Dangerous Midwife or Safe Midwife?

This post was written by Carla Hartley:

The admonishments to stop rocking the boat never end, but as I have said many times, while I sit still, someone drowns. I cannot stay silent. Midwives are human. They are fallible. They are NOT perfect. If they are hurting mammas and babies, they are dangerous. Period. Knowing what I know and staying silent would mean I am guilty of aiding and abetting what I consider to be criminal behavior.

I am in a position to hear about all kinds of midwives, all kinds of apprenticeships, and all kinds of information about childbirth educators and doulas. A big part of the enormous amount of e-mails, texts and calls I receive every day have something to do with dangerous midwifery practices.

Some of these include use of cytotec and pitocin to induce labor....and not just in the traditional ways. Some I heard about today curled my hair.

What would you think about midwives who are injecting pitocin directly into the lower uterine segment, having mothers drink incredibly dangerous induction cocktails which I consider a recipe for disaster, using a ventouse in a birth center, applying pitocin directly onto or INTO the cervix, showing up to births self-medicated, making all moms lie flat on their backs, yelling at moms to push, telling husbands to hold their wives down while she manually dilates, have a 50% transport rate, have an almost 100% incidence of tears "requiring" suturing, manual removals of placentas on a regular basis...and more.

I mean this is stuff that makes you vomit if you allow yourself to imagine witnessing it. This is NOT happening in hospitals, it is happening in homes, birth centers and midwives' offices.

I feel especially sad for a mom who has suffered abuse at the hands of a woman who calls herself a midwife. It is worse than if it were from a doctor in a hospital. We almost expect to have to fight for our rights in that environment, but at home, or in a birth center? The assumption is that midwives are the "guardians" of normal birth. (That is not what I think at all, but a general assumption touted by midwives on a regular basis.) Women assume that they are safe in a midwife's care, so when the midwife acts in another manner, they are unprepared and blind sided.

When it is a mother calling or e-mailing me, the question is often, what should I do and who should I tell? I don't discourage any mom from doing what she wants about the abuse she has suffered, but I do try to make a case for a better way to ensure that fewer women will be in the position she found herself in. Yes, reporting to NARM if the midwife is a CPM, or to the licensing board if she is licensed, might have some effect, but more often I am told it does not. Lawyers could be called, doctors can be called, government officials can be called. But I don't think that is the answer and would just make things worse for midwives who are innocent of these kinds of charges.

I am not convinced that we can...... nor that we should.... police birth workers, anyway. I think the better option is to educate parents and encourage them to expect the best out of those they choose to hire.

Yes, there are dangerous midwives, and I am completely alarmed by how many more I have heard in just the last year, alone. And by more, I mean an alarming number of dangerous midwives and an alarming number of egregious acts against women and babies. Every time I think I have heard it all, some new "trick" is pointed out to me. It breaks my heart and it makes my bood boil at the same time.

I am not guessing or gossiping. And furthermore, I am just telling you one tiny tip of the iceberg of what has been told to me just THIS month by very reliable sources.

This is the stuff that keeps me up at night. I believe I know EXACTLY how this has happened, but this is not that note (but boy oh boy is it coming).

I want to address what I think is an appropriate response concerning dangerous midwifery practices. Not only do I think that it is NOT our job to eliminate the dangerous midwives, I don't think we can. What I think we CAN do is help women learn what a SAFE midwife would be. If they know that, then they will know who to look for.

I am convinced that the only way to eliminate a dangerous midwife is to educate parents so that they ask the right questions and choose their birth attendant carefully. After a while, the dangerous midwives' business will decrease and people will be choosing someone else. Then she will have to decide to change or quit. That works in all kinds of service industries, in manufacturing, in retail and in aviation. My husband was a prominent figure in general aviation. He knew of many scoundrel competitors, but he also was wise enough to know that he had no power to eliminate them. Instead, he invested a lot more time and effort into educating his customers on what they should expect from businesses who cared about safety. He conducted seminars and wrote articles for the FAA and for aviation schools. His efforts were successful and many of the businesses with less than ethical practices were soon out of business. He never named names, he just concentrated on customer education and honest public relations. Consumers who are well informed make better decisions.

Some will argue that credentialing and licensing eliminates dangerous midwives. As you know, I disagree.

Licensure does not eliminate dangerous midwives, in fact it is more likely to nurture them. At least 90% of the horror stories coming to me are about....you guessed it....CPMs and/or licensed midwives. (I have to take a deep breath here and NOT go into a diatribe about why that is true.)

Even if a midwife is not guilty of any of the abuses I told you about earlier, licensing seriously compromises the integrity of the midwife/client relationship. Once licensed, a midwife is in a contractual agreement with the state about every client she takes. Think about that.

According to that agreement, she may no longer do what the mother wants if it would put her in noncompliance with the original contract. Many midwives tell me that becoming licensed has changed them in one of two ways: either they now practicing CYA midwifery and work according to the dictates of their license OR they have become a good liar. When Colorado midwives went for "registration" and one of the first ones to do that was one of my long time students. She called me in tears, telling me that she was no better a midwife for the paper, in fact she was not the person she had been. Now she lied on paperwork and lied for clients. "How," she asked, "will the parents know that I don't also like TO them?" She left midwifery not long after that.

A midwife who knew I was opposed to licensure called me in the early 90s to tell me that their midwifery organization really had no choice but to go for licensure in order to eliminate ONE particular dangerous midwife who they thought would not jump through the licensure hoops. But it backfired. Guess who was first. Licensure does not eliminate bad midwives.

Of course some midwives like licensure because it makes it legal for them to carry drugs and makes it easier for them to obtain third party reimbursement. After the stories of abuse I have heard, I have come to the conclusion that NO midwife should be carrying drugs. And I believe that the desire for third party reimbursement is the root of most of the problems that exist for midwifery today that were not an issue when I started. I am not convinced that either of those reasons hold water when it comes to making that choice. Hmm...."I can carry drugs but I have to say no to 30 or 40% of the women who want a home birth because when I opted for the ability to carry drugs, I signed away my option to legally assist a woman who has had a cesarean. But I do get paid by the insurance companies. " Not an acceptable trade-off.

I understand that some midwives cannot practice legally if they are not licensed....but they can still serve. That is until their sister midwives find out and turn them in to the state, which they are legally bound to do in some cases....or just because they can in others.

Licensure does not eliminate bad midwives nor can it assure good midwives. Again, if licensure requirements are as low as they are in most states, and if based on a medical paradigm, which most are, we are not producing safe midwives with that process. A piece of paper granting a credential is NOT assurance of safety. A thorough and applicable education is more likely to assure a safe midwife.

Having helped women become midwives for thirty years, and having been in the middle of this conversation for longer than that, I have definite ideas about what the definition of dangerous midwife is, but I want to start with what I think is more likely to produce a safe midwife.

I am thinking of some midwives I know who I would trust with my daughter's or daughter in law's births. They have attributes and attitudes that make me believe that they are SAFE midwives. I want women to look for a safe midwife, and hopefully, they will avoid the dangerous ones.

A safe midwife is one who knows her place....that is she knows that the mamma owns the birth and she does not. She has no illusions of grandeur about saving women or babies from birth. She is comfortable in her role as consultant, rather than authority.

A safe midwife knows that privilege and responsibility are not two separate issues, and that most of her work, in today's world, is to help women embrace both. That means that a midwife's job is to help the women find the information she needs and help her believe that she is capable of understanding and applying all of it.

A safe midwife wants to serve women who don't automatically default to the midwife's opinion. She hopes that women would question her and ask for sources and logic. The safe midwife wants to serve strong smart women who make the investment in preparation and feel good about their choices.

A safe midwife knows everything there is about normal birth so that she can recognize any subtle change and make appropriate recommendations the minute there is a deviation. That is, if the deviation starts to become a complication, which most deviations never do, so she would mostly just stay quiet.

A safe midwife is teachable. and humble. She is open to the possibility that she may have been basing her beliefs and practices on flawed information. She is willing to admit anything that she has been doing could be and have been wrong — and CHANGE IT.

A safe midwife is more likely to be one who views birth from the mother's point of view rather than her own, so that she never forgets that she has the potential to impact the mother and baby in ways that will last their lifetime.

A safe midwife keeps the calling in mind so that attending birth doesn't ever just become a job, as my friend Ashley reminded me a few days ago. If a midwife doesn't LOVE what she does, she is less likely to be a safe midwife.

A safe midwife recognizes the inherent safety in the natural biological function we call birth. She doesn't expect a complication to be lurking around every corner, but she is prepared for the very very rare times one is.

A safe midwife would not panic if her gadgets and gizmos didn't make it to a birth with her. She could still do her job without them.

A safe midwife looks to the science of birth rather than what the community standard of practice is. She holds every trick or procedure that her peers are using up to the scrutiny of physiology.

A safe midwife desires something for the mother and baby that goes beyond safety. If she desires THAT, she will be less likely to interfere in the name of safety.

A safe midwife is safe by intention. She makes a hundred decisions a day that etermine whether she is the kind of midwife I described first or this kind of midwife.

And you know I can leave the topic of safety without my signature definition: Hanzoffa, Hanzoutta, Mouthshutta!

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Carla Hartley is a friend, a midwife, a defender of mammas and birth...she is also the owners of Ancient Art Midwifery Institute and the founder of Trust Birth.

Natural-Motherhood is produced by www.natural-pregnancy-mentor.com

Midwifery Licensure

I have never for one second understood the rationale of licensing midwives.



What those who are pushing for licensure want, and what they get, will eventually be two very different things.




• They may start out with part of what they want: power and third party reimbursement. But professional equality and respect cannot be legislated and will never happen. So mark that one off the list.

The only place midwives will ever work with doctors is under them; CNMs are not considered equals.

Why do pushers keep telling me that they will gain respect and work side by side with docs as equals? On what planet?

And it will be an easy thing to reduce any power with the creation of licensing boards. And that alluring carrot of third party reimbursement can, in no way, be guaranteed for too long. Many insurance companies are refusing to cover home births attended by any kind of midwife, papered or not. Medicaid won't be far behind. Why would they pay for something that private sector insurance won't cover?

• You can try to sell it to congress as something good for women, but it has to be repackaged and that is a whole "nother" rant.

• It is also a fallacy that licensing of midwives will create greater access for women to midwifery care. It will NOT create greater access to authentic midwifery care. It will create a new profession, because authentic midwifery is antithesis to government control. Authentic midwifery serves only the mother, with no one in between. In the long run it will not benefit poor women, many of whom WOULD NOT HAVE CHOSEN HOME BIRTH. It actually holds potential to force poor women into home birth who would rather birth in the hospital. That is not the way to promote midwifery.

• And along those lines, do you really trust the government to make the best decisions for your family about anything? Do you want them controlling the most intimate and feminine of all biological functions from a desk somewhere? It will create a lot of red tape. Don't we have enough of that? Eventually this licensing idea will go the way of all other things controlled by any government. How long until woman may not choose their own licensed midwives but rather they will be assigned by zip code. The number of women who "qualify" for a home birth with a midwife will decrease, even faster than it already is.



How much more obvious could it be that licensure is a disaster in the making?



• Most CPMs aren't too concerned about their future in all this pushing because they are "in", right? Well, read a little history of the licensing of midwives in the south. That will give you a little less confidence in your safety. And the plan is already afoot to make it far more difficult to attain or maintain a CPM. How many of you who are CPMs today, will welcome a new requirement to maintain your CPM and/or licensure that involves years and years of college? Think you need a Masters Degree to be a good midwife? Well you might have to have one to be an "official" midwife within just a few years.

• The argument often railed at me is that midwifery needs to be like everything else. Really? Is birth like anything else? Should we lump it in with healthcare? (______________ leaving space here for you to think about the success of healthcare in general and what midwifery would look like as a part of that______________) Look at education and social work and related fields where the educational requirements for employment are escalating at a rapid rate. Do you really think that if you ply your way into the government controlled system that CPMs will escape that same kind of structured increase in educational requirements?



ARRRGGGHHHH! All that makes me crazy....



But here is what gives me even more concern:

• If we buy into the idea that midwives need to be regulated or licensed we are saying that midwives are likely to be dangerous and SOMEBODY needs to watch them.

• And then that those without paper need to be eliminated, which is whose objective? Not just the medical community, and the government, BUT The Big Push and others who seek to monopolize midwifery. Those opposed to woman centered birth is not just "them" anymore.....it is a lot of "us."

• And where, oh where, did we get the idea that licensing and regulation produces better midwives? In fact, from where I sit, it has just the opposite effect. When a credential is the goal, rather than the acquisition of knowledge and wisdom, the credential will replace knowledge and wisdom in significance. I can tell you that this has already happened, just as I knew it would.

• When the issuing organization has the power, rather than the mother, what happens to the mother's ability to make ANY decisions for her birth or her baby? Mothers own birth. Not NARM nor The Big Push nor any of the organizations who are at this moment speaking on the behalf of all midwives. Their presumption is that they are speaking for all midwives but actually they are only speaking FOR the midwives they have approved. I am guessing that half of them don't realize what is being pushed on "their behalf."

• And where are the mothers in this? They are completely left out, though they are held up as the beneficiaries of this fiasco. Yes, I know some are pushing, but they have not likely read the fine print. They think that it is all about legitimizing and freeing midwives. I understand that. But what will happen is that mothers will lose rights and freedoms while midwives gain some and when they lose some. As long as this is about midwives, the power will rest in the hands of the state and not in the hands of the owners: the mothers.



AND THE PUSH FOR LICENSING IS WHOLESALE PROMOTION OF THE LIE THAT BIRTH IS DANGEROUS AND ITS COROLLARY: SOMEBODY OTHER THAN THE MOTHER NEEDS TO BE IN CHARGE!



That is the most lethal aspect of this whole push. Once we hand midwifery over to anyone to regulate and control, we are turning mothers over to someone to regulate and control.

Regulating midwives is, in effect, regulating home birth and regulating mothers.


I may not be able to stop what is happening but I will never have to apologize to my daughters and granddaughters for having been complicit with stripping their birthing rights away.

I see the Trojan Horse for what it is and I am not going anywhere near it.

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Carla Hartley is a friend, a midwife, a defender of mammas and birth...she is also the owners of Ancient Art Midwifery Institute and the founder of Trust Birth.

Natural-Motherhood is produced by www.natural-pregnancy-mentor.com