Lisa Barrett’s betrayal of midwifery

Lisa Barrett’s ears must be burning. They’re talking about her in the Australian Parliament:

South Australian Deputy Coroner Anthony Schapel recently completed an inquiry into the deaths of two babies in separate incidents in 2007 and 2009.

Former midwife Lisa Barrett attended both births.

South Australian Health Minister John Hill told state parliament on Tuesday he had been advised that Ms Barrett was associated with two other incidents involving home births.

On October 7 this year, a twin died, with the Women’s and Children’s Health Network advising the state coroner of the death.

And on October 12, a woman presented at an Adelaide hospital in established labour.

A baby was born safely, but Mr Hill said the mother then took the newborn home, against medical advice.

The minister said the mother subsequently returned to get medical treatment for the infant, accompanied by Ms Barrett.

Mr Hill said he was also advised that Ms Barrett was involved in a coronial investigation in Western Australia relating to the death of a twin during another home delivery.

But Lisa Barrett has done more than recklessly put at risk and then lose the lives of four babies. She has betrayed the ideals of midwifery itself.

Everyone knows that midwife is the person (usually female) who assists women with childbirth. Where did the word “midwife” come from? According to the Free Dictionary:

… Wife in its earlier history meant “woman,” as it still did when the compound midwife was formed in Middle English (first recorded around 1300). Mid is probably a preposition, meaning “together with.” Thus a midwife was literally a “with woman” or “a woman who assists other women in childbirth.” …

Why would women need assistance with a perfectly natural function like childbirth? Childbirth is inherently fraught with life threatening dangers and having an assistant is known to improve the chances that both baby and mother will survive. A more complete definition of “midwife” would be “a person who provides life saving assistance to women during childbirth.”

Note that the definition is not “a person who helps mothers self-actualize by having the birth of their dreams.” Yet midwives like Lisa Barrett, who repeatedly preside over preventable neonatal deaths, have implicitly rejected the traditional lifesaving purpose of midwifery in exchange for a role as new-age life coach, exhorting women to self actualize through giving birth in a non-traditional setting while defying any notion of safety.

To understand just how much someone like Lisa Barrett betrays the heritage of midwifery, it helps to imagine how an African-American midwife of the 1920’s, or a European midwife of the 1500’s or even an aboriginal midwife of the Neolithic period would have greeted the notion that her job was to facilitate self-actualization through birth. They would have been utterly incredulous, assuming that they even understood the concept of self-actualization as opposed to mere survival.

How did some midwives go so wrong? It’s all about market share.

Midwives had the job description “a person who provides life saving assistance to women during childbirth” to themselves until relatively recently. In the past 100 years, though, it has become apparent that obstetricians can fulfill the primary purpose of keeping mother and baby alive well, and in many situations better than midwives themselves. To retain or gain market share, some midwives chose to diversify by redefining midwifery itself.

Instead of striving to give a healthy baby to a healthy mother, these midwives re-purposed birth as an exercise in self-actualization. They turned birth into an extreme sport whereby women are supposed to derive a sense of power and mastery by completing a self imposed task in the face of tremendous physical exertion or pain. It is a deft bit of marketing; the reality is that, in contrast to completing a marathon or climbing a mountain, any woman can have a baby without pain relief and in defiance of safety precautions and most mothers who have ever existed have already done it (or died trying). No matter; these midwives portray unmedicated birth as a rare accomplishment. The midwife’s role is not to prevent death, but to coach women in this effort to self-actualize.

Looked on from that point of view, the inexplicable becomes understandable. The claim that “a live baby is not the most important thing” is impossible to square with the midwife’s traditional role to prevent neonatal and maternal mortality, but it makes sense if the midwife believes her role is to facilitate maternal self-actualization.

The reckless encouragement to “trust birth” in the face of even the most serious complications makes no sense for the midwife who views her purpose as preventing death, but it makes perfect sense if she think that increased difficulty and risk (higher mountain, longer distance) equals greater accomplishment.

And it also explains the obsessive invocation of “choice” whenever the issue of safety comes up. The African-American midwife of the 1920’s, European midwife of the 1500’s and the aboriginal midwife of the Neolithic period privileged safety over “choice” whereas the midwife/facilitator privileges choice above all else.

Lisa Barrett may be a particularly egregious case of the betrayal of midwifery, but she is far from alone. Contemporary midwifery theorists, particularly those in Australia and the UK have provided the philosophical rationale for abandoning the traditional role of the midwife in preventing neonatal and maternal death for the more appealing (to them) role of midwife as facilitator of self-actualization. The emphasis on “normal birth” as a goal in itself, the rejection of rationalism for “other ways of knowing,” and the insistence that “a healthy baby is not the most important thing” represent a betrayal of the essence of traditional midwifery in which the health and safety of baby and mother is paramount.