An Interview with Heather Long
© 2006 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 77, Spring 2006.]
[Photo by Jennifer Rosenberg]
Elizabeth Davis was thrilled to be pregnant at the age of 20. It was 1972. She read the only two books she could find on the subject: Lester D. Hazel's Commonsense Childbirth, and Thank You, Dr. Lamaze, Marjorie Karmel's best-selling book that introduced the Lamaze method of childbirth to the US. These books were enough to convince her that she wanted a homebirth, but she couldn't find a midwife. She got a copy of Emergency Childbirth (by Gregory J. White, MD), which was what the do-it-yourselfers used then, and started gathering supplies, not entirely sure what she was going to do with them. When she was five months pregnant, a woman whom Elizabeth had only recently met invited her to attend the birth of her third child. The woman intended to give up the baby for adoption to a friend who couldn't have children.
"I witnessed this birth in a milk shed with a woman demonstrating more power and beauty and strength than I had ever seen. And, to top it off, she handed the baby directly to the adoptive mother who put it to her breast. That took an amazing amount of restraint on the part of the birthing mother and it just blew my circuits. I'd never seen anything like it, and I immediately did as other women of my era did and asked her to be my midwife."
However, when Elizabeth went into labor a month early her midwife was not in town. She had to make a decision: stay home and attempt the birth unassisted and with very limited knowledge, or go to the hospital where she would be literally tied to her birth bed. Concerned with her baby's prematurity, she chose to birth in the hospital. It was worse than she imagined it would be. She was given a lateral episiotomy, and her son was immediately taken from her to be scrubbed and processed. Although the birth itself was joyous and later she was able to breastfeed and bond with her son, the experience, she says, left her damaged. Elizabeth looks back on that decision as an intersection of her life and fate. She realized that in order to grow into a powerful woman, a confident person, she would need to transform painful aspects of that experience into growth on her path. She didn't know yet that her path was midwifery.
Elizabeth recalls the homebirth of her second child, a daughter, as a "beautiful, empowering, ecstatic, exquisite, orgasmic" experience. She was determined that, no matter what happened, she was not going to the hospital. "My midwives were very low-key. They stayed in the living room. They let me do my thing." What was so powerful about this birth experience was that she didn't take direction. "I really birthed from the inside out. I birthed according to every subtle nuance inside my vagina."
Today, Elizabeth Davis is a renowned expert on women's issues. She has been a midwife, women's health care specialist, educator and consultant for over 25 years. She also is the author of the classic Heart and Hands: A Midwife's Guide to Pregnancy and Birth. The book is an excellent and thorough resource for parents-to-be who are thinking about birthing their child with a midwife, or who are concerned about the medical establishment's over-control of birth. It's the sort of book that Elizabeth had searched for all those years ago. Elizabeth says that her recent updating of the book (for the fourth edition) reflects some of her own changing attitudes toward midwifery. "There were areas in the book where I recognized [that] in the early renaissance of midwifery, we really did tend to overdo it a little with the perineal massage and the internal exams." Elizabeth says when she first came to midwifery, "there were no midwives except those who were self-starting. There were no schools or ways to be trained to be a midwife. As a result, midwifery was often in reaction to what the medical community practiced." They made women lie down; midwives told them to squat. They ignored the perineum; midwives felt like they had to do more to support the mother through massage and compresses. "Now that we understand the physiology of birth, we know how to witness signs of progress without making excessive physical assessments."
The book also has been updated with new information on Group B Strep (GBS) and opportunistic infections, VBAC (single layer vs. double layer closures) and the Health Insurance Portability and Accountability Act (HIPAA) guidelines, as well as revised forms and a new, extensive section on postpartum depression. "I got to use Anne Frye's manuscript of Holistic Midwifery, Volume II, to update the whole thing, which was a great blessing. Her book is remarkable," says Elizabeth.
Feedback on the revised Heart and Hands has been positive. "The central message of the book hasn't changed, but I did a dramatic revision—I basically rewrote it from start to finish." The idea that birth is a natural event and that a woman knows how to birth is the essence of Elizabeth's message. In an excerpt from Heart and Hands, she says, "What makes midwifery so desirable to women? Simply put, midwifery promotes well-being. It is an art of service, in that the midwife recognizes, responds to and cooperates with natural forces. In this sense, midwifery is ecologically attuned, involving the wise utilization of resources and respect for the balance of nature."
Elizabeth's second book, Women's Sexual Passages, reaches out to women who wouldn't necessarily pick up a book on midwifery. Sexuality is presented as an expression of how we feel from decade to decade. "Each stage [of a woman's life] has its integrity and its importance, and it's perfect," says Elizabeth. "I want women to embrace all of what it means to be a woman." Women's Sexual Passages also contains a lengthy section on the sexuality of pregnancy and birth. She intentionally used the subject of the book to share the midwifery model and show the truth of what birth is really like. She also confided that she had trouble getting the book published because it didn't fit into a specific category—sexuality, psychology or women's health. "And that's the point," said Elizabeth. "The point is the integration of all these aspects of what we are."
Her third book, The Circle of Life: Thirteen Archetypes for Every Woman, written with midwife Carol Leonard, focuses on the psychological development of women with the hinge pins being the blood mysteries of menarche, birth and menopause. This book also fills out what women are in the second half of life. "I worked on this book when I was 45, stepping out of my nurturing years and really curious to know what was next. I didn't have a clear vision of what was coming for me." Leonard and Davis relied on interviews to gain a clearer picture of women as they age. "When we wrote the book, Carol and I were too young to articulate the stages beyond our own years. So we interviewed older women, who would look at the stages and go, 'Oh, yeah, I'm there,' and we'd say, 'Well, tell us about it. We're not there yet. We want to know.'"
Elizabeth believes this wanting to know is natural to women's ways of learning. Women want to see the bigger picture, to know how one stage fits with the next, what changes to expect and how to respond to those changes. This is the context around which she has built her midwifery program. Elizabeth is the co-director (with partner Shannon Anton) of the National Midwifery Institute, Inc. (NMI), a three-year, MEAC-accredited program that prepares midwives using the apprenticeship model. In studying educational theory, she found that most educational systems are built on the male model, or what she calls the "brick layer" approach, which puts together separate chunks of information that build and build to the "gold star" on top. When designing her education program, Elizabeth thought purposefully about how women learn. "Women use both hemispheres of their brains all the time. They multi-task. If a woman has a question or a concern, she will factor in as much as possible, deliberately soliciting conflicting viewpoints to see the matter from as many angles as she can before moving to the center for solution."
Heart and Hands is the beginning component of the curriculum, which starts with an integrated overview of midwifery at a basic and very practical level. "For example, when we touch on preeclampsia, we focus on how to recognize it and how to respond, not every detail of what causes it," Elizabeth explains. Once a student midwife has covered the general information surrounding childbirth and midwifery, the next step is topical coursework. The student now takes an entire section on preeclampsia and learns the finer details of this syndrome. This second portion of the NMI course work (taught by Shannon) has 52 modules, which students can take in any order that they find interesting. "This upholds our philosophy of education based on women's ways of knowing, as women want to know the context before applying themselves to the details. They want to know why they need to know. Ideally, a student will do these modules according to current issues in her apprenticeship." The program also supports a feedback system in which the senior midwife and student share their thoughts on births they attend and formulate together the student's next clinical challenges.
Elizabeth stresses the importance of sharing birth stories in one's personal life as well. She says that after 13 years in one of her women's groups, only now are the details of birth stories coming out. She encourages women to reach out to one another. Put up a notice at the neighborhood laundromat or YWCA that says, "Want to share your birth story? Let's get together for a potluck at_______." Or form a breastfeeding group, or create a support network for yourself and other menopausal women. When you hear a woman's story, Elizabeth says, encourage her to listen to someone else's story.
Elizabeth also noted the success of Eve Ensler's The Vagina Monologues, the hit Broadway play that celebrates female sexuality in all its complexity and mystery. "This is something that grew from grassroots storytelling, and now is part of our national consciousness." Along these lines, Elizabeth pictures a production about childbirth that wouldn't just be about birth itself, but all the planning and care that comes beforehand. She sees a split stage: on one half, a woman in a doctor's office asks a question, this side then goes dark and the other side lights up to show a woman talking with her midwife in her own living room. The audience sees that all these seemingly tiny interactions truly affect the final birth outcome and how the mother connects to her child. "How do we get this message out there? Midwifery is full of social and political elements. It needs to be brought to the forefront."
"We're in a culture that would rather women didn't go wild," says Elizabeth. "Our cultural response to women in any of the blood mystery passages is medication, subjugation and operation. We have Prozac for PMS, myriad medications for childbirth and only now is hormone replacement therapy for menopause disappearing." The operation part of what Elizabeth calls "the taming process" is surgery in the form of plastic surgery, episiotomy, caesarean section and hysterectomy. "In each of these beautiful, powerful passages, women have to find strength to go through them naturally, to really learn the lessons so that they are changed on the other side. My real mission is to expand the midwifery model to take care of women throughout the life cycle and to popularize a whole woman view."
"Midwifery is part of an international movement for women and children," says Elizabeth. Women's Sexual Passages and The Circle of Life were intended "to help women awaken to their beauty sooner, to help them empower their daughters and to love themselves no matter what age they are."
Throughout the changes of her life, a woman can become powerful and fully able to inhabit her place in the world. For example, imagine a woman birthing a baby girl with joy and confidence, and this girl later birthing in the same way. Elizabeth's daughter recently chose a waterbirth at home, and Elizabeth was there to catch her first grandchild.
Now imagine our world if more women passed on that faith in their own power.
Heather Long lives in beautiful Fall Creek, Oregon, with her husband and her daughter, who was born about a year following this interview.
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