Today is International Day of the Midwife and I find myself reflecting on the many midwives I have known and the incredibly diversity and gifts of the women who join this profession. In addition to the midwives I had for prenatal and postpartum care for each of my births, I’ve been privileged to know many midwives on the state and national level through our shared interest in maternity care activism and birth rights. With my first baby, I had prenatal and birth care with a family practice physician and a CPM. The CPM was gray-haired, pretty, soft-spoken and wryly witty and pretty much exactly what you picture a stereotypical midwife looking like! My prenatal care with this team was excellent, birth care so-so (I didn’t need much), but my postpartum care left a lot to be desired and I felt very cast adrift after the birth. I became very embroiled with midwifery activism and birth work after this birth and as a result my experiences with all subsequent midwives has been an interesting blend of collegial + consumer. My first birth was the only one for which I was consumer only. Though I’m not a midwife myself, my subsequent experiences all involved being a sister birthworker AND client, rather than solely a client. This has both benefits and disadvantages.
My midwife with my second baby was amazing. I loved her so much and I have felt a gap in every pregnancy following that I was not able to have her as a midwife again. She was gentle and caring and passionate and inspiring and wonderful. Cute and upbeat, full-figured, and intelligent, she had a soft and reassuring presence and gave wonderful hugs! We became good friends and she was a very important part of my life. My prenatal care and birth care with her was excellent. She was also helpful with postpartum care, but I don’t think I “allowed” her to be as helpful as she could have been because I couldn’t allow myself to be as vulnerable and needy as I actually felt.
When I was pregnant with my third baby, my much-loved midwife had moved away and found myself at a loss for who to choose for pregnancy and birth care. This baby died early in my second trimester and I found myself calling on the sisterhood of midwives for help when I desperately needed it. From the very busy midwife who talked to me kindly and patiently when I was freaking out over a retained placenta, to the Mennonite midwife who helped me from the road as she was driving to another state and connected me to yet another midwife several hours away who drove in to town to meet and help me when I was very scared and alone, it was during this experience that I realized very viscerally how much we need midwives in our lives. When I was pregnant again, I decided to choose the Mennonite midwife for my prenatal care and immediate postpartum care. She is a very capable and determined and intelligent midwife, but I felt an unbridgeable gap between us spiritually speaking and so was never able to fully connect with her emotionally. She embodied the gray-haired, no-nonsense “granny midwife” archetype. She provided great prenatal care and was very respectful of my wish for immediate postpartum care, but an unassisted birth. Postpartum follow-up care was limited due to snowstorms.
With my last baby, I felt a powerful need to feel taken care of again. I really needed to have some set aside time, space, and energy that was just focused on me and my baby. I knew that I needed a midwife! While I could have used the same midwife as with the baby before, this time it was important to me to develop the emotional connection I had with my second midwife—I needed a midwife with whom I could feel “safe” with all of me, instead of feeling like I had to hide my goddess sculptures when she came over! ;) It took some work, but I was able to find that. With this experience, I came to accept that the blur between colleague-consumer is my reality and I will never re-capture the feeling of being client only and being completely focused on in that respect, because I’m simply not just a client only. That’s okay. This midwife has long brown hair, wears lots of skirts and had the hippie-ish midwife feel I was craving. She is funny and talkative and connected to the roots of what midwifery is all about. I was safe with her in the way I needed. I really appreciated the midwife’s prenatal care (and the opportunity to focus on my pregnancy and baby), her respect of my wish for immediate postpartum care rather than birth care, and her postpartum follow-up care. I felt like this midwife offered the most complete postpartum care of all of my birth experiences.
I’ve mentioned before that the only vaginal exam I had during six pregnancies was at ten centimeters dilated when I went to the birth center to push out my baby (I also had to have one for a manual clot extraction following his birth and one for help removing the placenta after my miscarriage-birth of my third baby). This is totally cool with me. Somehow I’ve managed to labor and birth four full-term babies without ever knowing how dilated I am in labor! So, I loved reading this article about the pointlessness of vaginal exams in labor and the cultural attachment, even in midwifery circles, to cervix-focused childbirth:
“…There is also reluctance to change hospital policies, underpinned by a need to maintain cultural norms. The Cochrane review on the use of partograms on the one hand states that they cannot be recommended for use during ‘standard labour care’, and on the other hand states: “Given the fact that the partogram is currently in widespread use and generally accepted, it appears reasonable, until stronger evidence is available, that partogram use should be locally determined.” Once again, an intervention implemented without evidence requires ‘strong’ evidence before it is removed. The reality is that we are unlikely to get what is considered ‘strong evidence’ (ie. randomised controlled trials) due to research ethics and the culture of maternity systems. Guidelines for care in labour continue to advocate ‘4 hourly VEs’ and reference each other rather than any actual research to support this (NICE, Queensland Health). Interesting whilst Queensland Health guidelines recommend 4 hourly VEs, their parent information leaflet states: “While a VE can provide information about how a woman has progressed so far in labour, it cannot predict how much longer you will be in labour…” and that there are “…other factors such as the strength, duration and length of contractions as well as a woman’s behaviour and wellbeing that can indicate progress in labour”. Which begs the question ‘why bother doing a VE’?
The cervical-centric discourse is so embedded that it is evident everywhere. Despite telling women to ‘trust themselves’ and ‘listen to their body’, midwives define women’s labours in centimetres “She’s not in labour, she’s only 2cm dilated”. We do this despite having many experiences of cervixes misleading us ie. being only 2cm and suddenly a baby appears, or being 9cm and no baby for hours. Women’s birth stories are often peppered with cervical measurements “I was 8cm by the time I got to the hospital”. Even women choosing birth outside of the mainstream maternity system are not immune to the cervical-centric discourse. Regardless of previous knowledge and beliefs, once in labour women often revert to cultural norms (Machin & Scamell 1997). Women want to know their labour is progressing and there is a deep subconscious belief that the cervix can provide the answer. Most of the VEs I have carried out in recent years have been at the insistence of labouring women – women who know that their cervix is not a good indicator of ‘where they are at’ but still need that number. One woman even said “I know it doesn’t mean anything but I want you to do it”. Of course, her cervix was still fat and obvious (I didn’t estimate dilatation)… her baby was born within an hour…”
I also read this article about the now late, great midwife and activist, Sheila Kitzinger and how she connected her birthwork to feminism (as do I). I despise the article’s title, but it is still worth a read!
…In the Seventies, I was viewed as a radical for saying that birth was being depersonalised and treated as if it were a pathological event, rather than a normal life process.
To my surprise, it wasn’t just obstetricians who dismissed what I had to say. I also found myself in conflict with feminists, who saw birth in very simplistic terms.
Why? Because they claimed it was every woman’s right to give birth painlessly.
An article in Spare Rib, the radical campaigning feminist magazine, went further.
Without any evidence, the authors asserted: ‘Undoubtedly, hospitals, with all their faults, are the safest places in which to give birth. For this reason, we think we should press for improvements in hospitals rather than support a move to more home confinements.’
I was appalled at how my sister-feminists could fail to support woman-centred birth. Polly Toynbee, writing in The Guardian, was particularly virulent, dismissing me as a lentil-eating earth goddess…
Lentil-eating earth goddesses unite! Unlike Kitzinger’s experiences with the distance between some expressions of feminism and birth-care, I find that many midwives, whether explicitly or implicitly, understand the deep connection between midwifery care, birth activism, and feminism.
“Midwifery work is feminist work. That is to say, midwives recognize that women’s health care has been subordinated to men’s care by a historically male, physician-dominated medical industry. Midwifery values woman-centered care and puts mothers’ needs first. Though not all midwives embrace the word feminism (the term admittedly carries some baggage), I maintain that providing midwifery care is an expression of feminism’s core values (that women are people who have intrinsic rights).
–Jon Lasser, in Diversity & Social Justice in Maternity Care as an Ethical Concern, Midwifery Today, issue 100, Winter 2011/2012
Perhaps this is because midwives care so deeply about mothers and feminists might actually make the best mothers…
…As a mother who works extensively with other mothers, I appreciated Caron’s acknowledgement that raising children is a feminist act with potential to create change as well. “Another strategy for change is through raising children to be just and caring people. A media image portrays feminists as being against motherhood—but in fact, feminists make the best mothers. They raise children aware of themselves and the world, of options and values, of what justice means and how to work toward it, and how to be self-critical and self-respecting” (p. 203-204). Caron also explains that “in a just society, women would be free to make whatever decisions they needed to, for however long they needed to, in relation to political action in the public and the private sphere. All people would participate in the decision-making, and women would be supported in their decisions rather than, as sometimes happens, made to feel guilty for not doing enough or not valued for what they do.”
“…As we ready ourselves to accept new life into our hands,
Let us be reminded of our place in the dance of creation.
Let us be protectors of courage.
Let us be observers of beauty.
Let us be guardians of the passage.
Let us be witnesses to the unfolding…”
—Cathy Moore (in Sisters Singing)
In addition to midwives, we’re also celebrating mothers all week this week! First on our lineup of activities is our gift to you: our first ever coupon code for $5 off purchases over $15. Use code: MOTHER.
We’ve also got a giveaway upcoming, two new product launches, a new Facebook group, and two class announcements! Stay tuned…