Homebirth mothers, is your midwife emotionally manipulating you?

Pregnant woman in white smiles and her girlfriend touches her st

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.

  • Lou

    Very interesting read.. It’s scary to think that midwives or any health professional would manipulate their patients. But as we all know it happens in any speciality not just midwifery

    • fiftyfifty1

      “But as we all know it happens in any speciality not just midwifery”

      The difference is that it is an *encouraged part of the culture* in homebirth midwifery. When it happens with real medical professionals it is sanctioned.

  • NavelgazingMidwife

    One of the things that home birth midwives make sure of is that women do NOT have to play hostess to the midwife and assistants. We are very careful to tell them, specifically, that they do not have to take care of us. “We’re great at foraging” is what I used to say to my own clients.

    Other than that, the warnings are pretty spot on. I could tweak a few things, not being so paranoid about others, but generally, the commentary is correct. I was guilty of so many of these things myself, totally subconsciously, though. It was part of the midwife culture to be friends with the clients. I remember how bad I felt when a client didn’t like me after her birth… can STILL feel that sting… even though now I know it was a healthy pulling away of a client’s expectations with me. The midwives I worked with would say I am making an excuse for having clients not like me, that clients are *supposed* to REALLY like their midwives and anything else is wrong. I now see the difference between being friends and a professional kindness. It is much further apart than I would have thought.

    I’m tempted to write my own list similar to this. You might get me to write a post, Dr. Amy… wouldn’t that be great? 😉

    • The Bofa on the Sofa

      While you may not have expected women to play hostess, there are certainly those that do, and we’ve heard about them here.

  • I wish I had read this 8 years ago.

  • Ducky

    This is a really important post, Amy, thank you.

    I think some midwives are so effective at emotional manipulation because they do not even realize what they are doing consciously. They are that delusional and steeped in their own confirmation bias that they really think they know what’s best. Some are fully aware of what they’re doing and why, of course.

    Either way it’s important for women to be on the look-out for these warning signs. It would be great if an association of CNM’s would formally endorse this list or something. probably not going to happen?

  • Amazed

    Warning: don’t click this link if you’re having a cup of coffee of a glass of wine and you value your keyboard.

    Here, we’re blessed with the incredible insights of a pack of homebirting bitches regarding Gavin Michael’s death. Some of you may remember what I recognize as homebirthing bitches: I don’t care that she killed someone else’s child because she provided me with stellar care. I know it isn’t true because my stellar care, my experience is the only thing that matters. I am sorry for this unfortunate uneducated mother but she needs to own her outcome. Well, every day those vile women really expand my meaning by square miles.

    Enjoy (or vomit, as the case might be).

    http://community.babycenter.com/post/a48220624/midwife_christy_collins_negligence_results_in_tragedy_trigger?cpg=8&csi=2448133247&pd=1

    I have to admit that right now, if one of the bitches had a bad outcome with her praised midwives, the only person I’ll be feeling sorry about would be the baby. My supply of sympathy for their delusions is reaching its limit.

    To trulyunbelievable 20 who posts here as well: I praise you for your patience and self-control with this pack. There is a reason I shy away from natural communities who are so fond of unnatural internet – and it isn’t because I have nothing to say.

    • Ra

      From Page 1 of the thread above…
      “One of my best friends lost a baby – she did have a near-certification midwife (no other midwifes would take her case); the baby was 4 weeks overdue, went into severe distress and an emergency c-section could not save the baby.”
      I’m willing to bet that the baby would have been born alive if there was a hospital induction or c-section several weeks earlier. If the baby was so far gone at 44 weeks that an emergency c-section couldn’t save him that means the midwife was negligent–not that he was beyond hope.

      • Amazed

        Yeah. For these women, I think a new word should be coined: post-emergency c-section.

        • Beth

          seriously. The emergeny c-section took place about 4 weeks after the emergency started. No wonder it didn’t work.

          it’s like saying “when the fire department stopped by a few weeks later it was just a smoking ruin and there was nothing they could do to fix it. Clearly there would have been no point calling them sooner.”

      • Amazed

        By the way, did you notice that the best friend isn’t uneducated or responsible for the outcome? It’s reserved only for mothers who question their midwife, blame her and most importantly, make the news. As long as all can be hushed up, it’s just a sad inevitability. Even an emergency c-section didn’t help, so there was nothing to be done.

    • Trulyunbelievable2020

      Thanks for the shoutout 🙂

    • Couldn’t read it. So enraging I started to cry. You’re right, what a bunch of horrible bitches

      • Amazed

        They really, really enraged me. Got me out of my bloody mind. I was so furious that I wrote something very, very offensive and impulsive on the c-section post. Fortunately, I can recognize when I am being offensive and. I see no hope for them.

        For those who won’t click on the link: it’s all about blaming the mother and how Christy WARNED her but the stupid mother wouldn’t listen when their educated selves wouldn’t have even needed to be told to go to the hospital that suddenly became life-saving (and would have bounced back to evil the moment their blessed self came out with a healthy baba or whatever they call the baby).

    • Alannah

      Do screencap it. Dr Amy can use it for a post debunking the myth of the wonderful supportive home birth community. It’s all hugs and kumbaya until someone loses their baby. Then the knives come out.

      • The Bofa on the Sofa

        Yeah, Amy mentions a HB death and everyone is all “how dare you!”

    • Megj86

      THESE PEOPLE ARE DOING MY HEAD IN! CAN I PLEASE RALLY FOR SOME MORE SUPPORT IN THIS THREAD? Please and thank you 🙂
      (Is it a lost cause? Should I just stop commenting on it? Someone please tell me if I should give it up – i’m just seeing red at some of the comments and because of that I keep commenting. )

      • Amazed

        You’re doing a wonderful job. I would have supported you, were I a bit more patient or at least a mom… You see, I found Dr Amy after a baby died a preventable death here. It blew my mind out – until this moment, I had no idea that someone might choose to give birth at home.

  • Rochester mama

    I really liked the Centering Pregnancy model I went through. There was a group of ten of us that met with a CNM and an OB resident each time for 90 minutes. Were were all due within a month of each other and started meeting around 16 weeks. The first 30 was chit chat while we all got our weight, bp, measurements and got to hear the heartbeat and a chance to ask any personal one on one questions with either the CNM or resident. The rest of the time focused on nutrition, infant care etc… Even though neither the CNM or resident were there for my birth they both stopped by to meet my son while I was in the hospital. While I have no illusion they were my friends I certainly felt they were excited and happy for me because they saw me at every appointment. I feel like a got the best of both worlds. Long appointments and plenty of information (without having to take a separate class) and a world class facility and specialists at the ready if I needed them. I’m glad to see at least in MN it seems more and more facilities are offering this format.

    • Dr Kitty

      Which is fine for some people, but not for people who don’t like group things.
      Me for example.
      I would HATE that.

      I skipped all the parent craft classes that were offered, and told my husband that his only job if I went into labour was to get me an epidural, and that we would work out how to change nappies and feed and bath the baby ourselves because we’re not idiots.

      Really, being a Dr is not helpful sometimes.
      If you’ve seen Dara O’Briain’s NCT sketch, you’ll know what I mean.

      • Rochester mama

        True it’s not for everyone, just a nice option if you are looking for more than the in and out spend more time in the waiting room than with the provider prenatal appointments most low risk women get.

      • Bombshellrisa

        Thank goodness, thought I was the only one who skipped the classes. Husband and I agreed he would stay in the room and stay away from “the business end” and see how he felt in the moment when it came time for the cord to be cut. During one of my naps, the nurses showed my husband how to feed and burp the baby. We liked the quick prenatal appointments (although my doctor never once made us feel rushed, I always felt like we were the ones who were in a hurry to get out the door)

      • Mishimoo

        We skipped ours too, because after the second one my husband couldn’t deal with my after class anti-woo ranting any more and we weren’t learning anything new.

    • thankfulmom

      Did you all have your weight checked and the baby’s heartbeat checked with everyone in the room? I’m glad you had an experience you liked (sounds like a weekly childbirth class), but I would be very uncomfortable with this. What if someone had a fetal demise? They’d have a bunch of observers at their personal tragedy. How did they handle it when someone’s pregnancy deviate from the normal course? I had to be put on blood pressure meds. and then on insulin for the next pregnancy.

      • Rochester mama

        People did their own weigh in and gave the number to the person who did the BP, heartbeat and fundal measurement for you and entered it into your E chart. The set up we had, the two providers had curtained off areas. The least far along person in the group was like 16 weeks and everyone had already had a 12 week ultrasound (not that bad stuff can’t happen after that) if you became high risk at some point they transferred care to an OB. The 20 week ultra sound and Glucose tests were scheduled individually. Again not for anyone and you shouldn’t be forced to have your care this way, but it was great as a first time mom to have the long appointments and group discussions. We all signed non disclosure statements, but if we ever had something we really wanted to talk in private about we were told to stay after and we could talk in a private office.

      • areawomanpdx

        When we do centering groups, the individual care- weighing, heartbeat, measuring, is all done behind a curtain away from the group. First visits are done individually, and also visits after 38 weeks. It’s not for everyone, but the women that choose it really seem to love it.

  • lawyer jane

    My hospital-based CNM midwife actually did 3 of these things: encouraged me to lie in medical records, and seemed to encourage risks in the pursuit of “natural” childbirth. They also refused to have a clear conversation with me about when I would risk out of their practice and have to go to an OB due to high BP, so that’s kind of like #8.

    The woo, it penetrates further than you might think!

    • Gene

      That’s truly scary, as a hospital based CNM is supposed to work directly with a physicians.

      • The Bofa on the Sofa

        Again, an indictment on the CNM, who are supposed to be the “good ones.”

        Yes, they are less bad on average than CPMs, but still, the woo is way too strong.

  • Ra

    Great post! I’d love another similar one about how to tell if your healthcare provider is not actually a legitimate provider of healthcare services (refuses insurance, shoddy education, gives advice contrary to known best practices, etc.).

  • Laura

    My SIL chose a midwife who was voluntarily unlicensed so she could attend breech, twin, and very postdate deliveries for her last birth. I was (and still am) horrified, and when I was expressing my horror to my MIL, she kept defending her decision saying, “Oh, but this midwife is so wonderful! She takes the time to talk to her…” I cut her off by saying, “It doesn’t matter. She cannot legally carry medical equipment and she IS NOT LICENSED.” My MIL ended the discussion right then and there.

    Sigh…

    • Laura

      For myself, I do not want to be chummy with my care provider. It just feels so weird to me. Of course, I want to feel comfortable talking about my health concerns (even the downright embarrassing ones), but I don’t want to have tea and crumpets with them after they have used a speculum on me.

  • onandoff

    Midwife/patient relationships have always seemed so parasitic to me. It’s funny because many women cite privacy as one of the driving factors behind having a homebirth. To me, there is much more privacy in having a professional, objective health care provider who focuses on your health and your baby’s health versus a birth attendant who actually comes into your home, bores into your personal life, and worms her way into your child’s birth as an integral part of the experience.

    One of my good friends is a doula and as part of her service she writes a birth story for her clients. I can see the good in that. But the part of me that would never hire a doula (which is like 90% of me) says, who are you? and why do you think you get to narrate my child’s birth story? It’s such a personal thing, such an internal thing.

  • AlexisRT

    This is a good post, but I would suggest an adjustment to point 7. I have noticed that some providers request that partners NOT be present at certain times, I believe so the woman can be asked about potentially abusive situations. This is not all of the time, which is I think the point, but women should know that some providers may ask that partners not be present for part of an appointment and why.

    • Comrade X

      Yes. This was not always the case in the UK, but I believe that now they have indeed cottoned on to the idea that pregnant women should have at least one proper chance to disclose domestic abuse to someone who can help them.

      • Anaesthetist

        oddly enough if you read the latest CMACE reports its because lots of things that previously caused death eg haemmorhage, DVTs, anaesthesia etc have fallen so much, partly due to the focus put on them by the CMACE reports, research and reccomendations/ improvements to practice that other issues have become the ones to tackle- and one that has been highlighted has been violence in the context of relationships. Im very glad that this important (if not strictly biomedical) issue is getting deserved attention.

      • Dr Kitty

        Yep, you now have to have documented asking the woman, alone once antenatally and once postpartum if she feels herself to be unsafe in her relationship.
        I don’t actually mind that kind of box ticking.

        • Mishimoo

          We have that here too, but it’s twice antepartum and once postpartum along with basic mental health screening. I also ended up with PSTD screening questions this time around, which I didn’t mind at all because it shows that our CNMs are doing their jobs properly.

      • BeatlesFan

        Here in the US it isn’t just pregnant women… I get asked that every time I have a physical, or go to the ER for anything.

    • Stacy21629

      Here’s a flip side to that coin – I made sure I had a visit alone with my CNM home birth midwife before my last birth specifically to tell her that if she had ANY reservations or concerns during labor that I wanted in on the discussion and almost certainly would want to transfer…no matter what DH said. He is still much more firmly entrenched in woo and I didn’t (still don’t unfortunately) trust him to decide for transfer if I wasn’t mentally able to. Ultimately, we did end up transferring for decels. My CNM said it was actually her first transfer ever (only been practicing at home births for about 2-3 years).

      With my first labor I also had a CNM home birth (different state) – it was a very long labor and we really should have transfered for maternal exhaustion. We didn’t and I did eventually have the baby at home, but I found out after the fact that the CNM and DH had talked about transfer hours and hours prior…and didn’t mention it to me.

      • AllieFoyle

        Ugh, that doesn’t sound very empowering, mama.

        • Stacy21629

          It’s really not. 🙁 I was puking in my living room and the actual thought went through my head “I could be in a hospital with an epidural right now, but he doesn’t want me to”.

          I was very glad to have to transfer. That’s actually exactly what I was hoping would happen…an urgent reason to transfer that didn’t need intervention/C-section.

          It’s awkward…but I know how much *I* believed the woo when I was pregnant with our first so I try to have patience…I just also took measures to be safer too – US, all prenatal testing, GBS testing, heplock, CNM, rapid transfer. If I was still in the woo or DH had his way we likely wouldn’t have done any of that…

      • MLE

        If you don’t mind my asking, how did your DH come to hold these beliefs about HB/woo? I am always interested in the mindset of the non cigar-smoking-in-the-lobby types.

        • Stacy21629

          Same way I did – we conceived our first child, starting “researching”, both fell into the woo…I just happened to finish my medical degree (veterinarian) and realize the ACTUAL science behind home birth and came out of it.

  • Coraline

    Bravo, Dr. Amy!!! This post is SUCH a valuable resource for ANY mother considering hiring a homebirth midwife! I seriously hope this gets shared far and wide. Thank you SO MUCH for writing it!

  • Michelle

    This is a great post and I hope it gets shared far and wide. I will say that if you have a history of trauma, abuse, loss, etc. it can be really unsettling to go through the hospital model, where in a normal pregnancy you might see several providers and then deliver with someone who you have never met before. I actually considered a home birth with my second pregnancy for this reason, but I ended up with a MFM after I learned I was having twins.

    I don’t think it’s unreasonable to want a relationship (not friendship) with your OB/midwife, and that distinction is sometimes lost and gives CPM’s an opportunity to exploit people’s fears about the hospital. In my case, all I wanted was someone who remembered me in between appointments and did not need to be reminded of my loss history at each visit. My MFM was great and although he did not deliver my twins, he was an advocate who communicated really well with L&D and the on-call OB. If I were to have another I would try to see one OB/CNM exclusively and not bounce around to try to meet every provider in the practice like I did with my first.

    • AlexisRT

      This is quite difficult today though as OBs don’t want the constant call on top of all the other pressures in medicine. There are a few solo practitioners near me but most have consolidated into groups of 6+. My OB group had, I think, 12 OBs but I rotated between 2 of them for my regular appointments. That did mean I could have gotten anyone had I gone into labor and I was very lucky that one of my regular OBs switched so she could do my scheduled section rather than me getting someone unfamiliar.

      The problem is that the solo provider model of homebirth midwifery isn’t really sustainable. The midwife can take only a very limited number of clients to keep space open.

    • JennG

      I have trauma in my life and had been through therapy for PTSD when I had my daughter (10 years ago tomorrow, wow.) Then she died due to NCB-leaning medical error (a failure to intervene). That was worse than a week’s worth of triggers.

      • Michelle

        I am very sorry for your loss. I agree and knowing what I know now I would not consider a home birth.

  • Trixie

    I think this post is excellent. I would just add that many of these same points can apply to many doulas.

  • So spot on.

  • jenny

    This is an excellent post about red flags and hopefully will be useful to many women.

  • I like this post a lot (and I’m freaking picky, I’m sure regulars here have noticed).

  • Dsmith

    One of your best posts ever.

  • Zoey

    This post reminds me of when, a few weeks ago on a local board, a woman posted that she was afraid she was in pre-term labour (22 weeks) because she was having what she thought were intense contractions. She was wondering what she should do and a few of us told her to “get to the hospital NOW!” Apparently she did go to the hospital, and was checked, everything was OK and she was sent home. No problem right?

    However, her midwife was on the same board and was livid that she had gone to the hospital without calling her first. The midwife made this ridiculous post about why you should never take yourself to the hospital if you have a midwife because she knows way more about birth than the doctors and all they will do is force her to have a bunch of unnecessary tests. She actually told a woman that she should never trust her own instincts to go to the hospital because only SHE is qualified to make that decision for her. Why else would you do something like that if not to maintain control? Everyone else on the board was saying things like “it’s so awesome that your midwife is here to look after you” and didn’t see anything wrong with what she was saying, much less that she said it in a public forum. Ridiculous.

    • Comrade X

      That’s really really creepy.

    • Gene

      Any chance you could link or screen cap? Always nice to have concrete examples of completely inappropriate behaviour by these not-so-professionals.

    • Danielle

      That is really creepy. Especially given that she was audacious enough to say it with an audience.

  • Busbus

    I really only started to think about this after my last baby was born (at home, with a CPM). The relationship that midwives offer you IS strange. And I can definitely see most of the aspects Dr. Amy mentions in my own as well as other people’s relationships with their homebirth midwives. I think, in a way, the fact that so many other people are likely to disagree or worry about your choice of a homebirth makes it necessary for the midwife to “inoculate” you against those doubters. Plus, the idea of going through labor unmedicated is very scary (it definitely was for me, and more so the second time around). So, at least in my case, a lot of this time was spent on talking about my fears. (Now I think that an epidural would have served me better than all that talking… Oh well. Live and learn, I guess.)

    • yugaya

      What I love about seeing people like you leaving comments on this blog is the individuality that prevails in your accounts – some people in retrospect will denounce the whole homebirth narrative, some will agree with some of the things discussed but not each and every viewpoint, but even with that every comment like the one you posted above will have distinctly strong, personal voice.

      When you take that and compare it with what defenders of all things NCB like randompersoncomment wrote on the previous blog, it becomes even more apparent how much difference there is between these two worlds. People who take part in this debate who are thinking with a clear head speak their mind covering wide range of arguments, subjects and thoughts using individual phrasing, and people who are brainwashed into a narrative are only capable of reiterating the same set of slogan-like formulations which they were fed with until their ability to think about what they are saying got completely lost.

      • thankfulmom

        Wow, so very very well said!

  • Are you nuts

    I think it’s strange when women want to be best friends with their health care providers. Sure, I like my OB, but I have friends in real life. And frankly I wouldn’t want anyone I considered a “friend” poking around in my nether regions! I like the professional boundary.

    • not everyone has a lot of friends, for various reasons. Maybe that is just another way for midwives to exploit people who are vulnerable.

      • Are you nuts

        That’s a good point. If someone is lonely and looking to connect with someone, they would be especially vulnerable.

    • Elle

      Me too… I couldn’t imagine having an hour-long appointment with any health care provider unless we were discussing a serious medical problem!

      • BeatlesFan

        This just came up during a discussion/debate I was having online with my NCB-peddling, woo-tastic friend; she said that patients of CPMs are more likely to have informed consent because they are better informed than OB patients, citing the difference of the average length of appointments. I pointed out that A) my appointments were always timely and professional, and any questions or concerns I had were treated with proper care and information, and B) the length of the appointment makes not a damn bit of difference if you aren’t being given ACTUAL INFORMATION. A one-hour appointment with someone telling you “You got this, Mama! You’re a warrior birth goddess! Trust birth!” doesn’t exactly square up with “informed consent”.

        Additionally, for almost every one of my appointments during my pregnancy with my daughter, I either had to get to work afterwards, or had my 3-year-old son with me. If the regular (IE, not ultrasound) appointments had taken an hour, I would have been pissed.

    • AlexisRT

      I have 2 good friends who are OBs–one practices at the hospital near me, in fact. I would not use her precisely because she is my friend and I am a terrible OB patient. (Of course, I would if she were the only or best qualified person, but with OBs I have sufficient choice.)

    • Dr Kitty

      Uh huh…my friends ARE OBs and orthopods and paediatrcians and GPs and various other flavours of Drs.

      I don’t want them to treat me and I wouldn’t want to treat them.
      It would be…icky.

  • Busbus

    Great post.

  • Mel

    For other women and men who don’t have much experience with team medical players, here’s a quick recap of how my medical professionals – a MD, a psychologist (PH.D) and a physical therapist have worked together for the best outcome for a patient (me).

    The problem: My cerebral palsy is acting up again. My left calf muscle is really tight and painful and not responding much to OTC medications / stretching / heat. Because of the discomfort, I haven’t been able to exercise as much as normal which is causing my anxiety disorder to act up again.

    Solutions:

    – I meet with my therapist who, in addition to various behavioral options, recommended that I start a fast-acting anti-anxiety medication like Xanax. She strongly recommends asking my MD for options that are available.
    – Since I need a PT referral at the same time, I call for an appointment with my MD. I double-check that I have a signed release for my therapist and MD to communicate about my case if needed.
    – At the appointment, my MD agrees that the PT seemed to work last time and that I should restart it. My MD states that the PT folk are much better at bio-mechanical issues than she is. She discusses several medication options for anxiety control with me. We choose one that we both think will work. She sets up a follow-up appointment in 2 months and reminds me that I can call back anytime before that if I don’t think the medications are working etc. She says that my therapist is doing good work with me and that she’s very glad I’m seeing her.
    – I stop by the PT office that afternoon to schedule an appointment. The MD has sent over a referral with a nice, concise explanation of what’s going on.

    This is how REAL health care providers work: as a team, for the good of the patient.

    • Amy M

      I conceived via IVF, It was discovered at the first dating u/s that I was carrying monozygotic twins, but it wasn’t clear if they had their own amniotic sacs or if they were sharing. The RE passed this info on the OB who checked asap (because mono/mono is wicked dangerous) and she thankfully determined my twins were mono/di and she managed my whole pregnancy. However, if they had been mono/mono (momo), she would have referred me to an MFM toot-sweet, no hard feelings.

      I remember reading a story on mdc about a woman who claimed she was carrying mono/di twins, but she didn’t believe in prenatal care and she didn’t give a crap about TTTS or any of the other complications that can go along with such twins. There was a father on there imploring her to get some medical care, and she was all offended….some medical information might tell her something she didn’t want to know of course. I don’t even know if there was a midwife involved, but if so, a midwife certainly wouldn’t want to lose a homebirth of twins!

      • Elizabeth A

        Well, there’s Dreah, who posts here sometimes, who’s midwife did try to manage mo-mo twins at home.

        • Amy M

          Yeah, it wasn’t her, but that was a bad idea for sure, as Dreah unfortunately found out. d:( The one I’m thinking of might not have even had twins or even been pregnant for all I know, but she sure “trusted birth.”

          • Karen in SC

            You might be thinking of Blessed Jess, who ended up with a tiny tiny baby due to polyhydro– whatever it’s called that means too much amniotic fluid. Dodged the prolapsed cord bullet during the UC, and of course, all she needed was her mama’s milk afterward.

      • Awesomemom

        That just makes me sad. I have a friend that lost her twins hours before they were going to do some surgery on them to take care of some really bad TTTS issues that were going on. I can’t imagine not wanting to do everything possible to keep them healthy and alive.

      • Mel

        That rings so true to me because my twin and I were mono/di with TTTS..but it was over 30 years ago, so they didn’t know anything until we were born at around 29 weeks. I was the receiving twin, was roughly the color of a beet and weighed just under 3 lbs. My twin was just over 2 pounds and grey-white colored. We don’t really know exactly when each of us received the oxygen deprivation that caused our CP and her deafness, but honestly, it could have been prenatal or after birth with our underdeveloped lungs. Either way, TTTS is nothing to joke about and at least now there are technologies that can save some babies.

  • Mel

    Nice job, Dr. Amy.