No More Toe Dipping: A Case for Just Hiring a Midwife Already

It seems like the intense focus we at Indie Birth have had on education has started to pay off in a lot of ways locally and in far off lands.  Lots of women are more knowledgeable and more confident about birth.  Some of them are doing their own prenatal care in lots of different ways. They are preparing for undisturbed births, and they are weighing the options they have carefully.  When we go to births, it is clear that we are in mutual relationships where the family has taken responsibility and feels like they can direct their own experience.  Unfortunately, some people also seem to think that based on our support for free birth, and our belief in birth as an exceptionally fine tuned and natural process, that we don't really see a reason to hire midwives anymore - but this isn’t true!  There is confusion about how our beliefs about birth translate into concrete decisions about planning a birth.  We have had women ask which local midwives they should interview since they assumed we don't go to births anymore.  We have had women ask us to attend their birth and they have felt like they had to defend wanting us there since they assumed we only support free birth.  We have seen women seem to be tentatively planning a free birth but then want some (and seem like they would really benefit from) more formal support, and they don't know what to call that since midwives have gone so far off track, or seem mistrustful that even conscious birth attendants would be respectful enough at a birth.  I hope this is making sense. Essentially, what used to be called midwifery now is without a name in our culture, as "midwifery" has become something medical, controlling and cold.  This is really confusing for women trying to navigate what they want, and where to get it.  People don't know what we offer, perhaps since it is so inconceivable that we believe that birth almost always works, that undisturbed is best, and that we can still attend births and keep it undisturbed whenever possible while utilizing our skills and knowledge when needed.  As Maryn so eloquently put it, "The TRUTH is that a great birth attendant is a lot like the best of a freebirth with the best of having someone else care!".

I fully support the choice to free birth.  But it is not what I chose for my own birth, and it is not what I think most women want when given the option to have an awesome midwife with them instead.  My hope is that women can choose to have a family birth if they truly want to, but that they have the option of a knowledgeable, skilled, grounded, nearly invisible (unless needed!) midwife that can support them at home.  That is what I wanted, and what many women want, and we are doing our part in cultivating the creating of more of these types of midwives - check out <a href="http://www.indiebirth.com/conference/" target="_blank">our upcoming midwifery conference for example</a>.  I don't feel offended when a woman chooses to birth alone, just like I don't feel offended when they choose to birth with a doctor.

What I get nervous about is when women only want to utilize specific aspects of midwifery care, or have it only at specific times, as if it can be dissected into parts yet still be meaningful or effective.  At its heart, midwifery care is built on the relationship between the midwife and the family.  This is why last minute clients are not ideal.  How can we be unobtrusively observing if we are strangers in your home?  How can we use our clinical skills without disruption, but even more importantly, how can we use our intuition when we aren't all comfortable with each other?  Where is the trust?  Village midwives of ye olde times would have know you from the time you were born, most likely.  In that situation it would be no big deal to just show up in labor without ever having done "prenatal care".  This is what we try to explain to people who just want us there for the birth (plus the whole postpartum topic but I'll save that for another day).

So when someone wants to consult on a single issue, as if it is a simple question, it can be frustrating since it is likely anything but simple.  I'm thinking of times when perhaps a friend under doctor care sends me a message asking me what they should do about their terrible pitting edema that they have at 36 weeks.  If they were seeing me, we would likely have had several lengthy discussions about nutrition, as well as about the swelling as it started, in hopes to prevent it entirely rather than wait until it was more serious.  

Another issue I've noticed is the trend of getting help from facebook (including in a crisis!), or asking knowledgeable midwives to "sum up" potentially complex emergency topics like postpartum hemorrhage, shoulder dystocia, etc.  If those things were simple to understand and deal with, they wouldn't BE topics at all, and we wouldn't have several year long midwifery schools.  The fact that they are talked about over and over is because they aren't simple or straightforward.  We know they are rare, and are made more rare by undisturbed birth, but we are under no illusions that complications never happen.  And when they do happen, something that could have potentially been resolved by a midwife may require transport, and that is just the risk of choosing a freebirth (as there are drawbacks with every type of birth).  We have heard so many stories of women transporting in for things that would have easily been dealt with at home with a skilled midwife, even when the parents felt like they were as prepared as they could be beforehand.     

And if someone is choosing to birth without a midwife present, the more extreme example of this would be asking if they could just call us in labor if a deviation from normal comes up.  Non emergency deviations from normal and general reassurance that all IS normal are the primary and most important roles of the midwife at most births, not a small favor to ask, and it is not replicable over the phone.  If that is something a woman feels like she will want in labor, then she should hire a midwife to work with throughout pregnancy, birth and the postpartum.  A midwife acquaintance on the phone cannot serve as a substitute for a long standing relationship, her having been able to observe throughout labor and notice a deviation possibly sooner when it was easier to remedy, her being able to assess the energy, the emotional context, how well nourished, rested and hydrated you are, your vital signs, baby's heart tones, and the other hundred things we are assessing and observing (quietly or invisibly) at a birth.  A midwife can give cursory help from a distance, but frankly, "distance midwifery" is antithetical to what midwifery is. There are certain situations where this might be the best option (when there is no midwife close enough, or this is someone you've worked with throughout pregnancy and a deep relationship exists already), but I think it is not optimal, and frustrating when someone local asks for this since it is a blatant misunderstanding of what we offer and we why offer it in the way we do.  Asking someone to midwife over the phone is like asking them to do 90% their job with 1% of their tools (probably 0% of the money) and still much of the liability.  It just doesn’t make sense if you have the option to have someone there who will be unobtrusive and be able to fully offer their support with all the available tools if you need them.  

This is getting long and I want to wrap it up, but I feel like there is so much more to say and it is hard to be clear about this issue.  To sum it up - I think midwives serve an important role that most women appreciate in the home birth setting (we can do a way better job though).  I think we can tailor our offerings in many ways, but taking the heart out of midwifery by trying to work with clients in less personal ways is a bad move.  I also think we need to move away from the oversimplification of issues like postpartum hemorrhage and shoulder dystocia since there seems to be a growing trend towards, what I would call, overconfidence about the ability to deal with sometimes complex complications.  So if you want midwifery care, hire her for the care that she has crafted so carefully and thoughtfully.  If you want to birth alone, birth alone and know that we support that choice!