“Doctors in America were not always the powerful and authoritative profession that they are today. A century ago they had much less influence, income, and prestige. “In all of our American colleges,” a professional journal commented bitterly in 1869, “medicine has ever been and is now, the most despised of all the professions which liberally-educated men are expected to enter.” Although a few eminent doctors made handsome fortunes, many before 1900 could hardly scrape together a respectable living. […]

Beginning in the 1760s, some educated doctors took the initial steps to reproduce in America the professional institutions that in England gave physicians a distinct and exclusive status. They succeeded in organizing medical schools, and in some fields of work, such as obstetrics, doctors gained ground against rival practitioners. But they failed in their larger efforts to establish themselves as an exclusive and privileged profession. The licensing authority doctors secured had little more than honorific value, and during the Jacksonian period in the 1830s and 1840s, their claims to privileged competence evoked a sharp backlash that crippled their ambitions for the next half century. State legislatures voted to do away with medical licensure entirely. No profession was being allowed, Oliver Wendell Holmes told the graduating class at Harvard in 1844, “to be the best judge of its own men and doctrines.” Lay practitioners, using native herbs and folk remedies, flourished in the countryside and towns, scorning the therapies and arcane learning of regular physicians and claiming the right to practice medicine as an inalienable liberty, comparable to religious freedom.”

Paul Starr, The Social Transformation of American Medicine

“The obstetrician may say to the pregnant woman, through attitude, words or continual reliance on technology, “You have to prove to me that you can give birth to a baby.” The midwife, on the other hand, with her attitude that birth is, in most instances, a reliable event, says to this same woman, “You have to prove to me that you cannot have a baby!”The midwife is (or should be) an expert in normal birth, while the obstetrician must be an expert in pathology. This is exactly the way it should be. For it is that expert to whom we must turn when we do encounter the abnormal. I believe that oftentimes, the midwife is more likely to recognize situations which demand attention than the caregiver who sees all pregnancy and labor as a potentially dangerous and lethal process.”

Valerie El Halta, CPM

I admire the women who know from their first pregnancy that home is where they want to give birth. I never even imagined it with our first daughter. I thought that by going with a hospital-based CNM practice, we’d chosen the safest, most holistic path available. Unfortunately, despite our best efforts as a Bradley Method-educated team, I still left the hospital with an unnecessary incision in my abdomen and an equally deep wound to my spirit.

A year and a half later, we learned I was pregnant again. I made the rounds, interviewed all the usual “VBAC friendly” suspects and concluded that I just couldn’t do it in the hospital again. The care providers were probably just fine, but I didn’t have it in me to fight all the hospital procedures. I didn’t want to negotiate my way through labor again. It had been a traumatic year and I simply couldn’t imagine mustering the internal fortitude to fight and argue over every little thing.

Finally, friends from ICAN and my local La Leche League group shared their stories of home birth and strategies for how they were able to bring their husbands along.

When we interviewed the woman who became our midwife, a sense of peace settled on me. She was the one. The next six months were a continual confirmation that we chose the right path for us. The partnership my midwife and I developed over those months attended to both the physical and emotional issues that needed to be dealt with in order to ensure that I would be able to labor as effectively as possible. I can’t imagine how that could have happened in a more traditional medical model.

By trusting in her completely, I was able to achieve the safest, most non-interventive, peaceful birth I could have imagined for our second child. I can’t imagine doing it any other way in the future. And when I think that I may lose this option simply because we don’t have a path for licensure in Ohio, I become profoundly angry. We all deserve the right to choose where we birth and to use the care provider who can best help us to achieve that.

Want to share your story? The Safe Birth Blog welcomes submissions to “Family Voices.” Email soracolvin@gmail.com.

Black market for midwives defies bans, reads the Chicago Tribune headline. While Missouri’s new midwifery licensure law awaits a state Supreme Court ruling on its legality, mothers continue to give birth at home, even though their midwives risk felony charges for attending births. (A paid subscription to the paper is not required, but you will need to register your email address to read the article.)

Mark your calendar for Saturday, January 19 for an event being co-sponsored by Ohio Families for Safe Birth, Ohio Midwives Alliance and Ohio Friends of Midwives. Ida Darragh from the North American Registry of Midwives (the certifying organization for Certified Professional Midwives) will be in Columbus to facilitate an all-day workshop on legislative advocacy. Often, the biggest stumbling block people say they have to getting involved is that they don’t know what to do or say. The workshop addresses those questions and concerns. By all accounts, Ida does an AMAZING job and folks come away from the workshop feeling like they know how to do what needs to be done. More details to come as they get worked out, including cost and possible on-site child care.

“After pushing sweet baby Clover into the water, my midwife helped me turn her before I pulled her out onto my chest. She stared with big open eyes as she lay on my chest, skin to skin, bonding with mama. She rooted for my breast and nursed before we left the pool for warm covers in the bed.”

The Sunday photo album is a regular feature of the Safe Birth Blog. If you would like to submit a picture for the album, please email soracolvin@gmail.com.

Q: How many midwives does it take to change a light bulb?

A: Two. One to sit there and wait for the old bulb to fall out of the socket naturally with no intervention, and one to give emotional support.

Midwives practicing in out-of-hospital settings are a dedicated bunch. Anecdotal reports abound of inductions scheduled, pitocin administered, and cesareans performed in greater numbers just before a holiday. Midwives joke about how many events they’ve missed because of babies. I called my midwife away from her family Christmas gathering to attend my fifth birth two years ago. Somewhere, yesterday, a midwife (likely, more than one) missed Thanksgiving dinner to go to a birth.

As guardians of natural birth, midwives can’t schedule, speed up or surgically end labors for their own convenience. Their phones ring at all hours of the night. When a labor lasts two days, they don’t go off shift and let someone else take over. They learn to catch their sleep when and where they can. Their families get used to having them unexpectedly called away and not knowing when they’ll be back.

Midwifery is not a financially lucrative or widely respected profession.  Health insurance may refuse coverage for a home birth. Midwives who invest many years of their life into creating a freestanding birth center are frequently forced out of business by rising malpractice insurance costs or difficulty finding physicians willing to work with them.

In states like Ohio, where direct-entry midwifery is not legally recognized, midwives who have spent years training and passed rigorous national certification exams may also risk criminal investigation and prosecution should they accompany a client who needs to transfer to the hospital.

Midwives remain on the “front lines”of the battle for birthing women’s autonomy in  choice of birth place and management of labor, because they passionately believe in the value of their work for women, babies, and families. If you have benefited from the sacrifice and dedication of a midwife, take some time this Thanksgiving weekend to show your appreciation with a note, a call, or a quick email. And then, consider what you can do to help make midwifery care an option for everyone who wants it.

Having a highly trained gynecological surgeon attend a normal birth is analogous to having a pediatric surgeon baby-sit a normal two-year old child.

Marsden Wagner, M.D., M.S.

ICAN of Greater Cincinnati hosted a special screening of The Business of Being Born this past Saturday. Jerren Helwig shares her review of the film.

“We know there’s a problem, but what can we do about it?”

That was the response of everyone present at the Mariemont Theater on Saturday after seeing The Business of Being Born.

The movie is a documentary, made from the perspective of a pregnant woman and her husband who are friends with the film’s executive producer Ricki Lake. Ricki talks about her first birth and her desire for a participation in the process that she didn’t get to experience with her first delivery. This quest led her to have her second baby at home, in water, with a midwife.

Scenes of women laboring in the comfort of their own home are interspersed with historical information and scenes of birth in the US following the migration of women from home to hospital since the 1930s. The movie addresses some big medical screw ups, like scopolamine (one of the components of “Twilight sleep” — my mom had her first baby in this condition — these scenes gave me a stomach ache) and thalidomide (my grandmother had a baby with flippers for arms because of this drug).

The movie also lets you walk a few steps in the life of a CNM in New York City. She’s a cool, “with it” midwife, who loves her job and is ready to help women do their thing. She even shows clips of her own birth at home — her labor scenes brought laughter from the theater crowd. She tells everyone to get out, she says she wants her mommy, and she just doesn’t want to push because it will hurt, but she decides she should so she won’t be pregnant forever! She comments that she is able to sympathize with her clients so much better since she went through a rough labor personally. As a midwife myself, I was laughing hysterically because I could very much relate with those scenes!

Also seen throughout the movie were comments from Ina May Gaskin (American Midwife legend), Marsden Wagner, former director of WHO-maternal/child health (has any midwife movie been made WITHOUT him?), Susan Hodges, president of Citizens for Midwifery (I met her recently, she’s awesome!), Michel Odent, French Obstetrician and Researcher on Love Hormones (all his comments have subtitles because there’s no way you could understand otherwise, but they were REALLY great comments) and then various other men and women addressing different aspects of midwifery, natural birth, obstetrics, etc. The movie even had a few scenes from two obstetricians who did not support home birth and they were actually made to look quite ridiculous because they were speaking on a topic they knew nothing about.

Towards the end, the woman filming the documentary with her husband goes into premature labor with a baby who has IUGR (intra uterine growth restriction) and is breech. They decide to go to the hospital to their backup doctor (who was seen earlier in the film and was supportive of their midwife attended home birth desire) and have a c-section. Their little baby boy was very small (I can’t remember the exact weight, 3 pounds maybe?). The movie ended with a quick interview 7 months after the birth, talking about her feelings about how her experience had ended so differently than planned. After all, she had just filmed a documentary with all these women having ecstatic home births. She was sad she missed out, and said it wasn’t what she had hoped for, but she was very happy her baby was ok.

To sum up, The Business of Being Born was a comprehensive movie that touched on some great topics surrounding the history, present and future of birth in America. I was disappointed about how it ended - but maybe that was the point?

After the film showing, ICAN Cincinnati had arranged for a panel discussion of local birth professionals. The panelists were Jackie Gruer, President of Birth And Beyond, Certified Nurse-Midwife, and founder of the former Midwives Care birth center; Claudia Harsh, a physician acupuncturist and former OB/GYN; Stacy Hudepohl, a Certified Nurse-Midwife; Sylvia Lieb of Ohio Midwives’ Alliance, a Certified Professional Midwife; and Eileen Ryan, a birth doula and La Leche League leader. April Kline moderated. Each panelist gave her opinion of the movie. Ellen said she thought it was a bit “one sided” towards homebirth. Jackie said she loved it! She loved the clips from a Monte Python hospital birth scene (you can get it on YouTube - the machine that goes PING!). I would say that all agreed that there is a problem with birth in America. There were some great comments from the movie goers, all with similar sentiments.

Now, in my opinion, this is where the frustration in the room for the current situation had the potential to turn into energy for a solution. But nobody gave one. Everyone said, the problem is complicated and they don’t know what to do about it. What about rallying the troops around demanding better access to midwifery care? What if every one of those families went back with a plan to work towards that goal? Oh, the impact that would have made, after such a dramatic movie!

Maybe OFSB could arrange another showing of the movie and we could have information and a plan for how each person affected by this movie could take that home and make a difference for women and choices for childbirth in this country. Maybe we can do something about it!

Jerren Helwig is a mother of 4 and a Certified Professional Midwife.