is no reported data about outcomes that would directly demonstrate safety margins. 

Studies that have been done to compare safety and mortality rates of out-of-hospital birth to in-hospital birth, consistently show that out-of-hospital birth is 3-4 times more risky.  (See Wisconsin's WISH website)  Another interesting point to be made here is that MANA (Midwife Alliance of North America) did conduct their own study about mortality rates in home birth. When the study was completed, they decided to keep the results private, only issuing the release of their findings to researchers who sign a contract, agreeing to use the information to advance the cause of midwifery.  Hmmm, something to hide? 

A birth center's safety can only be considered "superior" when compared to free or unassisted birth.  You don't want to find yourself in a room with a care giver who views cesarean rates as the defining standard for safety assumptions.  Please make sure you have real conversations about risks and safety before choosing to have your baby outside of a hospital or hospital run birth center.  Are hospital's perfect?  No, but real risks, like your baby not surviving, are even higher when you choose to have your baby at a freestanding birth center.  Make sure you're in the hands of a care provider who is being honest with you about potential complications, risks, and all matters that would impact you or your baby's safety.  It is one thing to be honestly and accurately informed in making choices about where to have your baby, and quite another to make a choice without knowing the truth.        

Lansing State Journal: "Homebirth movement raises questions of acceptable risk..."

The Lansing State Journal has spent 3 months researching birth in Michigan.  Reporter Louise Knott Ahern did countless hours of research and interviews to compile a comprehensive piece about midwifery in the state of Michigan.  The article considers everything from philosophy, to birth options, and safety.  

You can pick up a print copy of the Lansing State Journal today, Sunday, June 3rd, or you can find all the articles, videos, and more at:

"Lawsuit brings home birth movement into the spotlight"

"Home birth movement raises questions of acceptable risk" 

"Who cares how the baby gets here?" 

"How far is too far in a birth emergency?"  

"Where do hospitals fit in with 'normal and natural' birth?"

"Birth Center's practices under scrutiny since March lawsuit"  

"Read local birth stories and share your own" 

(Notes: Be sure to check out the links on the left and right of the article too for extensive resources, interviews, birth stories, and more.  If you start getting pop up boxes asking you for a subscription, just clear your browser's cache.)  

Dr. Amy weighs in on the subject too on the Skeptical OB Blog: 

"Brilliant series on the dangers of home birth"

A full article review by Safer Midwifery for Michigan will be posted tomorrow. 

The real reason I chose a birth center

I'd like to welcome a guest post today by a Lansing area mom. Do you have an idea for a post topic? Are you interested in sharing your story? We would love to hear from you. Please get in touch with us here. 

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It took me a year, but I think I am finally able to be honest with myself about why I wanted to have my baby at a birth center.  I didn't chose a birth center because I thought it was safer. Or because I was scared of the hospital. Or because I think natural birth is better than medicated birth. I went to a birth center because I was lonely and I wanted to meet people.  That's the truth. Let me explain.

My husband and I moved to Lansing a little over a year ago from another town in Michigan. We got pregnant and had our first trimester of care out of state. When we came home I felt anxious to start building my social "nest" - surrounding myself with people that would support me through the rest of my pregnancy and into parenthood. With all of my friends and family out of town (and out of state) and no local network of colleagues or acquaintances since I work from home, I felt terribly isolated. The way I saw it, I had about twenty weeks to build a social hub for myself and my baby. How could I do it?

Then I landed on the perfect answer: I could have my baby at the local birth center - Greenhouse Birth Center! Plugging into that community of midwives and families seemed to be the fastest and easiest way to gather support for my motherhood journey. I felt that if I had a hospital birth, I would miss out on a one-time chance to forge meaningful, long-lasting friendships . . . the kind of relationships that build up around powerful, shared life events (like birth). Have you ever heard a woman talk about her hospital "community?" Me neither.

Through our pre-natal care, I did feel that I was building close relationships with the midwives. We talked for hours over the course of our pre-natal visits. They asked me about my Thanksgiving dinner. They met my mom when she was in town. They gave me hugs. We laughed, we cried . . . I figured we were well on our way to being buddies. I didn't have as much interaction with other moms as I had hoped (our birth class was really small) but I figured that would come after our son was born with Mommy & Me classes, breastfeeding support, etc. All in all, I felt very comfortable and welcome at the birth center and that was just what I needed . . . a place to go where everybody knew my name. As my due date approached I felt very confident. Not only was I healthy but I trusted that the close relationships I had been forging with my caregivers over the last 20 weeks would come in super handy during labor. I imagined that the midwives would know exactly what to do and say to help me. I also felt certain that they would support me if and when I needed additional help or asked to go to the hospital. Through all of this, it never occurred to me that we would have anything less than a stellar labor/delivery at Greenhouse Birth Center. After all, I had only ever heard positive things!

Unfortunately, I did not end up having a great experience. I had a frustrating labor and a sloppy hospital transfer. I asked questions during labor and got blank looks. The midwives told me I was completely dilated and encouraged me to push when it was too early. They stalled when I asked to go to the hospital after pushing for three hours then told me that, if I went, I would probably have an emergency c-section (which I didn't). We arrived at the hospital and spent the next 30 minutes answering basic health questions and filling out insurance forms, since we weren't pre-registered. Our midwife came with us but did nothing to assist in the transfer of care. We felt like people off the street. All in all, the midwives were passive and at times downright unprofessional during the time when I most needed guidance and support.  Happily, our care at the hospital was excellent and our son was born healthy. But my carefully laid plans for having the birth center as my social hub post-partem had gone right out the window.

I didn't feel like continuing relationships with the people who had disappointed me. I also felt embarrassed about "failing" and going to the hospital - how could I face other birth center moms with my story? I felt confused and insecure. Those feelings all persist but now, more than anything else, I feel angry at myself for making such an important decision based on my emotional needs. By placing such high value on my social "birth experience" as a woman and a mom, I actually jeopardized what was really important: the health and wellness of our baby. I will always regret that.

I wanted to write this post because I don't think my mindset in choosing an out-of-hospital birth was unique. After all, it seems that most couples these days are raising children far away from their support network of parents, siblings, relatives and friends. Unfortunately, the people that matter most to us - the people we want around during challenging times - are often scattered far and wide. For women, I think this distance is especially difficult during the childbearing year. I know it was for me. But I learned that no matter how lonesome you feel and no matter how much you crave a place to belong, it isn't appropriate to make important decisions about health care based on emotions. I won't be making that mistake twice.

The Hypocrisy of Midwifery

I'm growing weary of the hypocrisy that permeates much of midwifery and the accompanying NCB (Natural Child Birth) advocates that can't see the forest through the trees, despite their own great experiences. Those who "sell" natural childbirth say that it is safe and put it on a pedestal. But when a baby dies, they quickly change their tune and say that it was the parents "choice."  Never mind that the risks were never part of the conversation from the start, at least not in an honest way.

How is it that midwives can claim that home birth is safe - as safe as life gets, safer than the hospital - BUT the minute a baby dies the mantra shifts dramatically to place responsibility on the parents as having made the "choice?"  

Dear midwife, ...Wait a minute, I thought you said it was safe?  Isn't that the "choice" I made, choosing something safe, the educated choice that was better for me, for my baby?  I don't remember making a choice to put my baby's life at greater risk?  Did we talk about risks?  I don't remember talking about them, but I do remember talking about how close the hospital was, how sure you were that you could spot trouble with plenty of time, how we are born to do this and babies know how to be born, how you've been delivering babies for 30 years with a spotless record.  I remember choosing you because you told me this was safer for me and for my baby.  I remember all the awful things you taught me about what the hospital and doctors would do to me if we went there.  

I remember you telling me that a breech baby is just a variation of normal, that they tend to fall out.  I remember you telling me that you were confident in delivering him, that we didn't need another, more experienced midwife to be here.  I remember you telling me that recent research supports vaginal breech delivery and that we were good candidates for said delivery.  I remember you telling me you watched a video once on breech birth, was it Ina May's from 1980?  I remember you teaching me to trust birth, and building a relationship in which I would trust you, and I did.  Turns out that trust is exactly what blurred my rational thought.  Our baby never came home.   I trusted you to know what you were doing and to tell me the truth about risks involved so I could make a "choice".  

Instead, the choice people speak of was taken from me, by intentionally manipulating information and conveniently avoiding conversations about real risks involved.  Perhaps I should coin the phrase "choice rape" here. 

Things get even uglier when NCB advocates start defending negligent midwives by saying, "Don't take my choice away just because things went wrong for you.  Maybe you should  have done more research and picked a better midwife."  Why is it that in the Natural Child Birth movement, women are continually exhorted to "educate yourself, mama!" and "take responsibility" for your birth? We don't do that with any other aspect of medical care -- we don't tell women take responsibility for their own breast cancer treatment! Plus, to what degree can a person truly educate themselves when their main tool is the trust they have with their care provider (one who claims to be a professional), and frankly, Google?  I am not a researcher, nor am I a physician.  I am a mother who trusted her care givers to be professionally competent & honest in an area that they posed as an expert.

Dear midwife, . . . Why is sharing the truth about adverse care so viciously attacked?  Why does your good experience with a midwife mean you were smarter than me or did better research?  Why does your good experience mean we should excuse situations that weren't handled properly?  Do you not care about the fact that negligence is happening and being brushed under the rug?  Why should we not hold midwives professionally accountable?  Why should they fly under the radar without reporting outcomes, getting a degree, or carrying insurance?  Why is this about hoping you get lucky in whom you choose to attend your birth and not about consistently reliable standards of care & ethical practice? Why does asking for midwifery to improve its practice, be accountable, and function in a way that is professionally safe, somehow threatening to a woman's choice?  Holding midwives accountable is about doing the right thing, about making negligence known, and ensuring bad things don't happen to other families, not about taking away anyone's choice!   Why wouldn't we aim to improve midwifery if it really has something to offer?   

The hypocrisy has to stop.  Either out-of-hospital birth is safe, or it's not.   
A midwife is either ethical and responsible 100% of the time, or she's not.  Women are being educated about real risks or they are not.  
We're either making a truly informed "choice" or we're not.  
Midwifery is a profession of highly educated professionals, functioning on behalf of the safety and a well-being of mothers and babies...or it's not.     

Related Posts:

Ask an OB: "Risk Out" Criteria

Midwife Masquerade: Denial

The Importance of Defining Risk

Considering Out-Of-Hospital Birth?  Questions to ask your midwife.

What We're Seeking: Defining "Birth Center"

"What We're Seeking" is a bi-weekly series that expands upon Safer Midwifery for Michigan's statement of purpose.  This week's post examines more closely, the current state of "birth centers" in Michigan and further indicates improvements Michigan families deserve.

Freestanding birth centers are not currently regulated in any way in the state of Michigan.  I could literally wake up tomorrow, call myself a midwife, and open a "freestanding birth center" in my garage according to current MI laws.  "There are 215 freestanding birth centers in the United States, with more in development. The number of birth centers has increased more than 20% over the past 5 years; they are regulated in 41 states." (American Association of Birth Centers.  http://www.birthcenters.org.  Accessed March 30, 2012)  

What is a birth center?  

The term "birth center" refers to a facility that specifically is designed around birth.  Birth centers are generally more in tune with supporting and nurturing a woman in labor.  In Michigan, we have birth centers that are attached to or affiliated with hospitals.  We also have "freestanding birth centers," which is an entirely different model and a body of absent regulations.

 

What is a" freestanding" birth center?

 A freestanding birth center is one that is not affiliated with a hospital or a physician.  The birth center may have a consulting physician, but this relationship is as your midwife determines a consultation is necessary.  It is not in a capacity of oversight.  Freestanding birth centers are not required by MI law to be licensed as a facility or insured, nor are there any regulations that specify when you should consult a physician.    

How is a birth center different from a hospital?  

A birth center's mission is to support and perceive birth as natural and normal first.  The staff is trained to support women and create an environment that embodies this mission.  You may find options in a birth center that more traditional hospitals don't offer, such as birthing balls, water birth, birthing stools, etc.  A freestanding birth center goes further to offer things like homeopathy, placenta encapsulation, and the freedom to birth without any rules or regulations in place.

Freestanding birth centers do not have emergency medical equipment beyond oxygen.  They cannot intubate or give medications that would be used in a resuscitation circumstance. They do not use Electronic Fetal Heart Monitoring, instead using intermittent Doppler assessments.  Midwives working at a freestanding birth center may or may not be licensed as individual, may or may not carry insurance, and may or may not be trained in NRP (Neonatal Resuscitation Program).  The bottom line is that in the event of an emergency, they are under equipped for life saving measures. 

     

Who works in a birth center?

In a hospital affiliated birth center, you care is primarily with a licensed, nurse midwife.  If at any time during your pregnancy or labor complications arise, your care would shift to that of an obstetrician at the same birth center or hospital.  

In a freestanding birth center, midwives, doulas and other staff run the facility.  Some may be licensed nurse midwives, others certified professional midwives (no license), and other apprentices or lay midwives (also not licensed).  Often times midwives in a freestanding birth center have a physician they will work with to refer clients they determine to have complications.  (Bear in mind that this determination of need is solely at their discretion as there are no regulations.) 

Are birth centers safe?    

This is subject to opinion and definition of "safety".  It is our belief that a birth center affiliated with a hospital is the safest alternative to a hospital birth.  Medical technology and staff are immediately available and they have high standards for education, scope of practice, and review of outcomes.  It seems to be the best collaboration at present, between out of hospital birth and traditional maternity care.  As you will read in many of our other posts, without defined regulations, standards for education, defined scope of practice, and without reporting outcomes, freestanding birth centers vary widely in ethical practices.  This poses great risk in terms of safety.  It's difficult to determine what you're really getting into. 

Are birth centers licensed, insured?

Hospital and physician affiliated birth centers are licensed and insured, as are the nurse midwives who work in these facilities.

Freestanding birth centers may be insured, but many are not as it is not required by law.  Freestanding birth centers are not licensed through the state of Michigan as facilities.  Some of its employees may be licensed as individual professionals if they hold the appropriate credential (CNM), while other employees are not.  There is no requirement for any midwife at a birth center to have a license.

Are birth centers "accredited"?

Some freestanding birth centers are "accredited" by a national third party who supports regulation.  To find out if your birth center is accredited, please visit this link. Click on the "parents" tab and search by zip code.  If the birth center is accredited, it will say so in parenthesis next to the name of the birth center.  (Note: The Greenhouse Birth Center in Okemos is NOT accredited.  In fact there is not an accredited, freestanding birth center anywhere in MI.)   

What actions would improve freestanding birth centers? 

A freestanding birth center is essentially electing home birth in another house with no regulations, no insurance, and no reporting of outcomes.  In order for birth centers to be considered safe, they must be licensed as facilities & individuals, insured, and required to report all out comes. They should also have a board and policies established to review practices regularly, including insight from outside their own practice.  Even if these practices were in place, proximity alone makes them a greater risk to get the help you need in the event of an emergency.  

Free standing Birth Centers: Common Myths Revealed

The quotations below are taken from the website of Greenhouse Birth Center, a free standing birth center in Okemos, MI. Many of these statements - or versions of them - inform the philosophies and practices of birth attendants nationwide. They are reassuring and empowering. They are also woefully incomplete and oversimplified.  As with many things, birth cannot (and should not) be summed up in one sentence, one phrase or one mantra. For mothers considering out-of-hospital birth, it is essential to be able to think critically about statements like these. After all, birth is complex and our understanding of it should be equally complex. To that end, we've taken these statements of belief and fleshed them out a bit to paint a more realistic picture of birth and maternal care.

• "Birth works."  Birth often works, but not always.  Sometimes women and babies need help. 

• "Just as our bodies know how to grow and nurture our babies, they know how to give birth and how to feed them."  Our bodies are beautifully designed, but they don't magically know how to give birth or how to breastfeed successfully all of the time.  They are not perfect in function.  We have intuition, but we also have experts to help guide us when our bodies need help.  Birth and breastfeeding come with great challenges for most of us.  Many women and many babies have died during childbirth. 

• "The very things that help you go throughout pregnancy safely and well are the things that will help you give birth safely and well - health, confidence, support, privacy, and tender loving care."  What's missing from this list of what will "help you get thorough birth safely" is careful monitoring by educated, skilled professionals who can and will recognize signs of danger, acting appropriately to keep you and your baby safe.  Another  key factor in determining "safety" is the availability of emergency technology, equipment, medications, and medical personnel.  It's irresponsible and crazy to think if you're confident enough, trust birth enough, and are supported with love that things will turn out fine.  I used to think that, and it cost my baby his life. Safety means you and your baby go home alive, anything less is unsafe. 

• "The best way to care for a pregnant woman is to educate her, support her, nurture her, and help her watch for problems so that she can avoid them or correct them when possible."  All true statements.  You have to first accept that problems exist in order to appropriately address them.  Then you have to have the skills and knowledge to recognize them when they do appear.  I would add that appropriate transfer of care when the "problems" detected are outside one's scope of practice is critical. "Education" does not mean indoctrination and manipulation of research, data, and truth. 

• "That if a problem should arise with mother or baby, consultation and collaboration with appropriate health care professionals provides safety and smooth transition of care when needed." Also true statements, but without guidelines this determination of when the transition of care is needed, is very subjective.  There are no rules to follow, and nothing that defines what is high versus low risk.  To many home birth midwives, high risk is "just a variation of normal".

• "That the presence and assistance of experienced women -the midwives- are useful guides to mothers in their journey of pregnancy, birth, and parenting."  The ideal is there, and likely the intention, but for many of us we felt like we were "unassisted", left to follow our intuition, with no real guidance at all during labor.  "The presence and assistance of experienced women" is great as long as the relationship stays professional in making clinical decisions as oppose to influencing clients with personal agendas.  

• "That a safe, comfortable space, designed for gentle birth and individualized care is the ideal way to provide our services to the women in our community who want alternatives to the medical model of care but are not comfortable with a home birth."  I think this statement bothers me most.  The insinuated "safety" of a freestanding birth center is such an illusion!  There is nothing safer about giving birth in a different building than your own home when that building (aka freestanding birth center) adheres to no regulation, has no medical equipment for emergencies, has no insurance, has no guidelines for scope of practice, and doesn't report its outcomes.  To insinuate otherwise is fraudulent.  And, I would further add that sometimes birth is rather violent, even in a comfortable space.   

Please visit the Reformed CPM's post entitled, "Just Believing Does Not Make it So" for more on this subject. 

Take Action!

Thank you for your readership and support here on the blog - we truly appreciate it. The last month has been fast-paced and inspiring - there is a lot of work to do! Are you wondering what you can do to help us make midwifery safer for women and families in Michigan? Check out our Take Action tab!  There you will learn about our specific goals and find people to contact if you'd like to help improve the safety of midwifery care in our state.  You will also find form letters prepared to help you advocate for change. They are all available to download and edit, as you see fit, along with the appropriate contact information. If you have any questions about the letters, need help accessing them, or have ideas for other ways that we can help raise awareness and concern, please contact us. 

Here are just a few examples of ways you can help!

• Become a "follower" of our blog to stay up-to-date on political changes, state developments, and community conversations.  Share posts, talk about the issues, and ask questions in the comment section or via the contact form.

• Write a letter to Senator Whitmer, who is currently drafting a new bill to propose standards for education, licensing, scope of practice, and reporting outcomes for all MI midwives.   

• Write a letter to Sparrow Hospital's CEO, Dennis Swan, expressing your interest in developing a birth center affiliated with the hospital.  

• Write a letter to Licensing and Regulatory Affairs or Department of Community Health if you see a need for change in regulation or have concerns about particular midwives or birth centers in your area.  

Thank you for your support, interest and engagement - you are doing important work!