Tuesday, April 29, 2008

Midwives at Birth

For me, midwife assisted homebirth is a grey area. Many assume that, as a woman who is committed to encouraging and advocating for unassisted birth, I am opposed to midwives and midwifery. I am not. I always encourage homebirth, attended or otherwise. It's a personal choice, but unfortunately one that many women don't really feel free to make with full consideration of all the facts and alternatives available to them.

Not all women are ready to pursue or even consider UC. It's something that requires a little bit of a moment of "AHA!" (whether that's a sudden realization, or a gradual paradigm shift), and I think that women in this society have a lot of layers that that has to penetrate. I believe that, ideally, midwives can be instrumental in empowering women along the path of really trusting their bodies, birth, and learning to love and celebrate birthing. A midwife who makes you feel like you did it yourself, and that she wasn't necessary, is a good one. A midwife who leaves you feeling, "It's a good thing she was here with her training and equipment or it would have been bad!" is not empowering at all, and is most certainly a "med-wife."

One thing that is very important to most if not all UCers, and that isn't usually thought about by the general public, is that each and every person at the birth changes the dynamic. A midwife's very presence in the home changes things. Even if she is in the kitchen flipping through a magazine while you labor alone in the other room, the dynamic has changed. A subtle responsibility shift has occurred ... an "expert" is in the house "just in case"... and UCers feel that this takes away from mama's ability to tap into her inner voice/the leading of God, and shifts her trust to that person in the other room. Even in a completely hands off birth, she's already intervened, just by being there.

Now - just like any interventions, it is a mother's responsibility to be educated about the risks and benefits, to weigh them carefully, and to decide which ones she wants and which she does not in any given situation. The intervention of a midwife's presence might be worth the trade offs. After all, a hands off midwife can provide comfort and a feeling of protection against things going wrong, as well as more practical skills like herbal knowledge and clean up tasks...and as far as causing actual problems in the birth that's not necessarily an issue. The primary risk you run with a midwife is not being able to have the fullness of the birth experience that you might have with a UC; you might miss out on some subtle spiritual, personal, or marital growth... these are losses that would not even be noticed and therefore are easy to write off as negligible or even "not probable".

But the difference between a truly hands-off midwife attended homebirth, and a UC, is very subtle and much debated...

One thing to consider is that very few midwives as far as I can tell are truly "hands-off"... if she checks your dilation at all, if she checks the fetal heart tones, if she brings equipment into your bedroom, if she tells you what position to be in, or that you "should" take an herb at this time to hurry things along, those are NOT HANDS OFF. That is a midwife with her hands in. Those are absolutely interventions, and they involve her coming into YOUR birth space with HER ideas and "knowledge" ... undermining your intuition on an even greater level. If she says you need to get in a certain position, well then you must need to do that, since she is trained to know that for you. And even if you are not in agreement with her, what are the odds that your partner (or even you) will honor your "feeling" over her experience and learning? Men, for instance, can be very disempowered in their role as birth support and comforter when a midwife is around, beginning to look to her for guidance - rather than connecting with his partner for that. Even with a great midwife who tries to get a man involved, he is still drawn to taking his direction from her rather than from his wife and his own instincts with her. It's human nature in the face of an expert/authority figure.

UC is as different from assisted homebirth, as homebirth is from birth center, as birth center is from hospital... it's a spectrum, each offering different levels of intervention which each have their place.

For some women, a UC isn't a good choice, for emotional or other reasons... UC is a big leap from what is the norm, from what is usual and expected, and from how we see ourselves. When I first heard of it I was like, "Well, good for her, glad that worked out and that she really does trust birth... but that's a little NUTS!" I sure did not start out a UCer. [A brief history: I started out a little closer than some, since homebirth was all I wanted, and I loved midwifery and had a great midwife all lined up - that I had known for years (she'd been at my mother's two homebirths, and then I worked with her at her nonprofit grassroots organization for two years... so she was no stranger to me and a PERFECT midwife)... I wasn't forced into UC by financial concerns, by unavailability of a good midwife, or any other concerns. I was drawn to it almost against my will!] I can absolutely understand why a woman would be comfortable with a homebirth midwife and feel very empowered and peaceful with that choice, and I'm always glad to hear that someone is looking into it as a possibility.

My blanket statements are: 98 percent of women birth in hospitals. Most of them do NOT require any of the interventions they or their baby receives there. Homebirth is more often than not a healthier, happier choice for all involved. Healthy birth does not require physical assistance, as we are equipped with the instincts in the moment that we need. Some women have concerns or other needs that make a midwife a good, right choice for her birth. These choices are only between the woman herself and the Universe, and no one has any right to say "She shouldn't have an epidural" or "She should have someone who knows what they're doing there" ... our responsibility is to share what we've learned, to share information and our experiences, and to support each other in our journeys. It is not to make women have our same views and opinions, in the same way, at the exact time that we do.

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