Are Midwives Failing Women? by Linda Hessel
In Jan Tritten's editorial, "Out of the Pot, Into the Fire," (Midwifery Today, Issue 63) she wonders whether the reason that there is an unassisted birth movement is that midwives have failed women. Well, it is true that midwives sometimes fail women, though it is not only through their own faults or negligence or naiveté; it is partly because in order to survive they feel it necessary to practice in ways they might not otherwise. If one needs medical assistance, a homebirth midwife is certainly better in many cases than a doctor, so concessions to the medical establishment are justified so that women may continue to have that choice. Still, in some places it is illegal to attend women at home as a midwife, and in others the restrictions are vast. One must either, like Gloria Lemay, become a law-breaker and risk imprisonment and loss of livelihood, or one must bow to the powers that be and risk hurting women. Midwives are in a hard place, and the remedy will not be easy to come by.
The other way midwives fail is in my mind even less easy to remedy and is not even technically their failure, nor even something necessarily that needs to be fixed (depending on one's perspective,) but simply a consequence of living in a society where we are all so isolated from our communities and neighbors and even our families. It is enormously difficult for women in our culture to create the age-old scenario portrayed so movingly in Anita Diamant's The Red Tent. I recently had a conversation with a woman training to become a midwife -- she was touched by the magic and strength she was finding in her sisterhood of midwives, but noticed with confusion and concern that these qualities were only partially conferred (if at all) to the laboring woman. Her state of pregnancy is the reason for the existence of this sisterhood in the first place, yet the birthing woman has only a tenuous link to the sisterhood, for nine or ten months and probably only through one or two members. This is not enough time or occasion to build the deep bonds that conscientious, spiritual birth demands.
While all midwives are acutely aware of their weak political position, they seem, for the most part, oblivious to the fact that they seem to offer something to women that they do not have to give, and that pain sometimes results from this. They perhaps do not spend enough time among those they serve, asking and listening. Reading birth stories is not enough: they are often glossed over (due to the sentiment that a record of such a sacred event should not be filled with complaints,) or made up simply of measurable facts ("at two a.m. I was four cm. dilated.") To know these women's true stories it is necessary to get into the nitty-gritty of their conversations. (And with the internet it is easy enough to eavesdrop on as many of these as one cares to.)
Feedback from clients is not enough either. After the birth that I now consider to have been traumatic, I wrote the midwife a note thanking her for "all she does for women." A year later, pregnant with my second child and trying to come to terms with my growing feelings of anger over the way I was treated and managed, I was encouraged by my new midwife to talk to the first midwife. It was agonizingly difficult to even make the call to arrange for a meeting. How do you tell someone who has devoted her professional life to helping women that she has hurt you? How do you convey the hurt when it is subjective and personal? I fumbled with my words, trying not to hurt her in my attempt to explain. She didn't get it, not really. She saw the events of the birth differently; she did what she had to do. She wouldn't be held responsible for my pain. I now know that I am far from alone in this experience, judging from my conversations with other women; I have heard similar stories countless times.
Finally, midwives talking amongst themselves, the sisterhood, is certainly not enough, because it is far too easy to create a mythology of midwifery tailored to one's own fantasy when one does not consistently and constantly consult the source of one's calling -- the birthing women themselves. They would tell you that the mythology is beautiful, even in some respects an ideal to reach for, but that it fails to acknowledge the ramifications of certain basic truths about the nature of birth. Such as:
-Birth is a sexual event. Even if a woman cannot acknowledge this emotionally, she cannot intellectually deny the biology which puts birth neatly on her body's sexual continuum, along with making love and breastfeeding. The same hormones, we now know, are involved in all. And birth is closest to sex itself because it involved the genitals. The going in is sexual; the going out therefore is also. (Unless, of course, one feels that sexuality is at base phallic. And is it any surprise that in our culture this is just the case?) So birth is sexual, like it or not, and in our society we do not have a healthy model for revealing our sexuality in a group of people, especially people we do not know all that well. So for some women, to acknowledge the sexual nature of birth is to necessarily reject the presence and involvement of anyone they are not normally intimate with.
-The birthing woman is deeply open and vulnerable to the energy around her. Midwives are quick to point out that it is for just this reason that the typical hospital environment is not conducive to normal birth, but somehow assume that the midwifery model of birth is the solution, case closed, as if midwives themselves do not have wildly varying philosophies, personalities, and approaches to birth management. Something as innocuous as the midwives gabbing among themselves at a birth, or as well-meaning as showing the woman's mate how to be affectionate with her, or as "necessary" as taking on a tough tone to get a "hysterical" woman under control, can have a devastating effect on the mother's psyche, undermining her confidence and hindering the labor. Considering that the midwife can never really know what is going on inside a woman and what constitutes normal birth for her -- the midwife is limited by inherent physical and psychic boundaries, after all -- and given that she brings her own preconceptions about birth along with her (none of which may have anything to do with her client,) the midwife's guesses as to how her actions will affect her client are a groping in the dark at best. Some women intuit or know from past experience that with attended birth there is a very real possibility of inadvertently inviting well-meaning but nonetheless harmful influences into one's deepest self, with serious implications for the process of birth and the postpartum period; for some women this risk outweighs any desire or need for support.
-Birth is transcendent. Women often argue that to have someone else worrying about the practical aspects of birth frees them to experience the miracle and spirituality of it. But it can also be argued that most of us are incapable of being free from self-consciousness while being observed. Whose prayer or work of art or love-making is as true and deeply affecting when watched or directed as it would be if happening spontaneously and in complete privacy?
-Birth and bonding go hand-in-hand, and the alchemy of birth is such that strong attachments are created. Imagine -- the midwife has listened to your fears and conceits more attentively than anyone else, and you are feeling very fond of her, and already grateful. Now she is sitting between your legs and touching your genitals while murmuring soothing words to you. She tells you that you need to maintain contact with her by looking deep into her eyes. She is supporting you through the most intensely felt event of your life, witness to your most primal self, your screams, your shit, your loss of control. Now she is the first to touch your baby, and the one ultimately responsible for your baby's life. As the baby emerges the bonding hormones are flooding through your body; of course they're supposed to for the baby, but there also is the midwife smiling at you, praising you, hugging you. And then you are expected to let go, just like that. Oh, it was only a business relationship! She was hired help! Those feelings of abandonment, the sense of loss -- it is all irrational, you know that. But still, unbidden, the grief rises in your throat. And you don't tell anybody, because, well, you know, you don't want to appear needy -- it's embarrassing.
From the midwife's perspective, it is wonderful, no doubt, to be such a beloved part of the community, to be regarded as a wise woman, to be privileged to take part in women's lives and bask in the energy of their births. Through all her connections with women and their bodies and being the recipient of their admiration and love, the midwife also has the rare opportunity to approximate a "Red Tent" type of community for herself -- a group of women that have become most special to her, that fulfill her own emotional and spiritual needs. But there is always going to be the woman for whom the midwife is an unwilling recipient of attachment fueled by bonding hormones and a business relationship dressed in gestures of love. The midwife cannot remain a part of her life either because of time restraints or because the midwife simply has no basis for reciprocating her client's feelings.
Can we honestly blame the woman who declines to participate in something that for her ultimately means loss of her spiritual and bodily integrity, or of a relationship meaningful to her?
In the end, midwifery is never going to be able to supply what some women need, and does by its very nature interfere with the fulfillment of that need. Even the best midwife in the world is not going to be able to overcome that. I can tell you this from experience: the midwife who attended my second birth is as good a midwife as anyone could hope for. For me she was wise, knowledgeable, kind, and reassuring. Best of all, she agreed that I should define her role in the birth, a condition most midwives would refuse outright, or at least be very uncomfortable with. It was, consequently, a very good, empowering birth; I was truly grateful, and my gratitude endures to this day. She did not fail me, in the sense of being negligent. Regardless, I chose not to invite her or any other midwife to my next birth.
This is very simply not an issue of how midwives can improve themselves in order to "save" women from birthing alone. For anyone who cares about birth and women, and not just about her own desires and ego, it is important to understand and acknowledge that unassisted birth is a valid and whole choice in its own right -- because while a woman may not need a birth professional to catch her baby, she may benefit from other things that person may be able to offer, not least of which are understanding and acceptance. All of us outside of the mainstream birth machine have something in common: the danger of becoming victims in a political climate that is hostile to our choices. Let us be a support to one another, not just in philosophy but in action also, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled.
By Linda Hessel
The other way midwives fail is in my mind even less easy to remedy and is not even technically their failure, nor even something necessarily that needs to be fixed (depending on one's perspective,) but simply a consequence of living in a society where we are all so isolated from our communities and neighbors and even our families. It is enormously difficult for women in our culture to create the age-old scenario portrayed so movingly in Anita Diamant's The Red Tent. I recently had a conversation with a woman training to become a midwife -- she was touched by the magic and strength she was finding in her sisterhood of midwives, but noticed with confusion and concern that these qualities were only partially conferred (if at all) to the laboring woman. Her state of pregnancy is the reason for the existence of this sisterhood in the first place, yet the birthing woman has only a tenuous link to the sisterhood, for nine or ten months and probably only through one or two members. This is not enough time or occasion to build the deep bonds that conscientious, spiritual birth demands.
While all midwives are acutely aware of their weak political position, they seem, for the most part, oblivious to the fact that they seem to offer something to women that they do not have to give, and that pain sometimes results from this. They perhaps do not spend enough time among those they serve, asking and listening. Reading birth stories is not enough: they are often glossed over (due to the sentiment that a record of such a sacred event should not be filled with complaints,) or made up simply of measurable facts ("at two a.m. I was four cm. dilated.") To know these women's true stories it is necessary to get into the nitty-gritty of their conversations. (And with the internet it is easy enough to eavesdrop on as many of these as one cares to.)
Feedback from clients is not enough either. After the birth that I now consider to have been traumatic, I wrote the midwife a note thanking her for "all she does for women." A year later, pregnant with my second child and trying to come to terms with my growing feelings of anger over the way I was treated and managed, I was encouraged by my new midwife to talk to the first midwife. It was agonizingly difficult to even make the call to arrange for a meeting. How do you tell someone who has devoted her professional life to helping women that she has hurt you? How do you convey the hurt when it is subjective and personal? I fumbled with my words, trying not to hurt her in my attempt to explain. She didn't get it, not really. She saw the events of the birth differently; she did what she had to do. She wouldn't be held responsible for my pain. I now know that I am far from alone in this experience, judging from my conversations with other women; I have heard similar stories countless times.
Finally, midwives talking amongst themselves, the sisterhood, is certainly not enough, because it is far too easy to create a mythology of midwifery tailored to one's own fantasy when one does not consistently and constantly consult the source of one's calling -- the birthing women themselves. They would tell you that the mythology is beautiful, even in some respects an ideal to reach for, but that it fails to acknowledge the ramifications of certain basic truths about the nature of birth. Such as:
-Birth is a sexual event. Even if a woman cannot acknowledge this emotionally, she cannot intellectually deny the biology which puts birth neatly on her body's sexual continuum, along with making love and breastfeeding. The same hormones, we now know, are involved in all. And birth is closest to sex itself because it involved the genitals. The going in is sexual; the going out therefore is also. (Unless, of course, one feels that sexuality is at base phallic. And is it any surprise that in our culture this is just the case?) So birth is sexual, like it or not, and in our society we do not have a healthy model for revealing our sexuality in a group of people, especially people we do not know all that well. So for some women, to acknowledge the sexual nature of birth is to necessarily reject the presence and involvement of anyone they are not normally intimate with.
-The birthing woman is deeply open and vulnerable to the energy around her. Midwives are quick to point out that it is for just this reason that the typical hospital environment is not conducive to normal birth, but somehow assume that the midwifery model of birth is the solution, case closed, as if midwives themselves do not have wildly varying philosophies, personalities, and approaches to birth management. Something as innocuous as the midwives gabbing among themselves at a birth, or as well-meaning as showing the woman's mate how to be affectionate with her, or as "necessary" as taking on a tough tone to get a "hysterical" woman under control, can have a devastating effect on the mother's psyche, undermining her confidence and hindering the labor. Considering that the midwife can never really know what is going on inside a woman and what constitutes normal birth for her -- the midwife is limited by inherent physical and psychic boundaries, after all -- and given that she brings her own preconceptions about birth along with her (none of which may have anything to do with her client,) the midwife's guesses as to how her actions will affect her client are a groping in the dark at best. Some women intuit or know from past experience that with attended birth there is a very real possibility of inadvertently inviting well-meaning but nonetheless harmful influences into one's deepest self, with serious implications for the process of birth and the postpartum period; for some women this risk outweighs any desire or need for support.
-Birth is transcendent. Women often argue that to have someone else worrying about the practical aspects of birth frees them to experience the miracle and spirituality of it. But it can also be argued that most of us are incapable of being free from self-consciousness while being observed. Whose prayer or work of art or love-making is as true and deeply affecting when watched or directed as it would be if happening spontaneously and in complete privacy?
-Birth and bonding go hand-in-hand, and the alchemy of birth is such that strong attachments are created. Imagine -- the midwife has listened to your fears and conceits more attentively than anyone else, and you are feeling very fond of her, and already grateful. Now she is sitting between your legs and touching your genitals while murmuring soothing words to you. She tells you that you need to maintain contact with her by looking deep into her eyes. She is supporting you through the most intensely felt event of your life, witness to your most primal self, your screams, your shit, your loss of control. Now she is the first to touch your baby, and the one ultimately responsible for your baby's life. As the baby emerges the bonding hormones are flooding through your body; of course they're supposed to for the baby, but there also is the midwife smiling at you, praising you, hugging you. And then you are expected to let go, just like that. Oh, it was only a business relationship! She was hired help! Those feelings of abandonment, the sense of loss -- it is all irrational, you know that. But still, unbidden, the grief rises in your throat. And you don't tell anybody, because, well, you know, you don't want to appear needy -- it's embarrassing.
From the midwife's perspective, it is wonderful, no doubt, to be such a beloved part of the community, to be regarded as a wise woman, to be privileged to take part in women's lives and bask in the energy of their births. Through all her connections with women and their bodies and being the recipient of their admiration and love, the midwife also has the rare opportunity to approximate a "Red Tent" type of community for herself -- a group of women that have become most special to her, that fulfill her own emotional and spiritual needs. But there is always going to be the woman for whom the midwife is an unwilling recipient of attachment fueled by bonding hormones and a business relationship dressed in gestures of love. The midwife cannot remain a part of her life either because of time restraints or because the midwife simply has no basis for reciprocating her client's feelings.
Can we honestly blame the woman who declines to participate in something that for her ultimately means loss of her spiritual and bodily integrity, or of a relationship meaningful to her?
In the end, midwifery is never going to be able to supply what some women need, and does by its very nature interfere with the fulfillment of that need. Even the best midwife in the world is not going to be able to overcome that. I can tell you this from experience: the midwife who attended my second birth is as good a midwife as anyone could hope for. For me she was wise, knowledgeable, kind, and reassuring. Best of all, she agreed that I should define her role in the birth, a condition most midwives would refuse outright, or at least be very uncomfortable with. It was, consequently, a very good, empowering birth; I was truly grateful, and my gratitude endures to this day. She did not fail me, in the sense of being negligent. Regardless, I chose not to invite her or any other midwife to my next birth.
This is very simply not an issue of how midwives can improve themselves in order to "save" women from birthing alone. For anyone who cares about birth and women, and not just about her own desires and ego, it is important to understand and acknowledge that unassisted birth is a valid and whole choice in its own right -- because while a woman may not need a birth professional to catch her baby, she may benefit from other things that person may be able to offer, not least of which are understanding and acceptance. All of us outside of the mainstream birth machine have something in common: the danger of becoming victims in a political climate that is hostile to our choices. Let us be a support to one another, not just in philosophy but in action also, for the sake of freedom for all women to choose exactly how and by whom, if by anyone, our bodies will be handled.
By Linda Hessel