Getting Honest About Midwifery and the Flaws of the Natural Birthing Community

Thoughts have been bouncing around in my head for some time now.  Thoughts about midwifery and home birth and legality and skill.  So many thoughts I don't know quite what to make of them. 

As time has gone on and I have delved deeper into the natural birth community it I have noticed a few things.  Sometimes we are full of contradictions and hatred, just like everybody else.  Sometimes it seems that we hold the same strange reverence for midwifery as the rest of society holds for the trained medical doctor. 

I hear people talk about Ina May as though she were a goddess who can do no wrong.  I hear people talk about Ricki Lake as though she is the beginning and the end of birth knowledge.  I hear people say things like, "Just have a home birth, then everything will be fine."  Over and over again I have heard people talk about birth being safe and painless if only we are without fear.  "Trust Birth" is the motto and all complications are a result of failing to do this. 

Don't get me wrong, I respect Ina May and what she has done for women and midwifery in this country.  I respect Ricki Lake and am grateful for the difference that her movie has made in the world.  I loved my home births and value the beauty and yes, the safety of out-of-hospital birth.  And I do think fear can have a very negative impact on the birth environment. 

Oh, but I think we need to be careful too.

I wish I could find a clever way to say this.  A way to be funny about the flaws of the natural birth community.  I have tried in the past and it always kind of falls short.  I wish there was a perfect answer and I wish I knew what to say in just the right way. 

So here it is, the best I can say it without sounding too high and mighty. 

I think it is time we STOPPED acting like midwifery is always the answer.  I think it is time we stopped talking about birth as though it should always be trusted.  I think it is time we stopped acting like if something goes wrong it means mom did something wrong or it could have always been prevented. 

I think it is time we held midwives up to the same scrutiny in the natural birth community as we hold OB's.  It is time we realized that there are good and bad midwives.  Some are ethical, some not.  Some are skilled, some are not.  Some are smart and yes, some are idiots. 

I would love to see us stop talking about empowering women.  It drives me absolutely batty for natural birth supporters to act as though they have the ability to give a woman her own power.  OY!  What's next- we let her eat food in labor!?  Go us!

I would love to see women making their own informed choices and not getting their information just from blogs - yes- EVEN THIS ONE!  (Sometimes people send me questions- MEDICAL QUESTIONS!  And I have to say, it scares the living HELL out of me that somebody would ask me medical advice.  It does not stroke my ego.  It scares me.  I am not a doctor.  And if I WERE a doctor I am not your doctor!  But I AM NOT A DOCTOR!)  You should not trust me or any online personality with your health care. 

I love natural birth.  I think it goes right so often that it absolutely blows my mind.  I have read memoirs from midwives and it is shocking to me that more people didn't DIE considering the horrid conditions they were birthing in and the complete lack of care, nutrition, sanitation and support.  The female body is amazing.  The birthing process is well designed.  But please, please, please, we MUST recognize that it is not fail-proof.  We have GOT to see that birth doesn't always work.  There is very little in life that always works, our bodies included. 

I had an unassisted birth.  (It doesn't count towards my crunchy holy grail because it was accidental.)  It was an amazing experience and I am so grateful for it.  I believe that (for a few reasons that are too sacred for me to share), it was the right birth for our family at that time.  But I have to say that I was so very deeply grateful that everything was fine and healthy and beautiful.  I had experienced minor little bumps in all my other births.  A postpartum hemorrhage.  A baby that didn't breathe right away.  A wrapped cord.  All little things that were nothing because I was always surrounded by knowledgeable midwives who were quick and smart and respected the process but also knew when to step in, even in a small way. 

I have heard people in the natural birth community dismiss these little "needs" for intervention.  "You won't hemorrhage if you are birthing naturally and the baby nurses right away."  "The cord keeps pulsing so it is OK if the baby doesn't breathe right away."  "A baby can be born fine with a wrapped cord."  I must admit that I and stories I have shared have perpetuated these phrases.  And they are true- sometimes.  But not always.  Sometimes women do bleed out even when things are normal and they nurse.  Sometimes the baby doesn't breathe right away and needs resuscitation despite an intact cord.  And sometimes a wrapped cord necessitates an intervention. 

Not always - but sometimes. 

So, lets be honest.  Let's apply the same scrutiny and demand for evidence based care to OURSELVES as we apply to the traditional medical community.  It is kind of scary to look in the mirror and acknowledge our flaws as people and as a community- but it is so necessary.  Doing so will make us stronger.  Being honest about the down sides of the natural birthing community will make us better and more approachable.  We shouldn't be dogmatic.  We should be willing to re-asses and re-think and reconsider what we are saying.  We should realize that we are wrong sometimes.  That doesn't make us weak-  It makes us HONEST. 

I sincerely believe that more women want natural births than are getting them.  I think that part of the problem is us as a natural birthing community.  I think we can be scary.  I think we can be mean.  I think we can be so "out there" that "regular" women think we are freaks and want nothing to do with us. 

There is so much good we can do for birth.  I believe it must start with us.  Lowering the c-section rate will start with women and it will start with DEMAND.  But demand begins with education.  And people don't want to learn about natural birth if we make it look like an (scary) exclusive club that is just as fear mongering as their "let's schedule your c-section at 38 weeks" OB. 

We can do better. 


Cherith Melody said…
THANK YOU!!!!!!!!!!!!!!!!!!!!!!!!!!! Thank you for such an authentic, realistic and honest post.
Brittany said…
Thank you for writing this. I have been feeling for a long time that we really need to acknowledge the need for balance and moderation in birth. The medical community is going to continue to resist collaborating with us for as long as they continue to perceive us as reckless and irresponsible. We need to hold our midwives to a higher standard so that they can show the medical community that they can be trusted, to allow for smooth transfers of care, rather than the OBs feeling like they have to clean up the midwives messes.
aniC said…
Wonderful post!
the Brunsons said…
Thank you! I love natural birth and had my baby in the hospital with a midwife. I have always been uncomfortable with the "us vs them" attitude. Everything does not have to be a battle!
TLmidwife said…
Thank you for writing this. As a Midwife I cannot agree with you more. I support a woman's choice whatever that choice may be. There is no right way to birth if you the mother is making your own decisions. It is time that Midwives stood up and became accountable to each other and the communities they serve. It is time that we accepted that birth/pregnancy can't be "trusted" because it not something that can build trust. Trusting birth is like trusting the weather. It is sunny and beautiful often but there are also tornadoes and hurricanes. it is time to build important relationships with the medical profession because sometimes we need them. We need to be humble and understand that Midwives are not always the birth "experts" Peace and Love to you.
Anonymous said…
thank you for this humble honesty! I am one of those moms who would have died along with my firstborn daughter...breech and too doctor saw the critical need for an emergency cesarean to save us both thank God! so glad I was in hospital!
Unknown said…
I had a natural home birth. Everything went well. It was phenomenal, and I believe in supporting women who want to try for a similar experience.

Yet this strange antagonism and blithe insistence that there's only one way has been bothering me for a while and is the reason why I emphasise choice and education and different options rather than insisting a particular way is best. It's not best for every single person, and we shouldn't be alienating women. At all.
Unknown said…
Long, slow, standing ovation...
Adrienne said…
Great article! I believe most births would be best unassisted, but that requires a great deal of education. Simultaneously, I love to vision a world in which women, midwives, and obstetricians work together so they are all using their skills where they are truly needed!

Adrienne Carmack, MD
Physician & Birth Rights Advocate
Unknown said…
I got chills reading this. Thank you. You have no idea.

Momma of 7 on earth. (4 hospital, 1 unassisted, 1 midwife attended and one where my midwife was cut loose at the last minute)
Molly said…
This is SO good. It's clear you put a lot of thought into this post. Bookmarking!
Unknown said…
Part of being a midwife is knowing when home birth is not the right choice and being with our clients anyway while they are with their Dr.s sometimes it's about giving good concurrent PN care. The midwifery range of "normal" for birth is way more expansive then the medical model but part of caring about your client is recognizing when things are approaching the limit of that range, informing mom, and making a plan about what is happening, what we can and can't do to prevent and fix the issue, and finding out what mom wants at that point. Always better to be cautious, give mom all the HONEST info, and choose together; again, for best possible outcomes.
Pamela said…
As a former midwife who used to espouse dogmatic and black & white thinking, I have to applaud you. This is how I've been feeling the last couple years and I fear I have lost any sort of good standing within the NCB community because of it.

I don't care for fundamentalism of any kind - whether it's from the religious right, the medical model, or midwives. Life is not black and white. Nor does everyone need to fit into a small vial of "right".

Anonymous said…

I had a natural birth in the hospital. It was unpleasant and empowering and enraging. I had a very low-intervention homebirth. It was devastating and violently painful despite everything being done "right". I had a hospital birth with an epidural and pitocin and it was brutally hard and necessary but we survived.

I had a hysterectomy. The doctor said, "Your uterus was so fragile it was falling apart. I could not keep a clamp on it. I've never seen anything like it." That was a year after my son was born. I'd managed through three term pregnancies and two miscarriages with that "fragile" uterus, we now think might indicate a connective tissue disorder which would explain everything forever.

After my son's birth, I felt deeply betrayed by everyone who ever talked about birth in any way, shape or form. Everything felt like a lie. "Just wait, the baby will come." Hah, no. "Trust birth, and you will feel no pain." If that was true, my second child's birth would have been painless.

"Epidurals make you not feel your body." I wish. The epidural was the single most terrifying thing I've experienced in recent memory--the first one didn't work, then the second one went up too high and worked too fast and my bp dropped to 50/20 and they almost missed that my IV had blown when they tried to give me a bolus of fluid. Then it wore off in half an hour because I'm a special snowflake with fast 'caine processing.

"Epidurals will stop your labor." It didn't. It actually forced me to relax enough to let the baby come down. He was born under my own steam into my husband's hands.

"Breastfeeding is easier with subsequent children". Hah. No. Posterior tongue tie the midwife, doctor, nurses and I all missed for 2 months.

We have this idea that if we "do everything right" everything will magically be okay, as if "doing it right' were a spell we cast to get a result, rather than simply doing the best we know how and dealing with the cards we're dealt. Sometimes those cards include a wonky body that doesn't respond to the things you'd think it should, that sometimes needs a bit of help.
Wshinds said…
I think the natural birth movement DOES acknowledge that home birth is not right or safe for all mothers and that doctors save lives. At least it does in the UK where most births are managed by midwives.

I think the healthcare system in many countries is so powerfully skewed towards the medical model of birth that the whole debate has become distorted - those who are advocating for something that goes so strongly against the status quo have needed to shout very loudly to make their voices heard and this is not helpful to an intelligent and thoughtful exchange of views.
Unknown said…
Thank you for this! I tried to have a home birth but had to be transfered to a hospital after the baby stopped making progess down the birth canal at about 18 hours in. My midwife came to the hospital with us and I witnessed her lying to the doctors about how long I'd been pushing, and the doctors getting extremely irate about the fact that I had tried for home birth and waited so long before coming into the hospital. It struck me that the last thing women need while in the last stages of labor is to be in the middle of a battle between caregivers.

My birth ended in c section after 25 hours of natural labor. I had done a lot of reading and preparing for home birth, and everything I read told me that everything should go fine if I just believed in my body and let nature take its course. So naturally after this failed to happen for me I began to blame myself and I felt terrible about having failed my baby, my husband, and myself. It took a while for me to come to terms with the fact that it was through no fault of my own that things happened the way they did. I would love to see the home birth community take a step back and make sure that they are preparing women for every eventuality and empowering us to feel good about our births no matter what happens.
Anonymous said…
Thank you for this.
Anonymous said…
This comment has been removed by the author.
Sabine Lavine said…
I've always found it funny that members of the natural birth community say they are all about evidence-based care, but constantly recommend unscientific, unproven alternative medicine. Makes me wonder what they think "evidence-based" means.
Mama Birth said…
Re- NGM- For the record I have always "spoken my truth"- ALWAYS.
I have NEVER told people to "trust birth" blindly. (I have notice though that people read what they want to, not my thoughts.)I have shared this same message (poking fun or finding the flaws in the natural birth community) at least a dozen times in the last two or three years. Sometimes with attempted humor, sometimes not. Sometimes in an entire post, sometimes as a disclaimer.

I was never a black and white "trust birth" and I and frankly, I don't know how you got that idea or why you ever "stopped sending people to me". Nor am I moving towards the middle. I am the same person I ever was with the same opinions.

And to be honest- I don't really want your endorsement just like I don't want it from Dr Amy (she even wrote a blog post about how I had integrity). I get the feeling you are one of those people who like long as I say what you want me to say. Now you like me- because you happen to agree with me this time. I only want friends who like me even when they DISAGREE with me.

Your cruelty to a mom who shared a birth story on this blog was deeply embarrassing(for you) and spoke volumes about your character.

I don't know if you are a "pariah" in the natural birth community. But I can tell you (since you want me to be truthful) that I don't care for your blog because you are mean. Pure and simple- you are mean to people who disagree with you. I have seen you attack women who have unassisted births- thoughtful, seemingly kind, and aware women who choose unassisted birth (or go overdue, or have their babies at home, or, or, or). Yet you smugly attack them and cite their lack of education and your wisdom.

I have seen you be mean to women on this very blog because they had a birth that you deemed unsafe (even though all was fine and you didn't know the facts) and seen you condemn midwives when you know very little of the story.

No- if you are disliked it is not because you speak truth. It is because you speak with cruelty.
(I feel the same about many of the "trolls" in among the NBC. I recognize their hurt and their bad experiences and the lack of perfection in midwifery AND the truth in their words- but I will never endorse their methods of bullying and hate.)

Truth- I still think natural birth is better. I am not ashamed of that truth. Truth- I still realize that it isn't always possible. (To me- to recognize that interventions are needed is OBVIOUS and COMMON SENSE and I believe I have always had common sense.) I have always known that. If people like you believe I felt otherwise, well, you interpreted me incorrectly.
Mama Birth said…
Woah! I got a little long winded and preachy there! Thank you all for reading and for your responses. I am still amazed that anybody reads this little blog.
Anonymous said…
Mama Birth, people hear what they want to hear! I love you, and I think you handle yourself with considerable grace. You keep an even keel in a world full of sharks. Love your responses. Thanks for always being honest and continuing to speak your truths, and thanks for standing up when it's time to stand.
Enjoy Birth said…
There is no one right answer for each birth. A midwife is not always the answer, especially certain midwives! Even a trained, compassionate midwife isn't always the right choice. A woman should gather information and trust her intuition and make the best choices for her and her baby. No one else can know what the best choice is.

For one birth that may be an elective cesarean. For a different birth it may be homebirth.

Thanks for your post. It is important to acknowledge this.
Unknown said…
I think that natural home births are a great way to relax and relaxing is already half the battle for reducing pain during birth.
MC said…
My midwife just posted this on Facebook and it was a delight to read. All three of my kids have started as home births and 2 have moved to the hospital. Our youngest baby was expected to not live through labor and with the help of modern medicine is a relatively healthy 11 month old (with a genetic metabolic condition that kills most babies who have it). I am just starting to get over feeling like a total failure for having transferred to the hospital with our youngest; but he is alive now because we did transfer!
Unknown said…
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Unknown said…
Thank you for this. I started working in OB a yr ago after four yrs of being and RN in other arenas. I originally started nursing with the end goal being a CNM who does home births.

I now know that it is not always the safest option, and I'm frustrated with what I see as straight up lies and misinformation spread by the cult of home birth.