Wednesday, January 5, 2011

The Art of Deceit

One thing my mother taught me well was the value of honesty. Tell the truth, even if it means that you'll look bad or get into trouble, because if you get caught in a lie the consequences will likely be even worse. I have tried to apply this to every area in my life - but especially in Midwifery.

Don't lie about how many births you've attended. Don't lie about what experience you have. Don't lie about being comfortable with something you aren't. And for heaven's sake, DON'T lie about the beliefs that you have about birth and the way that you practice.

To do any of these things is not only deceitful, but also manipulative. A woman who hires a Midwife who does any of the above, isn't choosing with full disclosure. She isn't given the opportunity to do so, because she's been robbed by deceit. Now, to be fair I am speaking specifically of ongoing behavior. I am not speaking of past mistakes or of things omitted accidentally. I am speaking of women who choose to be Midwives, and then put women in danger by lying about the way that they practice.

NO care provider - whether s/he be Doctor or Midwife - should believe that they control birth. NO care provider has the right to TELL women what they can and cannot do. This is an abuse of power. I am completely blown away when I hear a woman tell me that her previous Midwife didn't ALLOW waterbirth. Or that she didn't ALLOW her to get into a squat or on hands and knees. Or that she didn't ALLOW her to birth in her own bed - she made her get on the hard floor.

This. Is. NOT. Okay. It needs to stop.

More so, women need to learn to watch for red flags. Not just when they have a hospital based care provider. Also (and almost more importantly!) at home. If you have a Midwife who places restrictions on you, no matter HOW logical the reason may seem, then you have a Midwife who believes she owns birth. It is YOUR birth, it is not your care providers birth.

Somehow it seems more egregious when this behavior comes from home birth Midwives. Many women believe that they are ahead of the "risk" (as far as having a bad experience) if they hire a home birth Midwife. Sadly, it's not that simple. I have come across more Midwives recently who happily induce at home for no medical reason (Midwife going on vacation, mom wanting to have baby on a certain date, mom being pressured by family members), and when they do so they not only put the woman and baby at risk for complications but they also put the woman at risk of losing the home birth she planned for. This is unacceptable. And yet, it happens ALL the time.

I have a huge issue with a statement I have heard from both Midwives and Doulas. "I may not agree with it, but I have to meet my clients where they are at."

This is a COPOUT. Plain and simple. If we know non-medically warranted inductions (whether they occur with natural ingredients or pharmaceutical) increase the risk of complications, it SHOULDN'T be done. This includes what some describe as "harmless" membrane stripping. The prenatal period is an amazing time for education. EDUCATE clients on why baby needs to come ONLY when baby is ready. EDUCATE clients on the physiology of labor, and why it is so very important to leave things be. It's a complete copout to say that we have to meet clients at where they're at. What if Midwives were able to circumcise? I know of some Midwives who have made the above statement who would hit the roof if someone asked them to circumcise their son. So why is this different? If you wouldn't compromise what you believe in and know to be the safest and healthiest when it comes to something like this - why on EARTH is it okay to do so for labors and births?

It's simple. It's not okay.

But some Midwives might lose some clients if they stood firm in keeping things as safe and hands-off as possible. Some Midwives aren't okay with losing volume, even if it's in order to make sure that births stay as safe and healthy as possible. I personally have never had a client ask me to strip her membranes. Or to induce her. Why? Because she knew I wouldn't, first of all. But also the fact that we spent the entire prenatal period talking about these things. It's really very simple. I believe in women owning birth. However, *I* don't have to be party to certain choices. I wouldn't attend a woman who chose an elective cesarean. I wouldn't attend a woman who chose an elective induction. I don't have any qualms with refusing to do things that directly puts the baby at risk.

Some Midwives have used this mentality as the justification for lying about the way that they practice. If a woman were to ask a Midwife how she feels about induction or waterbirth or ________, the Midwife could say whatever she wants about what she believes while in reality she may be doing the very things in births that she claims to be against. Women won't get a truly clear picture of how this Midwife will be at their birth.


*Watch for red flags, even with home birth Midwives. Not all Midwives believe in leaving things alone. Not all Midwives believe that you are capable of birthing without her help.

*You can fire a Midwife at any time. Seriously. Even if it's in labor. If she begins abusing her perceived power by trying to restrict you, or to force you to do something that doesn't seem right ... kick her out.

*If you ask "Can I birth in water/on my bed/in a squat/on hands and knees", and your care provider either flat out says no, or hesitates, or gives you reasons why these things may not be a good idea ... FIRE him or her.

*It is wonderful to love your care provider. However, if you ignore red flags due to this, you may end up hurting in the end.

*It is important to ask about your Midwife's hospital transfer and intervention rates. It is important to talk to women who have used your Midwife for their births. You are going to get the best idea of how they practice, from former clients. Did the Midwife do vaginal exams? How many? Did the Midwife seem nervous? Did the Midwife restrict her in any way? Did the Midwife interfere in the hour after birth, if there were no issues with baby?

*If a Midwife is hesitant to put you in contact with former clients, or has a million reasons why she has a high transfer or intervention rate ... RUN. Hire a new Midwife.

*Ask your Midwife how she feels about women going overdue, women being overweight, women having big/small babies, women having had prior cesarean(s), waters having been released longer than 4/12/18/24/48 hours, women wanting to birth in the water, women who don't want the Midwife catching baby (mom or dad or WHOEVER wants to do the catching). You have the right to make an INFORMED decision about who you are hiring to come into *your* home and attend *your* birth.


*We do not own birth. We do not control birth. We do not make birth safe.

*We have absolutely positively NO right to tell a client that they cannot birth a certain way.

*We have absolutely no business lying about the way that we practice. If you aren't a hands-off Midwife, don't you dare claim to be. Women have the RIGHT to know absolutely who they are choosing to attend their birth. Do not deceive them in order to bring in more clients.

*There are no varying degrees of abuse. Abuse is abuse. Vaginal examination without absolute INFORMED consent is abuse. Manual dilation of the cervix without absolute INFORMED consent is abuse. Administering drugs without absolute INFORMED consent is abuse.

*If we have too many fears about birth (I'm not talking about a healthy respect for what *can* go wrong...I'm talking about fear), we are going to end up screwing women over. Example ... asking them to get out of the water where they are laboring beautifully because WE are nervous is NOT okay. OUR emotions need to be under control and in check in order to serve women to the best of our ability.

*If we have fears about women going overdue, women being overweight, women having big/small babies, women having had prior cesarean(s), waters having been released longer than 4/12/18/24/48 hours, women wanting to birth in the water, women who don't want you catching .... BE HONEST ABOUT IT. Be upfront and let our clients know from the BEGINNING that we have issues with any of these things. That way they have the option of finding a care provider who will better suit them, and not freak out if they happen to fall in any of the above categories.

Women are so often deceived by their care providers. Midwives, let us be an example of the type of care women SHOULD receive. Please, just be honest. No matter how it may make us look. Remember that a Midwife will always have critics. Regardless of her age, birth numbers, licensure or certification status, etc. The LEAST we can do if we are choosing to attend women in birth is be HONEST about any and all of the things listed above.


nugget said...

Oh wow, I am so grateful to read these words! My first birth was such a terrible tribulation. And yes, I say tribulation. I emerged with both my life and my son's life, so for me that was the victory. the midwife I had displayed many of these red flags, she did not let me own my labor and birth, and interfered on a regular basis with my early postpartum moments with my son, often in fits of unrestrained rage, scaring me and my infant. He is going to be three in June and we still are nursing old wounds together. I wish I would have known these things, and was empowered. I would have told her to get the hell out of my house!

Christine Fiscer, Birthkeeper said...

Nugget, I am both outraged and heartbroken at the same time for you. NO MOTHER should have to endure this type of treatment - but to me it is more of an abuse when it comes from a Midwife, and at home. I pray your healing continues. ♥

If you would be willing to contact me and let me know where you lived when this happened, there is a ongoing project to put together a map of areas where this type of abuse is occurring. We are working hard to bring about awareness so that fewer women will have to be subjected to this abuse.