As we’ve discussed incidents belonging in the Childbirth Hall of Shame, I think it’s only fair to admit that some midwives are also guilty of putting their own interests before those of their clients. Another problem I have noticed among some midwives is that of fostering a dependency of the pregnant woman upon her midwife. Some midwives thrive on feeling that they are essential to a woman’s positive birth experience. In reality, we should be present as supportive bystanders–there to help as needed, but not directing or taking over the birth experience.
Imagine a lifeguard at a pool. She watches the swimmers, and frequently calls to them from the side, offering suggestions as to how they can “improve” their swim time. Occasionally, she jumps into the pool and corrects the stroke of a swimmer, or gives other directions. When a swimmer crosses the pool and reaches the other side, she beams with pride–they couldn’t have done it without her!
As ridiculous as this sounds, it is how many midwives function. In reality, a lifeguard is present to help when asked or when someone is in obvious distress. I picture a midwife’s role as quite similar. If a woman asks me for help, I will give it. If I see a woman in obvious distress, who seems to be floundering, I will offer my help. But at all times, it’s important to remember that it’s the woman’s experience, and her body already knows how to give birth.
Iris was a midwife who had quite a following of women who praised her highly. “I couldn’t have done it without Iris!” was frequently heard. “If Iris hadn’t been there, my baby might have died!” another woman would say. Stories of how Iris rescued women and babies from the brink of disaster were commonplace.
One woman, Genevieve, relates her story:
I was seeing Iris for my third pregnancy. I frequently felt that she was somewhat patronizing of me, giving me instructions in all sorts of things, and acting as if I was lucky she was there to be guiding me through the dangerous waters of pregnancy.
When I went into labor, I planned to stay home for a while, until contractions became strong and regular. But Iris insisted I come in to the hospital, so that she could watch over me and make sure my labor was going OK. Reluctantly, I went in and found that I was only 3 centimeters. Iris told me she needed to break my bag of water because my labor was poking along, and that increased my risks. Even when I told her I’d like to try some alternatives first, she disagreed. I told her that I did not consent to having my water broken, and she said she needed to do another exam to make sure of the baby’s position. While she was checking me, my water broke! I found out later that the hospital had little finger-size gloves that had a hook on the end, so that someone could break your water without you knowing it.
After my water broke, the contractions were unbearable. I tried to move around, but Iris wanted me to stay on the monitor, so I couldn’t move far. I asked her to monitor the baby intermittently, but she said she had patients to see in the office so couldn’t stay with me the whole time. At noon, I was 7 centimeters dilated. Iris came in to check me, and said that my labor was taking way too long and she needed to give me pitocin. I refused! I’d only been in labor for about five hours altogether. After I refused the pitocin, Iris checked me again, and suddenly I felt the worst pain I’ve ever felt in labor. I begged Iris to take her hand out but she loudly ordered me to push as hard as I could. “Push! You have to get your baby out now!” I looked over at the monitor and saw the baby’s heart rate was 118. I knew enough from my past births to know 118 was not a bad heart rate. I did push, though, because Iris scared me so badly. I’ve never had such pain in my life. It was about a half hour of my pushing and Iris stretching my cervix until I finally felt the urge to push and it didn’t hurt then.
After my daughter, Stella, was born, Iris took her hand and poked her fingers down firmly into my belly while she pulled on the umbilical cord. She said this was necessary to separate the placenta. All this happened even though I had written a birth plan and told Iris I wanted to let the placenta separate on its own. It was very painful to have the placenta pulled on that way. My placenta only separated partially, and Iris had to put her hand inside me to peel the rest of it off my uterus. I still believe that it would have been more likely to separate normally if she’d just left it alone.
I did go to a midwife again for my next child, though not back to Iris, and my experience with her was completely different. She made me feel respected, and she also respected the normal process of labor. She promised me, after hearing my experience with Iris, that she would not do any intervention without discussing it with me first and getting my permission. We talked a lot about when interventions might be needed, which actually made me feel more relaxed than Iris’s approach of, “don’t worry, I’m an experienced midwife and I can handle anything”. I had a wonderful birth and regained my confidence in midwives.
Physician, midwife — your title doesn’t matter. What does matter is your empathy toward the laboring woman, and your willingness to extend yourself to meet her needs, not consider only your own convenience.
Common sense tip for today: If you feel your wishes are disrespected by your provider, or you sense your provider thinks s/he is central to your experience, RUN! Even if you are near your due date, it’s never to late too find a provider who is respectful and supportive of your wishes, and acknowledges that you already know how to do this.
I always had this glowing, golden opinion of MWs. W/ #2 I had a precipitous birth, before my MD got to the hospital. After DS was born a MW from another clinic walked in and started interacting with my butt without ever even looking at my face. She cut the cord (against my wishes) called up a dose of Pit (w/ out reason and against my wishes) and proceeded to inspect my vagina. Luckily my MD walked in then and stopped her before she could apply cord traction (and told the nurses to hold the Pit as I was sitting there NOT CONSENTING). That MW was so ruse and so brusque – and so rough in her exam. And she never ONCE looked at my face. I guess it’s nice to have a job where people’s butts deliver babies for you and you never have to deal with people :p
Janelle, this is SO true.
Very early in my career as a doula I attended a birth with a midwife where the midwife had just attended another long-ish birth, and rather than call in another midwife in the practice when my client presented with SROM but no labor, she insisted on staying. When my client did not go into labor after repeated attempts to get things going with prostaglandins (Cervidil & Cytotec), walking, nipple stimulation, and accupressure, she proceded to order up a VERY aggressive Pitocin drip. I strongly believe that she did this because she was over tired, and just wanted to get home.
She was rarely in the room with the woman even before starting the Pitocin. After having the nurse start the Pit, the midwife left. When the contractions kicked in fast & furious, I finally went out to the Nurses’ station to talk to her. I told her that the contractions were much too strong for my client to deal with. She said “this is what labor is. She has to do this to birth the baby.” I didn’t want to argue, so went back to my client. But I’d had 3 babies myself by then, and had never had contractions like my client was having. The midwife did come into the room about 5 minutes later, observed a contraction, and turned down the Pit slightly.
My client went from 4 cm to 10 cms in less than 1.5 hrs. I always take copious notes about medications that are given, and what the IV drip rate is set at. So later, when I researched Pitocin dosing, I would learn that my client had been started at a dose that was 2-4 times higher than the reccommended starting dose of 0.5-1 microunit per minute. Further, her dose was doubled every 15 minutes (reccommended protocol on the package insert is to “raise slowly every 30-60 minutes). By the time I went and spoke to the midwife, my client was receiving 16 microunits per minute, when the package insert says that 6 microunits per minute mimics spontaneous labor, and levels above 10 are “rarely needed.”
Of course, to be fair, I’ve only once had a client on Pitocin who did not get to 12 microunits per minute. But the “double every 15 minutes” protocol is not what I normally see used in my area. Typically the Pit is started at 2 microunits per minute, and raised by 2 every 15-30 minutes.
Hi there,
I just wanted to stress that midwives’ mistakes can also go the other way.
I had a sunny-side up, nine and a half pound baby. My labour was very long – about 40 hours – painful, and difficult. I was at six centimeters for almost twenty hours, and there was no change in the position or progression of my baby.
My midwife had gone home to take a nap. While she was gone, my waters broke, and they were full of thick, brown meconium. Unfortunately, there was still no change in my dilation or the baby’s position.
My doctor, a well-respected and well-loved man who fully supports midwifery and home birth, and even attends home births with my midwife (we couldn’t afford one), let me know that he was getting concerned. My partner phoned my midwife to let her know that things were happening. My doctor recommended a bit of pitocin. At this point, he suggested that I have an epidural, as I had been at this for two sleepless nights, I was in a lot of pain, and I wasn’t coping well anymore. (Go figure, my midwife was napping at home.)
At some point during this time, they put a scalp monitor on my baby, too.
I took the epidural, and was very grateful for the hour or two of sleep that I got. My baby’s heart rate began to plummet, so I was woken up. I saw that my midwife had arrived while I was asleep.
My doctor came back in, examined me, and told me that I was still at six centimeters, and that the baby was still pretty high up. A number of other doctors confirmed his results. The heart rate continued to slow down, with no periods of recovery, and my doctor told me that he believed that a c-section was the best option for me and my baby (I don’t know what the heart rate was…There were all sorts of beeping alarms going off).
I trust him, my partner trusts him, my midwife trusts him, so we agreed to go ahead with it.
After we agreed, and as i was being wheeled to the operating room, my midwife began to make comments like, “Well, the baby was coping perfectly well with the natural contractions.”
When you invest so much in the hope of a natural birth – for example, going so far as to pay for a midwife in a place where insurance won’t cover it, despite being a low-income family – it is absolutely devastating to have a c-section. My midwife’s comments, which she made after the decisions had been made, and after she had napped through most of them, played over in my head for months and months after the birth of my happy, posterior boy. I suffered through an enormous amount of guilt and depression and constant “what if”s and “I should have”s. In her very brief and terse postnatal visits, I tried to bring up my feelings of guilt and confusion about the birth experience, and she was abrupt and dismissive and completely unsupportive. She made me feel like I had somehow failed her, or myself, or my baby.
And that’s not acceptable.
I hired her because I wanted her to be there for me, supporting me, supporting my decisions and listening to me. Instead she napped, left me alone, and then critiqued the decisions made my myself, my partner, and our doctor, much to the detriment of my spiritual recovery.
She wasn’t there for me. She was there for … I don’t know what. Her ego, her pride, her politics, whatever. And to this day, ten months later, I’m still angry and hurt and utterly disappointed.