What’s a Poor Midwife To Do?

This question came in to my blog in response to my archived post on the use of Castor Oil. Since it is a subject I seem to deal with daily, I’ve answered it where everyone can join in the discussion. Gloria

QUESTION

Hi Gloria! I am a student midwife, and in my state, women must be transferred to an OB if they have not given birth by 42 weeks. The local midwives (my preceptors) use castor oil as a last resort induction method. They don’t like doing it, from what they tell me, but they feel that, if after nothing else works (walking, sex, black and blue cohosh), it would be better to try castor oil and breaking the woman’s water, than to have a perfectly healthy woman transferred to the hospital.

What is your opinion on this? If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I do not plan on practicing here in Florida when I graduate from midwifery school, but I’d like to pass along some information to the midwives that I work with. Florida Student

RESPONSE

I am faced with a similar situation in my province. We have registered, government paid midwives who have to play nice with the doctors in order to have hospital privileges, a government salary, and publicly funded malpractise insurance. They have the same complaint “We hate to induce naturally but it’s better than what they are going to get in hospital. . . .” We also have the same mess here in B.C. as the rest of North America. Those membrane stripping, castor oil, acupuncture, herbal inductions don’t work because the woman isn’t ready to have the baby and, then, she gets on the prostaglandin/pitocin intervention-cascade train and the midwife feels so bad. . . but, hey, what could she do?

Canadian midwife with client

Canadian midwife with client

Every day, I thank my lucky stars that they used me as an example to the government of what a “renegade” midwife was. Midwives in my province could only become a professional body if they proved there was a “danger to the public” by NOT having a profession. I got to be the designated “danger” because I had proven for years that I would not lie down with the doctors and side with them against my clients. Obviously, the midwives organization would never have given me a license, even if I applied, so I didn’t have to bother applying. A few of my friends did and they were bankrupted and humiliated by the “professional” body. As soon as the government registrations were issued, we saw these inductions start. So many women in my community have been fooled by this cruel trick.

When the local midwives first obtained registration, there was a lot of righteous conversation about “evidence based” midwifery. The large multi centre trial about 41 week inductions conducted by Mary Hannah of Toronto (1) was pointed to by midwives to frighten women into being induced at 41 weeks. We had never seen this in our province prior to regulation. We had twenty years of experience as lay midwives with many post dates women and had not seen any problems but that experience was set aside in favour of the “evidence base”. Even though the midwifery empirical knowledge did not support Ms Hannah’s conclusions and even though the midwives were extremely conflicted and frustrated by the results of their labour inductions, they still obeyed the medical “evidence”. Then, the “evidence” was shown to be without merit. In 2002, Hall and Menticoglou published a paper in the British Journal of Obstetrics and Gynecology proving that Hannah’s study was wrong (2). Has that meant that midwives in my province are now encouraging women to relax up to and past 42 weeks gestation? Oh no, because now the doctors have kept on with their aggressive policies of inducing everyone at 41 weeks and, evidence- be- damned, they’ll make the midwives do the same thing. Science is trumped by community “standard of care” which basically means “we’ll all follow like sheep and hope the wolf doesn’t catch us”. Now, I don’t hear too much rhetoric about “evidence based practice” among local midwives. There is still a lot of lamenting about “how bad they feel” but the inductions continue unabated. Of course, the midwives don’t feel even 1/100th as bad as the woman who has had major abdominal surgery thanks to their aggressive policies.

I’ll post a link here to the B.C. Government Vital Statistics chart (click on Item 11) which shows that, prior to regulating midwives in 1998, there was an up and down pattern to cesarean rates and the rates remained below 25%. For the last reported year (2011) the rate was over 30%. This means that, since midwifery regulated on January 1, 1998 the cesarean rate has risen and the pattern has been a steadily upward climb. The cesarean rate is the score card of what is happening in obstetrics in any given jurisdiction. We’re obviously not doing so well here in B.C. When the registered midwives were soliciting the government for a professional designation, one of the cornerstones of their bid was that they would save the government money by preventing cesareans.

Cesarean Rates in British Columbia Before and After Midwifery Regulation

Cesarean Rates in British Columbia Before and After Midwifery Regulation

So, in answer to your questions: a)What is your opinion on this? I think it is disgusting that midwives are so cowardly and turn perfectly healthy pregnant women into wounded mothers. And (2) If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I will not be faced with a similar situation because I would not join an organization where I was made to go against my conscience, my common sense and my promise to my clients. If I was in such an organization and realized that I could not do my work with integrity, I would not be complaining about these ridiculous “protocols” I’d be changing them or resigning in protest.

(1) Hannah ME et al. Postterm pregnancy: putting the merits of a policy of induction of labor into perspective. Birth 1996;23(1):13-9.
(2) Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation:
nonsensus consensus. BJOG 2002;109:485-91.

related post: Castor Oil Inductions
This post was updated on Sept 5, 2014 to reflect B.C. Vital Statistics to 2011
Updated Dec 30, 2014 to include link to “Nonsensus Consensus”

37 thoughts on “What’s a Poor Midwife To Do?

  1. Yes yes yes to this. And this is why some of us have fought so hard against more goddam anti-woman regulations being implemented in Australia.

    Thank you, Gloria. *kotc* Really big heartfelt thanks for saying what I think as well.

  2. Thanks Gloria for posting this, I am a 3rd year Mid student in South Australia (I came to your talk at Lisa’s) and listened to your points on Induction, where even “natural” inductions using herbs and Castor oil are fraught with interfering with the natural process which made me think again!
    I spent several weeks for an assignment examining the research and epidemiological evidence for our “routine” policy of induction at 41 weeks and came to the same conclusion that there is no evidence that will stand up to scrutiny for this policy and we are in fact submitting primips to medical induction even before they are “Term’ with often devastating consequences.
    So what IS a poor midwifery student To Do? who will graduate this year and has no choice but to work in the system as the maternity reforms here are tying us up royally as you know.
    We have about 19000 births a year in South Australia and 5000 are being medically induced and now only a miniscule amount of women birth after 42 weeks (79 in 2008 to be exact) with absolutely no improvement in our perinatal mortality or stillbirth statistics. What a Mess!
    Do you have room for an apprentice in a year or so??
    Loved meeting you and am so inspired by your work and story 🙂

  3. Exactly! I chose a lay-middy over a registered middy any birth .. and this is exactly why .. she is there for me first always. Thankyou x

  4. Gloria… reading your words gives me hope for my own future as a midwife in North America. I am so grateful that I began long ago apprenticing (briefly) with a lay midwife, and that 25 years later (after taking time for raising kids and fostering strong marriage) I am returning to apprenticeship with a CNM (who is becoming more and more radical with each passing day). You’ve walked your talk and then some… and I truly appreciate your sharing. Lay midwifery is where my heart is and perhaps where my future lies.

    AND… Florida Student: Thank you for asking a GREAT question!

  5. I was lucky enough to have a midwife who was also a close personal friend with my most recent baby. She told me that she had to refer me, but I did not have to go, or have to accept the induction orders. That was very freeing for me. I realized that I could still steer things, but that I would just have to be a bit more forceful about it since the OB was not going to present these things as options.

    Had I known that, I would not have been induced with my second (who was fired out of me like a cannon – I was repeatedly told that I just didn’t know what it was supposed to feel like, but I went from 3cm-birth in 36 min…). Should the opportunity present itself again I as the mother will stand up to the ‘rules’, I just need to know that I can.

    I guess I am saying that as the mother – go ahead and do what you have to do, but tell me what I can do. As the mother I can decide to oppose the system. That might chain you (as midwives).

    Gloria – I appreciate your commitment to not join an organisation that is going to tie your hands – as such you are a great voice and mentor. The system(s) – as there are many in North America – need people in them who think the way you do too, so that changes can be made. It is great to have the voice of reason outside the gate telling those that go near that there is change needed, but it is the voice (and actions) of those inside that will bring the most change. Slow, painful, but change nonetheless.

    🙂

  6. On behalf of women whose natural, normal, healthy birthing patterns lie outside the thrice-damned protocols…. *thank you* for standing up, and thank you for giving other midwives courage to stand up.

  7. This is one of the main reasons why I am not pursuing becoming a registered midwife at this time. Post-dates inductions are just one of many disturbing compromises. To quote Gloria, I will not be “made to go against my conscience, my common sense and my promise to my clients.” Yet every peaceful, noninterference birth I attend reaffirms for me that I can’t NOT be a part of supporting women through pregnancy and childbirth.

    Perhaps we need midwives (and OBs and GPs) on the inside working toward change as well. Perhaps there are some out there who are already desensitized enough, or adapted to compromise enough that they can be a part of that slow process of change from within without feeling like they are losing their soul. I don’t think I am one of them.

    I question whether midwives should be in hospitals at all. Not to be ungrateful, or to belittle all the hard work that many have put in to get us to this point, based on the belief that it would make midwifery more accessible to everyone. But I see midwifery changing as a result. Too much compromise, too many policy based decisions, faulty risk management and kowtowing. And before you know it, we have midwives in hospitals… but we no longer have MIDWIFERY.

  8. Sarah, you make a great point about no one being able to “make” you go in for your induction. It’s so true! And sadly it is a truth that I would argue most women simply do not know.

    We are not told we can make decisions for ourselves. We are not told to seek out our own sources of information. Too often we are told just to *be afraid*. And as Gloria has pointed out in this post, it is, sadly, not only doctors and nurses telling women this: it can be midwives as well. And why? Surely it is because the midwives are themselves afraid.

    As a fellow member of the Informed Choice Coalition pointed out today, fear in midwifery seems tied to hospital birthing.

  9. Gloria, thank you so much for your response! I feel very similarly…sometimes it is very difficult to go against the grain, though. Thank you for your courage. You are such an inspiration to me.

  10. Re: the woman makes the decision to be induced

    This is a way of deflecting the corruption of the profession of midwifery. Midwives are there to “mother the mother”, to provide experienced advice, to guard what is normal and to do her very best for the wellbeing of the mother/baby. If she is there to nod and wink and do double talk, she needs to stop calling herself a midwife. It’s not complicated. An example might be when you travel on a plane. If someone calls themselves a flight attendant, do you need to question their instruction if they ask you to pull the oxygen mask toward you? Do you need to know that sometimes they pump chloroform through those masks? Will you wonder about other strategies for getting off the plane alive? NO, because there is an intelligent assumption that the flight attendant has your best interests at heart and she has no other agenda except to get you off that plane alive. Women do have a right to assume that a midwife will put everything else second to her client’s wellbeing. They shouldn’t have to have a best friend or a sister who is a midwife to advise them in order to give birth with good health.

    re: changing the system from within. another wishful thinking ruse to deflect the fundamental problem with hospital birth. Midwives are minnows in the whale system. They are swallowed alive before they even know what hit them. Gossip, tattletaling, bullying and ostracism are the stock in trade within every hospital environment for controlling the staff. Just ask anyone who has worked in one. You can’t bring a calm serene demeanor to a woman’s birth if that is your background environment. Context is decisive and the context for hospital birth is “control and efficiency”. Birth is not controllable or efficient. That’s why you don’t see a real “birth” in the hospital.

    Something to notice is that for many women, it takes two screwed up births to get the third birth somewhat acceptable. If we had midwifery, we would have a lot more “hat trick women”–women who have had three beautiful births in a row.

    Birthing women aren’t stupid and uninformed. They trust the word “midwife” and it’s wrong for a professional to say she’s doing midwifery when she’s really pimping for the doctors.

  11. I love and hate this post. Love you stance, and hate that this issue exists.

    I had to comment with one suggestion, seconding what others have said above (keeping in mind that i don’t know how laws/rights differ between BC and the USA). One thing midwives can do, even if transferring the mother to an OB, is make sure she knows her rights! Ultimately, as unfair as it is, it is going to come down to the mother refusing inductions and calling the shots.
    More information about post-dates ‘dangers’ needs to be mainstream, and people need to know that you can walk out of the hospital if you don’t like what’s happening to you. Knowledge is power.
    This is where a doula or some other kind of advocate can come in to the picture as well… i know firsthand how painful it is to be the mother faced with scare tactics and made to stand up for herself, but i’m sure it’s far less painful than the c-sec i could have ended up with.

  12. Gloria is a GIFT to all pregnant women … sadly we moved from Vancouver while I was pregnant. Had we stayed, Gloria was our chosen midwife. I am certain that if I were under her care my natural, home, water birth wouldn’t have ended up in hospital with a C-section.
    I remember so clearly, her call to check in with us to see how the birth went & her heartfelt words when she listened to the tearful birth story.
    The world needs more people like Gloria, who live by what they believe in & stand up for it. Great post!

  13. Im not a birth professional, but I try to do my part to inform the pregnant women around me. I have a lot of pregnant and young mother friends in my circle because of the community I belong to. anyway, Im always telling people that they have the right to say no, that they can walk away at any time. usually women are grateful to receive this knowledge, but I have yet to hear that any of these women I know have actually said no to an induction when the doctor is giving them the “your baby could die” spiel.

    I agree with gloria. there’s no changing the system from the inside, and midwives should not have to “wink wink nudge nudge” their good advice to their clients who trust them. I think it’s utterly unacceptable what some women (ME!) get when they hire a “midwife”.

  14. Wow!! Very well said!! I am an aspiring homebirth midwife and I couldn’t image sacrificing my beliefs and the wellbeing of a trusting mother to some protocol. I am also the mother of two home born babes. One at 42 weeks 2 days (happy, heathly and 8lbs). The second at 42 weeks 5 days (happy, heathly and 10lbs). I don’t even want to think about what scary things I would have been subjected to in a hospital.

  15. I honestly don’t know why Mary Hannah is still allowed to publish her work- the Hannah term breech trial was an absolute mess that again influenced daily practice at hospitals all around the world and it’s taken a decade for the SOGC to wake up and again “recommend vaginal breech births”. Argh! I’ve worked with several postdates clients and I wasn’t aware she’d done one on postdates….I’ll have to find it.

    I was hoodwinked by the title of midwife with my second birth, and ended up with a castor oil/enema induction the day before I hit 42 weeks because the only midwife in my province was going to drop me from her care. It was a hard lesson to learn, that my view of midwifery and the reality of what it’s become are two different things altogether.

    Because a title can be so misleading, I like to encourage women to really get to know their midwives. There are some amazing midwives out there, but today, in many areas, if you want an unhindered birth, you need to look underground, look for “traditional birth attendents”, find a doula who supports homebirths, check out UC. These are all valid options that people often overlook.

  16. YESSSSSSSS. you are a source of inspiration.

    women are taught to believe that their provider is their savior ~ even by midwives. but no provider can insure any sort of outcome, neither can they take responsibility for outcomes. we are all human, and do our best. “birth is safe, interference is risky”, as carla hartley says.

    i will be the woman who walks by her side, and will refuse any sort of induction unless the woman feels something is wrong. women walk with their child inside of them. they have a feel when something is wrong, especially if encouraged to take responsibility. this is THEIR body, THEIR child, THEIR birth. no one can ever take that away, unless she gives her power away.

    women need to remember that they are FREE. and to never give their power away.

    providers should remember “first, do no harm.” and how much harm do we do, with fear and interference…

    blessings on women who walk this path, gloria. and who stand up to tell the truth.

  17. “I think it is disgusting that midwives are so cowardly and turn perfectly healthy pregnant women into wounded mothers. ”

    As an RM, I think that is really hurtful! I definitely try my best to provide care for the mamas I work for, and while I do support women who choose care outside our scope (for all the “rules” there is a REALLY simple one to use- “when a woman chooses care outside the scope of the midwife”- takes about 10 minutes to document an informed choice discussion and you can do what you need to do) But it is continually hard to provide good care when the other midwives are passing judgement on you for being “too left” or “too right”.

    There is space for a wide range of midwives, and while I view myself as a fairly left-wing midwife, I think it is hurtful to refer to midwives working in the scope of practice of the college as cowardly. Just my $0.02…

    For midwives who are looking for their “loop hole” It exists and is definitely under utilized! 🙂

  18. I think it is quite cowardly and stupid of any birthworker who would rather look to to others locked in the same system, rather to the women that she serves. That is NOT midwifery.
    As a midwife I am with women, supporting them so they can be free persons to give birth freely, to mother their babies freely.
    So, if a woman is punched and bullied by her partner I tell her she needs to get away, give her phone numbers, or take her in my care and drive her to a safe place.
    So if a woman is “presented” with “if things are not moving a long next week we will have to start induction” at her 40 wk visit, I tell her to change your care provider.
    So if that woman is told ON THE DAY of her 41wk visit that she already has a booked non-stress test for the next day (because her “midwife” went behind her back and started stirring the pot) I say don’t go, and run away. Who cares if you change a provider … none is better than this.
    How many more beautiful placentas and womb-fulls of amniotic fluid called ‘deteriorated placentas with signs of calcification’ and ‘low amniotic fluid’ will it take?
    Is the risk of stress of induction worth it? Why not have the c-section right from the start?
    Why not call the registered midwives OB-nurses and RETURN midwives to midwifery, with their own autonomy?
    Perhaps the best thing would be to have registered midwifery go belly up so we rise up from ground up again.
    Phoenix rising.
    Gloria is not going to change anything. Love her … but the reality is there.
    Until we stop asking for permission to say NO, or stop expecting someone else to tell us that we can say NO we will not make a headway.
    Do you know how many times it takes a strong birthing woman to say NO to a vaginal exam by her RM at a homebirth?

  19. I agree, V. well said. women are the ones with the power because they are in the system but not of the system. they can say no. RM’s have to fear losing their livelihoods, but for the mothers there is nothing to fear but fear itself.

  20. Mhairi, I give you full credit for being the only registered midwife in Canada who would even attempt to reply to this blog post.

    Here’s a quote that sums up the problem with midwifery that tries to please the medical profession:
    ‘Nobody does as much harm as people who feel bad about doing it.’ William Burroughs

    What happens to the woman who just doesn’t know that she will have to refuse post birth pitocin injections, erythromicin in her baby’s eyes, Vitamin K injected into her baby’s thigh, antibiotics, and other medical practices that have been mandated for Canadian midwives?

    Even very well informed, highly educated women don’t know some of the invasive, unnecessary things that will happen due to the medicalized training of the modern Canadian midwife. I’m thinking of the poster “V” above—I’ve seen the video of her second birth at home in a water tub. The midwife pesters her after every push to have a vag exam, “V” clearly says “NO” and, then, the pestering starts again after the next push and thus continues until the baby is finally birthed. Is that informed choice? I don’t think so. The courts have decreed that, in rape cases, “no means no” but in the mind of V’s reg’d mw, “NO” simply means “maybe in a few minutes”. I won’t put the link to V’s birth but it’s online and she might share it.

    I don’t think it’s possible to deny that the hospital has been brought into homebirths in Canada due to government regulation of midwifery. Midwives may be “hurt” by having it named but it’s a fact.

  21. What about just changing your dates? It always irks me when women give the date of their first day of the last menstrual period….they do not know what kind of a bind they are getting themselves into by just giving that one piece of information. Do not tell them anything!

  22. Gloria, this jumped off the page for me: “Something to notice is that for many women, it takes two screwed up births to get the third birth somewhat acceptable.”

    This is me. I had two coerced c/s without labour and thereby two premature babies, the first of which was so premature that his skull would mould to my hands while I breastfed him and from sleeping so that I spent weeks gently re-forming his skull manually. He had breathing problems until 6 months pp, and his skin was so soft that I couldn’t even feel it under my fingertips.

    I look at pictures of him now and see how obviously premature he was. He was my first and a c/s because otherwise, “if I [went] into labour, he could [have] die[d]” from his frank breech position. His brother was also a no-labour c/s for the very same positioning ‘reason.’

    For my third baby, I saw an OB in my 1st trimester (midwives wouldn’t even talk to me seriously- I’d had ‘shared care’ for the first two pgs after breech was indicated in the 3rd trimester) but left his office and never returned.

    I freebirthed the next baby with my first labour- at 46+3, a 9 hour painless birth. It was GLORIOUS! He was 10lbs 3oz, strong and beautiful. 🙂

    I then freebirthed another boy at 42+3 at the tail end of a flu that my whole family had. It was a precipitous labour- 3 minutes long, and he was 10lbs 8oz. Also beautifully formed and strong.

    Now I am 45 weeks tomorrow with our fifth baby.

    Our first 4 were born in Ontario and now I am in a Canadian territory. I would not even consider asking a midwife to be present at my births after the first two. I have a deep respect for midwifery and have seen through years of research that began after my second c/s, how it has collapsed as a woman-centered and truly beneficial art.

    Just the hockey-bag-sized tote of intervention paraphernalia that a midwife in Ontario was required to have present at births was extremely off-putting. If birth is safe, and midwives support that reality, then why the hospital-in-a-bag???

    My then mw, who became a friend, a few yrs later said that she felt like OBs hands, like she was expected to go through all the same motions with all the same cautions and procedures, but just on a much more rigorous schedule. She felt used- doing more work for less pay, enduring the upheaval of her whole family to be present for her clients, and then being highly scrutinized by the OBs who were her overseers. She was only a few yrs in, and already burning out. 🙁 She began with passion and an overflowing heart for loving the families she worked with.

    Anyway, I don’t need any pity. I enjoy freebirthing and happen to prefer to be alone anyway, and if someone even tried to examine me during labour, I’d likely send *her/him* to the hospital, lol- not intentionally of course, but I am very focused and mama-bear-like in labour and pp since my 3rd birth experience.

    BUT the lack of truly woman-centred midwifery has obviously left a huge vacuum for the majority of women in childbirth.

    Natalie, I didn’t know my dates for my first two because I was taking bcp’s and had bleeds while pg. So, I was ‘required’ to do u/s for dating, which ended up being waaaaay off and obviously not helpful when two premature babies were taken early because of it. The first was extreme, and the second child not so much, but still obviously early.

    Also, my surgical records indicate nothing (even though I spent time in the ICU for full-body anaesthesia paralysis and a heart rate that wouldn’t go above 38 bpm after the surgery- for three hours) and the hospital staff refused to admit that my child was obviously premature and instead just told me that I cannot take my eyes off of him ever- not to pee, not to eat or leave the room at all- ever, not for a second. So I didn’t.

    I tended a baby and brought him to health at a stage of growth and development that would have usually meant him living still in my womb, and in the worst case scenario, in the nicu for at least a month or longer. It was very, very difficult and it has taken me seven years to recover my own health from those experiences- and with a huge amount of diligent effort, not passive recovery.

    My midwife was then just newly practicing and we grieved this whole scenario together. She didn’t know the horrors of the medical industry so intimately previously. She was not prepared for it, and the medical industry representatives (OBs) took full advantage.

    Gloria, thank you for your willingness to address these issues. And thank you for being available to discuss them openly. I have tried to talk people out of supporting the regulation of midwifery where I live, but I have not found a single sympathetic ear. It may be more helpful to attend to how it is regulated, I don’t know, but it would be better to have a better model in place before regulating so that midwifery doesn’t end up swallowed whole, like it will be if this goes through.

    I am sad for what will happen once midwifery is regulated and it’s “available to all” through gov’t funding. I’d rather pay the $2500 out of pocket and receive actual care than pay more with my life and births than I’ll ever be able to recover. But that’s just me. The women here want the regulation for funding. 🙁 They don’t know how much that will change things- how it will create the conflict of interest that plagues midwifery in Canada where this has already happened.

    After my 3rd birth, I was asked to do a lecture from the perspective of a (finally) educated former client on the state of midwifery by the College. I was also asked to consider becoming a midwife. I declined both: the first because I was due with my third child during the conference, and the second because I could not adhere to the stipulations and counter-conscience requirements placed on mws.

    If it were legal (here it still is), I would only consider lay-midwifery and my clientele would have to choose my offer of service based on their own perspectives on their needs and whether or not I am suitable to meet them. This would be the only chance we’d have at enjoying a mutually fulfilling and compatible relationship.

    I wish you well, and again, thank you. 🙂

  23. Pingback: Gloria Lemay » Blog Archive » Third births: finally getting it right

  24. I can only speak of “care” here in the U.S. but it is SO NOT TRUE that a woman can just say NO to the induction or whatever else is being required of her. When you enter a hospital, your civil liberties are anilhilated. If you don’t agree to “best practices” or “medical advice” you may be forced to be analyzed by a psychologist or psychiatrist (even during labor), have your baby taken from you by child protective services, forcibly confined at the hospital, or forced to undergo surgery (c/s) or other medical procedures by “emergency” court order (maybe b/c the OB thinks your baby is too big). IT HAPPENS. Procedures are often done to the baby without the parents’ consent as well. Like my friend whose premie was about to be discharged but then she was vaccinated despite my friend REFUSAL TO CONSENT; the baby developed heart and breathing problems and had to remain in the NICU for weeks longer, and finally go home with a monitor.
    For the mw to tell the woman that she is “allowed to refuse” is a completely disengenius cop-out.

  25. I’m really replying more to your recent podcast on this very subject than this post. In your podcast you said that one of the pro-licensesure points midwives sometimes cite is the ability to serve impoverished women whose care is government funded and who would otherwise not be able to afford hiring a midwife. You responded that it is not a compelling reason because midwives already have enough of a client base from the more educated and more financially secure middle class, so they have no impetus to reach into the impoverished communities, and they largely don’t. It may be true that they don’t have motivation to reach beyond the comfortable pool of more privileged mothers, but that’s not a compelling dismissal of the fact that government funded midwifery care allows access to all women regardless of financial and language barriers. When I contemplate this situation, my response is – how do we cross that financial (and often racial) divide and give all women more choice? I actually find most of your points on this subject compelling, and they give me pause. I am critiquing that particular point not because I want to contradict you, but because I want your arguments to be even more compelling and convincing to people like myself – who are on the fence about licensing.

  26. paintbird: so why go to the hospital to begin with? I’d rather birth on my own in a parking lot than under those conditions?

    Glo: yeah, took me two births too. I mean I ‘knew’ but I still tried appeasing everyone else except me. If there ever will be a third time I will look after myself and my own babies. Thank you very much.

    Imogen: I really love what you wrote. That is where I am at in my heart of hearts.

    Glo again: I don’t know if you read my status and the “discussion” after the 39 week membrane sweep by an RM. I find it really sad what I understood from the comments. It left a very foul taste in my mouth after reading those. Why do these new midwives think that being one of the “lesser evils” is midwifery?? Where are their ethics. Today’s midwifery in BC is all about a lip services and assisting to the OBs. They may as well call themselves nurse-midwives. If an RM is willing to induce, and even push on the mothers, a 39 weeker, or even a 40 weeker what are they here for?
    I had been wrestling with my decision and subsequent acceptance into a nursing program. I felt like I may be selling my soul. Today, I realized I will not be. But I sure as hell would be if I registered with the college as a ‘midwife’ under the current conditions.

  27. I think the putting down of others whether they be nurses, midwives, OBs, lay midwives, doulas, mothers, children, or traditional birth attendants is sad. I am a registered midwife in BC and i have not sold my soul. yes there are “rules” that a RM is suppose to follow but women are autonomous human beings and can make ANY independent choice when provided with information.

    There is room for many different care providers and I honestly believe there are just as many great nurses, midwives, and doctors as there are crappy ones. I sincerely wish we could all work together in an effort to provide care to ALL women and respect ALL their wishes and hopes for their birth.

    Also, just a note about Gloria’s comment regarding registered midwifery and the rise in c-births…if you were to poll RM’s I am certain their “personal” c-birth rate would NOT be 30%. I know midwives whose personal c-birth rate is under 10%.

    Why the judgment? We should spend more time working together and YES changing the system from the inside and outside rather than hacking one another to death!

    Alyson

  28. paintbird: Thank you! I always get so frustrated with the “You can refuse anything. Women have to take responsibility for themselves and they’ll be fine.” arguments when it comes to hospital birth. I generally agree that more women being willing to stand up and refuse to be put through that ringer is what it will take to change the system, but the fact is that, at least in the U.S., sometimes court orders get issued, family services gets called in, and hospital staff manhandle laboring women. As someone who gave birth in restraints after attempting to do something as simple as walk up to the maternity ward on my own, not ride in a wheelchair, I know all too well that it can and does happen. I’m fairly certain that if I had not had precipitous labor, I would also have had a forced cesarean.

    Re blog post: Gloria, I really love you for this. I unfortunately fell into the trap of believing I was safe from ridiculous OB practices with a midwife and a planned out-of-hospital birth with my first. It was sprung on me when I was in labor that my midwife’s partner was transferring my care because she didn’t have time to attend a birth that day. I’ve really struggled with what happened from there. My midwife heard about it and met me at the hospital, but at that point the damage was already done and she couldn’t recommend we leave without risking her privileges to practice in that hospital. She also couldn’t do much about the fact that the hospital staff was clearly forcing things on me that I had not consented to and was actively arguing against, or, once again, risk losing her hospital privileges. I do believe she spared me major abdominal surgery by meeting me at the hospital, but at what cost? And how many other women under her care have had the same experience? Should I bear some sympathy in her direction given that I know her hands are tied if she wishes to continue to enter that hospital as a care provider in those rare occasions a woman in her care truly needs to be there?

    I’m now expecting my second child (any day now!) and looking forward to a gentle homebirth under the care of a direct entry midwife who I am proud to work with and know well. After my previous experience, I’m not sure I would trust a midwife to attend, even a lay midwife, without knowing them very well and having seen first hand how they approach birth with other mothers. I briefly considered having this child unassisted. I find it very sad that I found myself considering freebirth, not because I am deeply comfortable with it for myself, trusted that I could handle anything that might arise, or found a peace with that approach that nothing else could give me, but because I simply felt I could not trust most birth attendants to place the well being of myself and my child, and our wishes, over their own habits and local politics.

  29. I was actually really for registration of midwives here in Alberta, but after seeing the ridiculous bs rules, I’m just pissed off. I’d like to be a midwife, but there’s no way I can practice like that after having had 2 freebirths (& planning for a 3rd). Which means there’s no where to get training for me. No midwife is going to take me as an apprentice and even if I could get accepted to the new program at Mount Royal, I guarantee a lot of what they teach is going to be fear mongering inaccuracies designed to produce “midwives” who will not only follow the rules, but who actually think they’re doing the right thing. I don’t think I could keep my mouth shut about it. And it all leaves me…nowhere, I guess. And I have to wonder how many other natural minded women who want to be true midwives are in the same situation as I am.

  30. Alyson, I didn’t say that the “personal” c section rate of individual midwives is 30%. I said that part of the promise that was made to “sell” a licensed profession to the government funders was that midwives would contribute to a kinder, gentler obstetric scene and, thus, fewer cesareans would be done. That did not happen. We can all own that high cesarean rate, if we choose. It’s simply a measure that, no matter how “sad” or desperately earnest we all are, women are being cut open in record numbers in the province of B.C.—if you want to be sad about something, that’s worth some emotion.

  31. Amen, Gloria. The issue is that there are not enough midwives understanding who we are working for. We are with and for women. End of. Negotiation may be a part of that but being true to yourself and the women we care for overrides and supersedes everything else. I teach my student midwives this and I will not with conscience back down from this. And the reason?…I have seen too many things done to women that is not right, all in the name of convenience, fear, personal opinion, control etc. And I have listened to the sories of too many women that tell the tale of the fear, trauma and abuse at the hands of those that do not have them at the centre. So I will not ever go against mine and the women I am caring for…

  32. Gloria, B.C. is lucky to have you as a rebel midwife and voice for mamas. Sitting at home 4 days ‘past my due date’ I definitely feel the anxiety of others beginning to manifest. And you are right: it takes a few tries to get it right. And it takes a lot of courage to go against the mainstream ideas, myths, lies and misconceptions that are all-pervading in the birthing industry (which is what the medical model has become). I appreciate your readiness to NOT work from the inside out when it comes to midwifery. All too often well-meaning birth workers choose to go that route and find their hands tied with legislation, legalities, threats and career-ending decisions. I am a firm believer in personal responsibility. I tell women I know who are or are about to become pregnant that the most important thing they can do for themselves and their child is to learn everything they can about childbirth: the good, the bad the ugly so that they will be the most well-informed possible when hard decisions have to be made. All too often women do not educate themselves and put themselves and their babies in harm’s way because they don’t want to take responsibility when something ‘goes wrong.’ The above comments re-assure me that I am not the only one who has been abandoned by a ‘midwife’ when I didn’t fit the mold of her model of care. (Though completely complication-free and healthy)
    After one ‘natural birth’ in the hospital attended by a long-practicing midwife who did nothing to prevent me from tearing, who ruptured my membranes, who hep-blocked me, who gave me a catheter and instructed me to ‘push, push, push’ for hours because we were on hospital time, I chose to home water birth my second with a doula friend of mine after a mainland midwife told me at 7 mos. that she changed her mind and would not be attending my planned home birth after all! I could not have done this if I hadn’t done all of the work myself to make it happen. I live on an island south of you in the states, San Juan Island, where all too often women are instructed to be induced in the mainland hospital for fears of ‘not getting there in time.’ Or simply scheduling their c-sections. Its a very sad state of affairs when the women where I live (Population 3-4000) are given three options: Have your baby with an OBGYN in the mainland hospital on their schedule, have your baby with the one and only licensed midwife contracted to work in the same hospital, or go it alone. Waiting for baby number three, with my birth tub filled and my feet up, I feel confident that at least the decisions made for myself and my baby are going to be made by me (an LMP with 6 years of unofficial childbirth education).
    And no, I will not be ingesting castor oil or rupturing my own membranes to ‘get labor started’ because babies come when they come and time is relative. 😉

  33. So many moms “totally understand” this and still they choose the regulated midwives because they never believe it will happen to them… and then it does. Not always, but it does. And, for some reason – they can fight for the minority when it comes to something they believe in… but then they stop fighting for an even smaller minority because its “just not worth it” or its “too hard” or its “not that bad.” They’ll fight against unassisted birth because “that’s unsafe” and then encourage moms how it is totally safe to have a homebirth WITH a midwife. It’s only not that bad when it’s not YOU in the situation. What is “safe?” Who IS important enough to fight for? I don’t even think half the birth advocates in these systems even understand what they ARE fighting for…

  34. Lisa… I am definitely one of those women. Not only can I not be a midwife in such a fear-driven regulated system… I can’t handle the sue-happy consumers either. And, it kind of breaks my heart. I love being with women. It is actually something I feel like I could do well… but I don’t believe in the way that I would have to practice – and the people that are out to get other midwives who don’t practice the same way they do… I’ve never felt more unsupported than by other birth workers. It is so sad how elitist people can become. 🙁

  35. What do we do to fix this, Gloria? I see it all the time as an advocate in my community. I see the statistics and the induction rates sicken me. The scaremongering disgusts me. HOW do we get midwives to run the show and make the doctors start answering to THEM and the women that hire them? I know in my heart that things aren’t going to change until we reach every woman and make her strong enough to fight these “standard of care” policies, but a lot of women are scared that they’ll be forced into compliance and/or lose their midwife. It is terribly unfair and dare I say it, misogynistic that the doctors get to call all the shots and women are just supposed to lie down and take it. We KNOW that 40 weeks gestation is NOT a guarantee that baby is ready to be born. I have read so many stories of women with underground midwives or unassisted birthers who go to 43 weeks and beyond. I am just at a loss as to what to do to reach the consumers of birth and put the power into the midwives’ and women’s hands and put the doctors in the role of consultants needed for that 10-15% of cases when they are actually of any value to birthing women. If you have any ideas on how we can accomplish this please feel free to contact me.

    • I know you’re asking a rhetorical question, Carly, because, if I knew what to do, I would have already done it. Keep up the good work. Tell the truth. Educate. Don’t buy into the factory birth mentality. Thanks for what you do.

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