Why Some Women Don’t Want Midwives at Their Births
by Laura Shanley
(This article originally appeared in Midwifery Today Magazine, Issue 63, Autumn 2002)
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Most midwives are kind and caring people who truly want to help women have better births. Many of them feel called to the profession by a higher power, and the praise they often receive from their clients reinforces their belief that they are doing God’s work.
Yet midwives aren’t for everyone. And just as some midwives feel called to help women in birth, many women feel called to give birth without them. According to the health departments in Arizona, Wyoming, and Colorado, nearly one-third of all homebirths are unassisted. In Colorado alone, every other day a baby is born at home unassisted. Unassisted childbirth, or UC as it is often called, is growing in popularity. A search on the Internet produces dozens of UC web sites, chat rooms, and support groups. Still the question remains, why would a woman want to give birth without assistance when it is readily available?
I first became interested in birth in 1976 when my husband-to-be David gave me a copy of Grantly Dick-Read’s Childbirth without Fear. David was fascinated by Dick-Read’s theory that birth is not inherently dangerous or painful. In fact, it should give a woman a feeling of “exaltation.” Interference, Dick-Read believed, both from within (primarily fear triggering the fight/flight response) and without, is responsible for the majority of pain and problems women encounter in labor. His solution was twofold: women need to face and conquer their fear of birth, and birth attendants need to stop interfering in the process. In other words, we don’t need to invent a better mousetrap. We simply need to learn to move out of the way and allow women’s minds and bodies to work unhindered.
Dick-Read’s ideas made sense to me and I was eager to put them into practice. But the following year when I conceived our first child, John, David and I decided to take it one step further. Rather than try to find a noninterventive doctor or midwife, we would simply give birth by ourselves. We both believed in the power of our own minds and felt confident that with a little bit of faith, we could create the birth of our dreams.
I went into labor with John on a summer afternoon in 1978. Around midnight I lost my mucous plug and the contractions intensified. We never timed them or checked to see how dilated I was. Instead we trusted that when the time was right, our baby would be born. Less than two hours later, I gave three or four pushes, and John was born face first into David’s hands. I delivered the placenta about 45 minutes later. Our birth had been a resounding success!
Two more births would follow in the next four years. Nicholas was a beautiful little boy with a congenital heart defect. I birthed him gently into my hands on a summer day in 1984. Unfortunately, he died several hours later. The coroner told me he would have died regardless of where he would have been born. We were thankful that his short life had been spent at home, in the company of those who loved him. Michelle’s birth two years after that was so fast I hadn’t even told David I was in labor when she slipped into my hands. The cord was around her neck but I simply unwound it.
All of my births were easy, yet not one of them was free from what some would consider “complications.” To me, however, they were simply variations, and because no one was there to “instruct” or “guide” me, I knew what to do. And I got better at it each time I did it. By the time I had Michelle, I understood that to even tell David I was in labor would have altered the process to at least some degree. I had finally grasped the concept of nonintervention.
Of course, some would say I had taken Dick-Read’s theories too far. Many women find the presence of a midwife comforting if not outright helpful, and it is not my intention to dissuade them. But I think there is something to be learned from women who have chosen to give birth unassisted, and so I put the question to several women in the UC community, “Why didn’t you want a midwife at your birth?” Here are a few of their responses.
Midwives as agents of the state
When a midwife attends a birth, legally she is required to intervene. Although the law varies from state to state and country to country, generally it is safe to say that midwives must time contractions and measure dilation. If a labor is not progressing at the speed that some government officials have arbitrarily decided it should be, a midwife must choose between breaking the law and transporting the woman to the hospital. Even if a woman manages to give birth within the government’s timeframe, there are restrictions on how soon after the birth the placenta must be delivered. Such was the case for my friend Diane who gave birth in a small town in Colorado several years ago. Diane hired a midwife to attend the birth but the baby was born fifteen minutes before the midwife’s arrival. Diane and her husband were thrilled, but their happiness was short-lived.
“I just knew I shouldn’t have let her try to pull it out,” Diane told me shortly after she came home from the hospital, “but I guess I was too afraid to speak up.”
While Diane’s case may not be the norm, most midwives will agree that the fear of prosecution is always in the back of their minds to at least some degree. How can it not affect the way they practice their craft?
When Amanda Counter became pregnant several years after enduring a disastrous hospital birth, she considered hiring a midwife but ultimately decided to give birth unassisted:
Lots of women say they want to be midwives to be an advocate for women and their right to choose how, when, where, and with whom they give birth – but are those rights really the first thing midwives are concerned with? In this litigious time, I think not. The bureaucracy stands in the way of pure attended birth. To me it is not desirable to have someone present in my home that is ultimately concerned with preserving her license. Part of that motivation to preserve the license may mandate things like fetal monitoring, vaginal exams, and time limits…these are all things that have proven disruptive to the process. All of that in addition to the fact that as far as I’m concerned, birth is a private event. It is really unsavory at this point in life to think about having other people in my home during birth.
Amanda’s unassisted birth was all that she hoped for and more. She is now one of the more outspoken members of the UC community.
Who knows best, mother or midwife?
While the idea of nonintervention is certainly not new in the midwifery community, many midwives still believe that birth needs to be “assisted.” It is not uncommon for a midwife to break a woman’s water in an attempt to speed things up, or tell a woman when she can and cannot push. All of the women I know who have given birth unassisted have known when to push, and most of the time their babies were born with very little pushing. I theorize that most women begin pushing long before their babies are ready to be born, simply because a midwife has told them “it’s time.” At the very least, women wear themselves out unnecessarily, and often they damage their bodies in the process. If a woman is at all in touch with her instincts, she will know when and when not to push.
Maka Laughingwolf, a former midwife’s assistant, wrote recently about the differences between her midwife-attended birth and her unassisted birth on a UC email list:
At my midwife-attended birth, my progress was repeatedly monitored using a Doppler fetoscope and cervical checks, and I was informed by an external source what was happening within my body. At my unassisted birth, I had only myself to rely on for information. I talked to my baby, and I listened to my intuition. I didn’t need tools or examinations to know that my birth was happening normally.At my midwife-attended birth, my midwife told me it was time to push because a vaginal exam had told her I was 10 centimeters dilated. I didn’t feel ready to push but I did it because she said it was time. I pushed for 45 minutes, my baby remaining posterior until just before he crowned, then rotating VERY PAINFULLY (for me, at least). I know my baby was somewhat strained by my pushing efforts because I remember the midwife telling me to “breathe better” and hearing his heartbeat speeding up when I did. At my unassisted birth, I pushed only when I could not do anything BUT push, and it took less than five minutes and only a couple of pushes before he was born. I know my baby was not the least bit strained by this few minutes of pushing.
After my midwife-attended birth, I felt uncertain about my ability to mother my baby, and I frequently called my midwife to ask “silly” questions. After my unassisted birth, I knew that my instincts had given me the ability to mother my baby just as I had birthed him…on my own, without experts to “help” (or more likely, hinder!) me. After my midwife-attended birth I felt dependent, weak, uncertain, and disempowered. After my unassisted birth I felt independent, strong, confident, and empowered.
The fact is, too many midwives give lip service to the idea that “women know how to give birth!” They tell women to trust their bodies and believe in their own abilities – but not to the point of giving birth without them.
The need for privacy
If women were choosing UC simply because most midwives are too interventive, the solution would be to find a noninterventive midwife. But many women find that anyone’s presence at birth is a hindrance, regardless of whether or not they physically intervene. Linda Hessel, a mother of three, one of whom was born unassisted, shared her thoughts on the subject:
I think it is very important to point out that for many women UC is not just about avoiding intervention. My first birth was badly influenced by the intrusive and interfering actions of the midwife but for me the answer was simple enough: find an unintrusive, noninterventive midwife for the next birth. This, I fear, would be the general response to an article positing that the avoidance of intervention is a primary motive for choosing to give birth without a medical professional present – that it is not a valid position to take because “hands-off” midwives do exist.My second birth was attended by a midwife who understood that normal birth is facilitated by doing nothing extraneous to the basic process. She respected my desires and encouraged me to listen to my instincts. It was not until after that birth, my good birth, my empowering birth that I began to have a great desire to just be by myself in birth. Unfortunately, I was a bit caught up in trying to justify this desire, and vilifying the basic role of the midwife was a good way to do that – and I was quite able to do it even with my dear, beloved, “perfect” midwife. But doing so shifted my focus away from what was important to keep at the forefront of my consciousness: that I simply wanted to be alone.This became excruciatingly clear to me after the birth of my third child, which was medically unassisted but during which I allowed someone other than my husband and children to be present during the labor and immediately following the birth. This person did nothing to interfere – she offered nothing but support, sitting for a few minutes talking to me. She retreated to another part of the house when the labor got intense, and only reappeared to cry tears of joy at seeing the baby in my arms.
Yet in the days after the birth I was overcome with feelings of grief and rage. Now I knew what it was that had been wrong about my other births – it wasn’t so much that they were made more difficult or the normality threatened (though this was certainly true) – it was that these people with whom I was not already intimate were not supposed to be there. In the days after birth, when one is more open and vulnerable than at any time of life except during labor itself, this hit me hard and deep. She wasn’t supposed to be there. My concentration was thrown off with her arrival – and my inhibition reared its ugly head, marring the rest of the labor, even after she left the room.
That, however, wasn’t the worst of it. It was the time following my daughter’s emergence that should have been my husband’s and mine alone. All of a sudden there was this other person diverting my attention from the most amazing event of my life – abruptly, without being able to control what was happening, I shifted from being inside birth, inside my husband’s love, inside this timeless, holy intimacy, and stepped outside of it to acknowledge someone who was not inside it. It’s a difficult thing to describe, and I’m afraid that because I don’t describe it well it will seem to others like a small thing. It wasn’t. It was glaringly, heartbreakingly huge.
Linda is not alone in her belief that privacy is as essential to birth as it is to sex. Many women are finding that observers at birth, no matter how well-meaning, hinder the process rather than help. Lori Taylor, an entrepreneur, teacher, and mother of two in upstate New York, first learned about the need for privacy in labor from French obstetrician Michel Odent.
Before I had any particular plan to have children, I happened to read Michel Odent’s Birth Reborn. As he tried to reduce hindrances on women in birth, Odent realized that simply his presence hindered birthing women. He stopped attending births and even went so far as to not attend the homebirth of his own child. Birth had been invisible to me before this book. After this book I was determined to be fully conscious of the choices I made, and not introduce any hindrance during labor and birth.Soon after that, I decided to have a child. I arranged for a homebirth with a certified nurse-midwife. By most standards, this was a reasonably uncomplicated homebirth of a first child. But eventually I saw that by inviting two midwives into my house, I had invited hindrance. My rolling labor stopped cold after the midwife changed from her usual hippie clothes into green hospital scrubs. Once in her scrubs, she asked my husband to boil her surgical tools in a pot. It was another full day before I shot my baby out to a chorus of “Push, push.” The baby flew, in the four-limbs-out startle position, past the first midwife into the hands of the second, spreading meconium along the way. Yes, I birthed at home, but I invited the hospital into my home. I got oxygen, pitocin, bright lights, verbal abuse, 12 stitches, polite chitchat, and a very frightened baby.It was only in retrospect, after telling and retelling the birth of my first child, that I realized what happened. I was not able to have the birth I desired because I hadn’t taken full responsibility for it. My birth was mediated. During labor I desperately wanted the midwives to give birth for me.
By the time my son was conceived two years later, I knew I would give birth alone. My husband and I were partners in this decision. When birth came, it was smooth, calm, and very powerful. Though I had many friends and supporters, I went through pregnancy and birth without advisors. I cared for myself, actively kept my own health in balance, and allowed the whole experience of childbirth to transcend the conventional emphasis on physiology and pathology. The very presence of a midwife, and all that implies, draws away from a woman’s own birthing world – at least that was the case for me.
The homebirth midwife here is now my friend. She and I have talked a great deal about the birth of my first child. She knew I was planning to have another. Once I was pregnant and I made an appointment to chat with her about it, she assumed I was approaching her for care. She slid her form across the table to me, and I slid it right back. She knew right then what was going on and I simply let her know that I loved her but wouldn’t dream of inviting her into my house again to attend the birth of my child. When I walked out of her office that day, she said, “I know that watching you go through this will make me a better midwife.” I believe it has. She intervenes less. But I have heard the stories and seen the videos of some recent births she has attended. I still see intervention all over them. Because most midwives haven’t had an unassisted birth, I don’t think they understand how interventive their mere presence at birth can be.
The future of midwifery
Many people have asked me if my goal is to put midwives out of business. To the contrary, I would like to see the profession flourish – albeit in a different form. In the future I envision, midwives will be educators, helping women to reconnect with their innate knowledge and power. They will do their jobs so well, their services will rarely be needed at birth. Some midwives are already moving in this direction. I often get letters from midwives who are supportive of unassisted birth. Melanie, a student midwife, wrote to me recently saying,
I’m a student midwife and even if it would mean I’d be out of a job I think women do have the ability and definitely should consider unassisted birth. I became a midwife because I believed that birth was natural, not a medical condition. However, the more research I did the more I realized that midwifery was just as medical a field as obstetrics. Just when I was about to reconsider, I found out about the Association of Radical Midwives. In a way, ARM encourages unassisted birth, but certainly not without research. To be honest I’d only like to see my clients come to me once, and then feel confident enough to go it alone.
Unfortunately, not every midwife shares Melanie’s enthusiasm for unassisted childbirth. Just as some doctors believe all babies should be delivered by doctors, some midwives believe all babies should be “caught” by midwives. In doing so, they limit a woman’s choices and undermine her ability to take charge of her own life.
When all is said and done, the only person capable of deciding how, where, and with whom a woman should give birth is the woman giving birth. Women, not midwives, are the true experts of birth. For those who are brave enough to recognize and believe this, the rewards are beyond measure.