Dear Homebirth Mother,
You are planning a homebirth and you can envision it down to the last intimate, spiritual, joyful detail.
You’ve been seeing a homebirth midwife and your relationship with her is awesome. You’ve never had that kind of warm, supportive relationship with any healthcare provider. The connection you have with your midwife makes you feel very good about your decision to have a homebirth, even though your doctor, your parents, your in-laws and your friends have expressed concern about the baby’s safety and your safety.
I’d like you to take a moment and consider the relationship with your midwife. Right now you experience it as incredibly supportive and affirming, but is it possible that your homebirth midwife is emotionally manipulating you?
I suspect that you have a visceral response to the question. Of course she isn’t manipulating you!
I’d ask you to think again and consider these 10 signs that your homebirth midwife is emotionally manipulating you.
Let’s start with the basic premise that you have hired a homebirth midwife to provide care for you and your baby in labor. In other words, you have hired her in her role as a medical professional. Therefore, you need to judge your relationship with her based on whether it comports with an ethical patient-provider relationship.
1. Does your homebirth midwife encourage you to think of her as a good friend?
Your friendship may be one of the unexpected dividends of hiring a homebirth midwife. You didn’t realize that she would spend so much time with you discussing your philosophy of childbirth and your prenatal care, let alone discussing your fears, hopes and dreams. That would be great if you were looking for a new best friend, but it’s not great in someone who purports to be a medical professional. A close personal relationship with a doctor, nurse, or midwife is neither desirable nor ethical.
Certainly a medical professional should be kind, and, hopefully, empathic, but he or she should not try to become your friend. A close personal relationship could compromise your midwife’s ability to provide appropriate care, and, equally importantly, it can compromise your ability to evaluate the care you are receiving. If you feel you cannot question your midwife’s recommendation for fear that you will hurt her feelings, you are being emotionally manipulated.
2. Does your homebirth midwife ignore professional boundaries?
Professional boundaries protect both patients and midwives. There should be no confusion; your midwife should be your health care provider, not your friend. So it is important to consider whether your midwife blurs or crosses professional boundaries in your relationship.
How can you tell? Does your midwife expect you to act as hostess when she visits or while she is attending your birth? Does she expect you to provide meals and snacks and attend to her comfort when she is in your home? Does she encourage you to confide in her about issues that have nothing to do with your pregnancy? Does she make you feel bad if you don’t agree with her recommendations? These can all be signs that your midwife has crossed professional boundaries to create a relationship that allows her to emotionally manipulate you.
3. Does your homebirth midwife encourage distrust of other medical professionals?
A real medical professional does not disparage other medical professionals. Real medical professionals work together for the benefit of patients. No obstetrician would encourage you to distrust your perinatologist, or express disdain for the medical philosophy of the endocrinologist who follows you for diabetes.
Real medical professionals depend on each other to provide you with the best possible care. That’s why it,s a warning sign if your homebirth midwife encourages you to distrust obstetricians or other doctors. If she has a disagreement with another professional over management of your care, they should discuss it between themselves, and you might even wish to be present to evaluate their differing points of view. If your midwife is unwilling to do that, you have to ask yourself whether she is encouraging you to distrust other providers for her own benefit (to keep you as a patient, to deprive you of information that might lead to you questioning your recommendations) rather than for your benefit.
4. Does she encourage you to lie to other medical professionals?
The is a huge red flag. A real medical professional will NEVER counsel you to lie to another provider. Besides the fact that it is deeply unethical, it is incredibly harmful to your well-being. No doctor can advise you appropriately if you are lying in response to their questions. There is absolutely, positively no benefit to you from lying to a doctor about anything. You only stand to lose when you lie. Your homebirth midwife, on the other hand, often benefits when she convinces you to lie because the lies invariably make it easier for her to hold on to you as a patient and to hold on to your fee.
5. Does she encourage you to distrust your family and friends?
One of the hallmarks of emotional manipulation in any setting, not just a medical setting, is the efforts of the manipulator to separate you from the people who care most about you, partners, parents, other relatives, and close friends. Encouraging you to distrust your family and friends (“They aren’t as educated about childbirth as we are.” “They are steeped in a culture of fear.” “They are sheeple who cannot imagine defying authority figures.”) is encouraging an emotional barrier between yourself and those closest to you with the goal of increasing the midwife’s ability to manipulate you into doing what she wants, not what is best for you.
6. Does your homebirth midwife encourage you to lie to your family and friends?
This is another huge red flag. An ethical provider has no reason to encourage you to lie to partners, family and friends. In fact, a good provider will encourage you to enlist those closest to you in supporting you through this momentous event.
7. Does your homebirth midwife try to isolate you from your family and friends?
This is perhaps the biggest warning sign of emotional manipulation. A real medical provider has no need to bar your family and friends from appointments or the birth itself UNLESS you specifically request it. Only someone who views family and friends as possible threats to her influence would encourage you to exclude those closest to you from this emotional experience.
8. Does your homebirth midwife insist that she will “let you know” when you are allowed to consult a doctor or transfer to a hospital?
Who’s in charge here, you or your midwife? Who gets to decide how much pain is too much? Who gets to decide how long a labor is too long? Who gets to decide whether a complication is worthy of consultation with another medical professional? It should be YOU, and if it is not, you should be worried. When the midwife is in charge of these very personal decisions, she is more likely to meet her needs than yours.
9. Does your homebirth midwife discourage medical tests that would involve you having contact with other providers?
An ethical medical provider is never threatened by the thought that test results might lead you to another provider. No obstetrician will recommend against testing that would reveal a high risk condition for fear that you would transfer to a perinatologist. No obstetrician advises against diabetes testing for fear that you might need to see an endocrinologist. They are not threatened to learn that your care is outside their scope of practice. In fact, the sooner they find out about complications, the happier they are, because they can enlist the help of others in providing you with the best possible care.
There is no legitimate medical reason for a homebirth midwife to discourage routine prenatal tests or special tests for special circumstances. There are only emotional reasons: if you are experiencing a complication she may lose you (and your money). Don’t be fooled by someone who counsels you to avoid prenatal tests to “preserve” the chance that you can have the birth you want. That’s emotional manipulation.
10. Does your homebirth midwife encourage you to take risks that would allow you to stay home? Does she insist that complications are “variations of normal”?
No real medical professional would ever encourage you to risk your health or your baby’s health. No medical professional would ever praise you for willingly risking your life or your baby’s life. A real medical professional wouldn’t tell you that you were brave, or a warrior mama, or demonstrating your trust in birth. Those are all forms of emotional manipulation designed to strengthen the midwife’s control over you for her benefit, not for yours.
If you’ve answered yes to any of these questions, you need to consider that your homebirth midwife is emotionally manipulating you toward the outcome that is best for her. The best outcome for her involves maintaining psychological control over you, having you look to her and only her for affirmation and advice, having you praise her, and, of course, having you pay her.
Do you think your homebirth midwife is awesome? That’s great, but just be sure that she is not emotionally manipulating your toward that belief, by encouraging distrust of other medical professionals or by encouraging discord with and isolation from family and friends. Just be sure that she is not emotionally manipulating you by insisting that she can and should control your care even though she has never checked for pregnancy complications or is ignoring the complications that do occur by reclassifying them as “variations of normal.”
If she is emotionally manipulating you to stay with her care, the consequences for you and your baby could be devastating.