by Judy Edmunds
© 1994 Midwifery Today, Inc. All Rights Reserved.
[Editor's note: This article first appeared in
Midwifery Today Issue 32, Winter 1994.
Reprinted in the book
Life of a Midwife.]
I asked my husband to read Open Season
by Nancy Wainer Cohen. I think it will help him understand more clearly
who I am and why I do what I do. For midwifery is not really something
I just do. In many ways, it demonstrates something essential about who
I am. I cannot imagine not being a midwife. But why accept the harassment,
interrupted sleep, postponed vacations, the emotional turmoil? It obviously
isn't for money; in fact, I gave up a lucrative career in management when
it interfered with my practice. Status? Power? My former supervisory position
had plenty of both. Free time? You must be kidding!
I decided to become a midwife for complex reasons. For one, I had been
subjected to rude, sometimes inept, and mostly indifferent gynecological
care. A lot was taken away from me, including my uterus at age 19. I want
to give something back to women by providing an alternative. More to the
point, I believe in the beauty and dignity inherent in all women. I am
awed by their strength and power and am fortunate to be able to attend
births where these qualities are so clearly displayed. Having a share
in drawing out that power, respecting that dignity and nurturing the spirit
of courage is being privy to a bit of creation itself. It is an incredible
Midwives try to convey these simple truths: Birth is not a clinical
exercise. It is not a medical procedure. In nearly every instance, it
should not be major surgery. Nor should it even routinely include minor
surgery. Rather than being a time of weakness with beds, shots, fasting,
IVs and wheelchairs, it is a time of energy and strength. Raw power. Mightiness.
Courage. Sometimes our victories are great: a beautiful home VBAC after
doctors had convinced the woman her body was defective. Sometimes the
victories are small: a routine hospital birth, yet no drugs were taken
to dull the senses. Still, considering the tales of woe amassed in Nancy's
book, we see we have work to do, a long way to go. Birth abuse continues
to take place. In fact, how many hospital birth horror stories have you
heard? And yet, how many times have you been asked, "Just what, exactly,
does a midwife do?" or "Mid-what?" Considering that only
a small percentage of women choose to birth at home, we recognize that
many women don't even know what this choice could mean for them.
Last month, a friend asked me to help her at the planned hospital birth of her
second child. She had experienced a long labor with her first child. She'd wanted
to walk, but had been inhibited by the noisy hospital environment and monitoring
protocols. Yet, her family was very uncomfortable with the idea of homebirth, and
she felt she might like drugs for the pain. And, of course, her private insurance
would cover everything in the hospital. The plan, agreed upon by her doctor, was
for me to monitor her during early labor at home, where she could move about freely.
When she was in active, progressive labor, perhaps 7 centimeters, we would move to
the hospital where I would continue to provide support and advocacy while the doctor
"completed" the birth. It had been years since I had attended a hospital
birth, but I knew this doctor and felt quite comfortable with the arrangement.
At 6 a.m. she phoned to report her water had broken during the night.
The fluid was clear and contractions were just beginning. She planned
to rest a bit more; I told her I would be over soon to check on her. Meanwhile,
she phoned the doctor's office. The chosen doctor was unavailable, nor
would they contact her second choice. She was assigned a doctor she had
never met. She called back later that morning to report on her progress.
When the doctor returned her call, he sounded practically hysterical and
demanded she come in immediately. She patiently explained what her plan
was. He yelled at her and told her not to "let that midwife touch
you," saying she would probably get an infection. She reported this
to me, feeling despair that her plan was unraveling. Her husband felt
torn; he wanted to follow "doctor's orders," yet he also wanted
to support his wife.
I explained that I had never had anyone contract an infection as a
result of my care. I was always very careful and used sterile gloves for
exams with ruptured membranes. I explained that exams should indeed be
kept to a minimum under these circumstances. They discussed this anxiously.
Her husband still leaned toward going to the hospital. In order to be
properly acquiescent ("the good, obedient patient"), and to
avoid making waves, they decided to go to the hospital. They phoned the
doctor to see if he was in his office and were told he was in surgery.
They were instructed to go to the hospital, where a nurse would check
This changed things. It was not "The Doctor" who would be
checking her, but a random floor nurse. Commonsense snuck in. They realized
that an exam by an experienced midwife might be more appropriate, and
that the chance of infection could, in fact, be greater at the hospital.
So we stayed home. She was 3-4 centimeters and effacing well. The next
exam, following a shift in labor intensity, was mid-afternoon. She was
7-8 centimeters—time to go in.
At the hospital we encountered: the curt receptionist, trying to instill
guilt that we had waited so long to come in; paperwork; the 10-minute
wheelchair ride through the twisted maze of corridors to the room; the
obligatory urine sample; imposed stripping of normal clothing to don the
faded, degrading, open-backed hospital Johnny; denial of food; forced
monitoring while strapped in bed; the nurse's exam (I'm not sure how dilated
you are. I will have to check my dilation chart at the nurse's station.");
the doctor's sarcastic, put-upon remarks after a rough exam ("It
will be hours yet. I'll be waiting around."); derogatory remarks
about her maternal age (early 30s); assorted staff members bursting into
the room to look for the doctor or a particular nurse; and finally, the
maneuvering toward a cesarean because her water had broken 12 hours earlier.
At one point, I noticed that I could actually feel the cocoons of tension
and anxiety the staff were cloaked in. The feelings were so strong, they
were nearly palpable, nearly visible. When one of the nurses stood next
to me, I felt my shoulders rise and my neck and arms stiffen as I absorbed
her energy. I had to consciously breathe and drop my shoulders.
Every time a staff member came in, the door was left wide open. The
noise was incredible: banging, clanking, nurses shouting from room to
room. We "hid" in the shower. This helped her relax and resist
the strong, premature urge to push. Breathing, blowing, water, massage—we
were getting close! Reluctantly, at the mom's request, the doctor checked
her. ("You've got a hugely swollen anterior lip. It could be a couple
more hours!" he said as he whisked out, leaving the door ajar.) I
quietly closed the door, guided her to sheets I had spread on the floor,
and helped her kneel forward. In minutes, the lip was gone and the head
moved down. I asked her husband to get the doctor.
"Ugh! What are you doing?! You want to have it on the floor?!"
The doctor announced his entry by yelling this at her, his tone one of
utter disgust, even as we were rising toward the "good patient"
bed. The doctor jumped and flailed around on one foot while he put on
his booties, the dusky green of draping linens splashing everywhere. The
room became a rush of activity. The bed was broken down, stirrups pulled
out, monitors attached, trays assembled. Thrusting his fingers into her
vagina, he announced, "You've got plenty of room in there! Very stretchy!"
then turned immediately to his tray and produced a large syringe and needle,
which he quickly plunged into her perineum, distending it beyond recognition.
"Ouch! What was that? What are you doing?" she cried. "Oh, it's
just in case I have to give you a little snip," he remarked casually, even as
he applied the scissors to her still loose and "stretchy" perineum. The
head was just barely visible. My heart leapt and my stomach churned as he hacked
away at her, leaving a long, thick, ragged, bleeding wound. I felt as if I had been
cut, too. It was horrible. "Push! Push!" they chanted. The baby plopped
out. The doctor snapped on the cord clamp even though it strained at the stump, and
suctioned the baby roughly. With sharp scissors, he sawed on the cord, the instrument's
point scraping across and denting into the baby's abdomen. The infant's face screwed
up into a silent scream of terror. I felt weak in the knees. I had just witnessed
It was not over yet, however. The mom released a very small amount of blood due
to the cord being yanked. The doctor ordered the nurse to "Pit her." The
mom balked and asked for an explanation. She looked back and forth at the doctor
and me. "Take it or you'll be anemic! You don't want to be anemic, do you?"
he said. In turn, I quietly explained she was in no danger, that her blood loss
was well within normal parameters, and that she had the option of the Pitocin to
help her uterus contract. "It's either the shot or a blood transfusion!"
The doctor knew full well that her religious beliefs prohibited her from taking
another's blood into her body, not to mention the fact that her blood loss was absolutely
minimal. It was clear that the remark was meant as a threat, a bludgeon against
non-compliant behavior. "Doctor, you know that is out of the question."
Instead he shouted, "Well, I could just let you die on the table!"
I had never witnessed such uncalled-for hostility—yes, hatred—at a time that should
have been a sacred, joyful, peaceful moment. My heart was deeply hurt.
Her husband, rendered impotent by the violent exchange, told the nurse
to do whatever the doctor wanted. Pitocin, of course, was not the issue.
Nobody was really opposed to it at all. The mom just wanted to be included
in the decision-making process, to participate in her own birth. Clearly,
her coherence, and my presence, thoroughly threatened and angered the
He pulled out the placenta, stitched her up, brushed himself off, and turned
to leave. She timidly called out, "Thank you, doctor."
This should have been a victory. She did very well: she had averted a cesarean,
labored without drugs, and deserved to be quite proud of herself. I was thrilled
for her. Yet, as her arms reached out in futility for her baby who lay crying across
the room, naked, on the warming table, I was grieving. I felt sick inside. This
is not how birth should be! This is just plain wrong.
Anxious for a touch of gentle reality, I phoned one of my moms
(in her 40s, by the way), who was "overdue" and planning a homebirth, to
tell her it was "her turn." She knew the other mother and had wondered
who would have her baby first. Shortly after she talked to me she went into labor,
and in no time I was on my way to her home.
Driving there, I shed tears as I worked hard to diffuse the hurt I felt. I did
not want any of that nightmarish experience to taint the upcoming birth. I wanted
to enter this home filled only with love and excitement. This would be a time for
Her children were bubbling with anticipation as I calmly set things
up. The mom came from the bathroom and sat on the rainbow-cushioned birth
chair I enjoy using. I sat on the floor in front of her, my hands encircling
her ankles for connection. Music played, the children chatted, and her
husband and friends softly exchanged stories as they turned the video
camera on each of us in turn. Quiet calm. Peace.
Gradually, the baby's head moved lower, gently breathed down with gravity toward
our lowered voices. The heartbeat, heard at intervals, thumped strongly away. Scented
oil was applied to the perineum; the aroma filled the room. Delicate massage, easing,
helping...the baby emerged amid tears of joy into welcoming arms, across an intact
perineum. Time passed, the cord pulsed, the baby nursed. Still calm. Still peace.
Excitement... happiness... healing. Some gentle examinations were performed in due
time. The children discussed names as they took turns holding the baby. At last,
snuggled up between the parents in their bed, the baby smiled while drifting off
into satisfied sleep. Yes, this is how it should be. This is right.
What a contrast I had seen within a few short hours. What a gift we can bring our
sisters at this special time of their lives. So I ask: Does this account move you?
Did the doctor's arrogance anger you? Then vow to be a true force for change. Vigorously
promote nonviolent birthing. Resist the urge to imitate in any way a medical system
that ritualizes such familial abuse. Provide a true alternative. Don't sell out
for the convenience of a shift and a salary. Be strong. Be proud. Trust yourself
and trust birth. Educate everyone you can. Help more and more mothers to have their
babies gently in their very own home.
May we always remember why we are midwives and what we must bring to births: calm,
quiet, peace, excitement, joy, love. Blessings on each of us for the good work that
we do. May all our births take place with graciousness.
Judy Edmunds has been a community homebirth midwife for 13 years. She
has joined Midwifery Today as a contributing editor.
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