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.