Editor’s note: This article first appeared in Midwifery Today, Issue 32, Winter 1994.
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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 privilege.
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 her.
This changed things. It was not “the doctor” who would be checking her, but a random floor nurse. Commonsense sneaked 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 a rape.
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 doctor.
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 healing.
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.