Keeper of Birth: WHO Year of the Nurse and Midwife
I am a keeper of birth. I stand at the door of life, expecting life to happen, biology to flourish, the breath of life to take easily, as it so often and usually does.
I am also a witness to the fragility of life: that place where the spirit and the body have transition, the place where biology—genetics, disease, accident, and sometimes circumstances of birth, can make transition to mortality a risky proposition at best.
God called me to work at this juncture, to guardian the transition, to be a doorkeeper. I will tell you how.
Like so many birth workers, my own first birth experiences were foundational in guiding me on this path to becoming a midwife. My first labor and birth were routine, but interventional in ways that interrupted biology. Without including many personal details, I was led (society was led, doctors were led, culture was led) down a path that perceives birth as ALWAYS dangerous, ALWAYS perilous, something that should be rescued from, saved from. Birth is often referred to as delivery. Delivery from what? Peril? Evil? Danger? I had wanted to explore my own edges of tolerance for pain and power, and I felt the autonomy of choice removed from me through a process of increasing intervention that did affect the bonding I had with my baby and increased complexity in establishing lactation. Through the miracle of prolactin and oxytocin, we connected and bonded later, but I often have wondered what that might have looked like if fear had not been the overarching motivator in all the decisions made during that health care experience for our family.
So I chose different care providers the next time. I chose a different path to labor and birth. I chose midwives for my own providers, and in choosing, I started down a path where I took God’s hand in guidance for my education, my preceptors, my life experiences, even my childcare arrangements for my children were blessed and arranged for by God when I stepped out in faith, both with a desire to serve, a desire to learn, and a desire to preserve my family. I became a volunteer breastfeeding counselor, even while I birthed and raised my own children. I became the “go to” person people asked about lactation questions for a good number of years. I landed on my feet several years later, having passed my midwifery board exam, and applied for licensure in my state to practice as a licensed midwife, in out-of-hospital settings. I prefer to work in the home setting, but I can also work in a free-standing birth center. I cannot have hospital privileges, which suits my practice model just fine.
In my education process for midwifery the things I learned HAD to include intersectionality. I am still a neophyte in my educational process, learning about the dynamics and forces that shape and affect the women I serve. But maternal and infant morbidity and mortality in the U.S. being what they are (bad and high), and obstetrics currently still ensconced in being one of the least evidence-based branches of medicine, I have had to educate myself thoroughly in social justice issues and bioethical issues that seem extremely disparate, and yet come together at the nexus of women’s health. I work in a field that itself has been discriminated against, with an intentional smear campaign against midwives in U.S. history from the late 1800s through early 1900s, with racial and ethnic overtones against “dirty midwives” and traditional healers. I deal with the fallout of racial issues and eugenics from the 1920s when I fill out birth certificates. I sense echoes of horrific abuse and enslaved women, including Lucy, Anarcha, and Betsey, who had surgical techniques practiced, performed and perfected on their unanesthetized bodies when I (rarely) use a speculum to view the cervix and vaginal walls of my client.
I also have to believe the best of my collaborating fellow professional health care providers. When I have a client who needs a consultation with an OB or specialist, it does me no good to expect that their primary motivations are money, power, or savior complex. While those things may be true to some extent, I believe deeply in the fundamental goodness of people, and people who are audacious enough to go into health care, nursing, medicine, anaesthesiology, and other fields, have an intense streak to both help others and for things to “work out” against all odds. This characteristic is a fantastic blessing when someone’s life is on the line, and the doctor or nurse has to be willing to throw all their effort into resuscitation. The double-edged sword blade of it is that they are sometimes ill-equipped to know when things are within a normal amount of variation and no intervention is required. There is also over-intervention present in current obstetrical practices, and still so much benevolent patriarchy, as some health care providers project the “doctor knows best” aura. I sometimes provide parallel care for clients so I am the recipient of the report of the eye-rolling response my clients have to the hand-patting and “don’t worry your little head” attitudes they get from the parallel providers. I was at an integrated training for life support in obstetrics a few years ago, and heard from multiple instructors, “you know what happens to those women who bring a birth plan in for a natural birth.” What happens to them? Just the fact of wanting a conversation about their health care decisions (i.e., a birth plan) makes them more likely to have a cesarean section.
I use the word “client” intentionally. As a midwife supporting physiologic labor and birth, my fundamental view is that labor and birth are not medical events until they become so. What I mean is that our bodies are designed to labor and to birth, and can be supported to successfully do so a majority of the time. That does of course, require excellent childbirth education, exploration of the concepts of pain and fear, cultural views of labor and birth, and sometimes doing the hard internal work of adjusting those views and embracing one’s instinctive self. This can be really challenging for some of my modern, efficient clients. When what is best for labor is to release control, allow surges (contractions) to happen, decrease our alertness and cerebral acuity, and allow ourselves to feel safe and supported, many women find that place a quest to achieve. When society and culture require you to be at the top of your game all the time (succeeding in business and academics), on guard all the time (taking a self-defense class and carrying pepper spray to walk to your car), and commute for long distances (reclining in your car dealing with the stress of traffic), fostering a sense of belonging, safety, security, and relaxation to engage the hormones for the most safe birth possible is really a long trek. This is especially hard for women of color, and most especially Black women.
There is something that is culturally wrong when I have to alter the postpartum instructions I am giving based on whether my client has secure housing, has to go back to work within days of giving birth, or is on the run with her children in an intimate partner violence scenario. I want to tell all the women and birthing people I serve to stay in bed for a week, stay home for a month, and don’t carry anything except their baby for at least two weeks. Instead, I occasionally find them packing for moves and hauling boxes when I come for their postpartum visits, stopping to breastfeed their babies every hour or two. I tell them that the strength of their postpartum bleeding is related to the exertion that they are putting forth, and if it gets heavier they need to slow down. You try telling a mother of many to slow down.
I believe I am a midwife with eyes wide open. I have a degree in biology; I understand that life can be feckless and unlucky, the genetic or circumstantial experiences just toss the dice badly, and ALIVENESS isn’t something we can count on. But I also am frustrated with a system that assumes bad things are always going to happen, and health care decisions must be made “to keep from getting behind the 8-ball.” (an actual quote from my OB). You know, given even less-than-ideal growth conditions, life flourishes. If there is sufficient nutrition and rest, and enough emotional support and excellent health care, most women and birthing people will be able to have a vaginal birth, even a lovely and empowering birth.
When I talk about safety in birth, I say birth is as safe as life is. When my clients choose to birth in their homes, they are choosing one set of risks, and for clients who labor and birth in a hospital setting, there is another set of risks. Autonomy and personal choice and decision are hallmarks of my care. I want EVERY birthing person to be fully informed about all their choices, and the consequences and sometimes fallout of the choices they make, even when they didn’t have full information. My clients often feel like my informed consent documents are LONG and DETAILED, and we spend a lot of time talking about what care might look like in a hospital, with other providers, and with me. Those details are the education process to be able to make informed decisions.
I believe the midwifery model of care is an excellent health care model for everyone, and should be implemented without delay across the United States. I am U.S. based, and my information is primarily U.S. based. And whether it is good or not, health care policy from the U.S. trickles down around the world and usually gets amplified in often not-so-good ways.
My favorite parts of being a midwife are all wrapped up in the mother-baby dyad. I love seeing a birthing person labor (occasionally) for hours or days, accepting the next stage of release of control, as they gain the next level of ability to manage discomfort as the baby navigates the passage through the pelvis and the mother’s healthy cervix widens to accommodate what is, after all, a big passenger. I love seeing the moment of birth, the peak of oxytocin, the mother holding her baby triumphantly, and everyone in the room weeping with love and exultancy. Very often this mother felt her power all taken away in a prior birth experience, and like me, was looking for something different, to take back her autonomy and power. And HER choice and HER effort, in concert with HER baby’s effort brings her to this place,where she will mother/parent her baby with power and confidence.
This is not the birth experience of everyone I serve. But if their experiences take another direction, intervention, cesarean section; I still hope they feel supported in the decision-making process and informed. And this is the other side of my work, also my privilege—to “mourn with those that mourn, and comfort those that stand in need of comfort”—when my heart breaks a thousand times, supporting women who miscarry, who cannot conceive in the first place, or who mourn their birth experiences and wish they had also had the triumphant labor and birth.
I follow social movements of policy and law, ensure my licensure in the states I practice in, and educate myself according to international organizations’ standards. But my own midwifery model of care is based on this: I make a difference in the world one and two people at a time. I do everything I can to get out of the way and help women and birthing people find their autonomy and power. And like the parable about throwing starfish back into the ocean, I know that this midwife “made a difference for that one.”
Becky is a licensed midwife who lives and practices in northern Virginia.