Contemporary midwifery is to a distressingly large extent about wresting back economic control of childbirth from obstetricians. Midwives have woven a convenient fantasy about how obstetricians “stole” childbirth (and the money it represents) from midwives. That fantasy rests on a profound unwillingness to acknowledge both historical and scientific fact.
It is a historical fact that modern midwifery was made possible by modern obstetrics, which has ushered in an age in which childbirth seems safe. Previously doctors were called to childbirth in only the most dire circumstances. With the switch to routine hospitalization for birth and the routine presence of obstetricians, and, in particular the easy access to pain relief, midwifery went into decline.
[pullquote align=”right” color=””]Women came to prefer obstetrician care because of its safety and increased comfort.[/pullquote]
Don’t get me wrong; obstetricians were only too happy to supplant midwives, but that isn’t the proximate cause for the decline in midwifery. It is a historical fact is that women came to prefer obstetrician care because of its safety and increased comfort.
So midwives have fought back by deriding both the safety and the comfort of obstetrician led hospital birth. In addition, midwives took careful note of what obstetricians offer and offer the exact opposite. The tragedy is that in doing so, they are startlingly willing to sacrifice the safety of babies and the comfort of women.
The midwifery plan to wrest childbirth back from obstetricians is predicated on the following:
If obstetricians medicalized childbirth to make it safer, then midwives would de-medicalize it to make it more enjoyable, and, for added impact, would declare that childbirth was safe before obstetricians got involved.
If obstetricians offered screening tests and measures to prevent complications, then midwives would insist that “trusting birth” was all that was needed.
If obstetricians offered pain relief, midwives would proclaim that feeling the pain improved the experience, tested one’s mettle and made childbirth safer.
If obstetricians whisked babies off to pediatricians to make sure that they were healthy, midwives would claim that skin to skin contact between mother and infant in the first moments after birth was crucial to creating a lifelong bond.
If obstetricians insisted that modern obstetrics was based on science, midwives would accuse them of ignoring science, and if that didn’t stick, they’d insist that scientific evidence was not the only form of knowledge.
If obstetricians placed the highest value on a healthy mother and a healthy baby, midwives would place the highest value on a fulfilling birth experience.
In contemporary midwifery, every day is Opposite Day.
No matter what obstetricians offer, midwives insist that it is unnecessary, disempowering, harmful and contradicted by the scientific evidence. Or as feminist theorists. Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction, describe contemporary midwifery:
…the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.
The ultimate irony is that midwives are engaged in psychological projection. They are doing just what they accuse obstetricians of having done. Midwives are trying to wrest childbirth back from obstetricians and give it to those to whom they believed it rightly belongs … midwives themselves.
Thank you for taking the time to publish, it’s unfortunate but the “natural birth propaganda” craze still seems to entertain a captive audience of uneducated and easily impressionable women. Your work is greatly appreciated, please never stop writing!
OT – I’m watching some episodes of Louie that DVRed recently, and there’s a bit where a Hip Manhattan Woman is bragging to her friends about her surrogate (standing right there) – “She’s going to have a natural birth, no drugs, and we’re going to the birth center in Brooklyn, the not certified at all, they’re totally committed to the natural process…” and some mumbling about Drugs and Vaccines as Louie walks away. It’s a perfect send-up, and now I’m hearing Brooke’s posts in her voice.
(She goes into labor in her apartment and Louie takes her to the hospital, and the Hip Woman shows up utterly furious that her Experience was ruined.)
I remember that episode! Lol
Well thank you this gave me a real chuckle. I’m not sure which is funnier, that once again you make assertions without providing any sources for your “historical facts” or that midwives are all about money while you foster hate and use click bait titles to get money in your own pocket from advertising and your book deal. I also find this pretty hilarious because most hosiptals make money off of natural birth too by offering lamaze classes, birth centers with nicer sheets and jacuzzi tubs than the standard L&D rooms, advertising themselves as baby or breastfeeding friendly. Most hospitals have adopted practices like rooming in, giving the baby to mom to hold immediately after birth, having lactation consultants on staff to help initiate breastfeeding for the first time. Most hospitals/OBs have stopped practices like giving women narcotics during labor and delivery, routine episiotomies, limiting who can attend the birth etc. If these practices that are encouraged by doulas and midwives are “bad” and the studies that show they are beneficial not valid, why are hospitals rushing to accommodate aspects of “natural birth”? I doubt physicians are being controlled by lowly uneducated midwives.
Consumer demand is the reason. And a lot of these practices don’t cost a ton of money. They fall into the “experience” category. So offering Lamaze classes, rooming in, jacuzzi tubs, breastfeeding support, rooms that look less like a hospital room, all of that is in response to consumer demand. Meaning, women started asking for them, so the hospitals started listening. And if it helps to attract women to give birth in a hospital setting, with medical assistance and support immediately available, then everybody wins. Nobody has said that an unmedicated, vaginal delivery, rooming in, immediate skin-to-skin contact and nearly mandatory breastfeeding initiation is bad. If it takes those things being an option in a hospital so that women will be more inclined to have their baby there, why not? It doesn’t cost a *ton* of money and if it helps women feel like they have more choices, then why not?
And midwives do not attend a woman for what they call prenatal care and attend a birth for free, do they? They have bills to pay, family to feed, those type of things that cost money. They also don’t have to pay malpractice insurance in case something goes wrong and they have a playbook on how to avoid paying damages if things go sideways. So, no, OB’s are not worried about midwives “stealing” money from their practice. If giving a little in things that don’t *really* matter helps women choose the hospital, why not? I believe OB’s don’t want women to give birth with a relatively uneducated CPM and the nightmare that that situation can create.
Doctors are not being controlled by midwives, but midwives peddling lies about what they can promise in terms of decent pre-natal care and testing and safe delivery practices can lead some women to wonder whether those basic services are a reasonable standard of care.
When a midwife tells a woman how to cheat on a gestational diabetes test, or to not bother with GBS testing, that midwife puts the mother and baby at risk. Mother isn’t to know that if she assumes there is a basic standard of care that medical professionals follow, and that a homebirth midwife is a medical professional.
And when a midwife claims that homebirth is as safe as hospital birth, she is either a liar or a fool, but the woman isn’t to know that either. After all, the midwife was so sweet, and that’s what’s important, right?
Doctors end up picking up the pieces in both cases, but hey, what’s a few dead babies?
But homebirth is safer, especially if you sip raspberry leaf tea, bounce on your birth ball, get on your hands and knees and chant “welcome earthsiiiiiiiiide”, MUCH safer than the “cascade of interventions” at the hospital where evil scalpel wielding surgeons perform unnecessary c-sections to make it to their golf games on time. I plan to deliver at home with my midwife, I’m 42 weeks with a breech baby, but this is just a variation of normal, my midwife dispelled all of the myths for me and I expect to have this baby any day now, just going to bounce on my birth ball and sip my tea, yep any day now.
Most hospitals/OBs have stopped practices like giving women narcotics
during labor and delivery, routine episiotomies, limiting who can attend
the birth etc.
Well…sort of. Most hospitals offer narcotics during labor, but most women opt for the easier, more effective, and lower side effect epidural (with or without narcotic medication in the epidural) rather than IV narcotics. But they are still offered as an option. Routine episiotomies were dropped due to lack of evidence that they were effective. While the NCB movement did spur investigation into this issue and deserves credit for that, it was the results of clinical trials than led to the change in policy. Also it should be noted that episiotomy does still have a place in obstetric care, just not as a routine measure. The issue of who can and cannot attend labor is, as far as I know, a policy change based on preference. I’m inclined to give the NCB movement at least partial credit for it as well, though I would note that it occurred in the social context of increased patient rights in general, including allowing relatives to stay with patients in more situations, i.e. rooming in with hospitalized patients, etc.
So I don’t have any problem with the idea that the NCB movement has had some good ideas and improved obstetric care in some ways. But it has a fatal flaw: Obstetric practice changes when the data show that current practice is suboptimal. Can you point to a situation in which CPM practice has changed after data from clinical trials or epidemiologic studies demonstrated that their current standard was suboptimal?
Brooke, you’re giving ME a real chuckle. If this was your first post here, what you wrote would make more sense. But it isn’t and you don’t.
No one is saying that all NCB practices/theories.what have you are bad. No one. No one is saying that the medical model is all good.
There are good & bad on both sides. And you know this.
You talk about hate? Some of your comments have been every bit as bad-if not worse-than the most cringe worthy comments I’ve read on this board.
If you want to affect change-if you want people to listen to what you are saying-if you want to be taken seriously-climb off your soapbox and listen and relate like a grownup. One who can take criticism. You don’t like how people talk to you on this board? Go away or suck it up and take it. Welcome to being a grown up.
But no, you’d rather type with your nose in the air and your superiority that everything you say is gospel truth.
And apparently you have quite a bit of time to do so. I wish I knew your secret.
Are there any home birth midwives in the USA who are required to carry liability insurance?
Colorado doesn’t require it, which gives DEMs an unfair market advantage over OBs/hospital care.
Yes, not many states require it. If you search “insurance” on this blog there is a relevant analysis.
“Are there any home birth midwives in the USA who are required to carry liability insurance?”
I believe it is required for CPM’s in Florida, that’s the only one I know off the top of my head….
Interesting to note that in my country midwives don’t have financial competition with OBs as both are working in hospital setting and their salary is not dependent on who delivers the baby (standard setting is that midwives handle low-risk deliveries but OBs oversight their shifts and take over if necessary). Exception is homebirth midwives but they are few and homebirths are not popular (not the least reason is that they’re expensive as opposed to hospital births which are basically for free). Nevertheless, there are cases again and again where midwives don’t call in OBs soon enough and are trying several interventions without success when CS would have been the fastest and safest mode of delivery (and often ii ends with emergency CS anyway, just with already damaged baby). I don’t know if it’s due their professional “pride” or due to overall lack of resources in hospitals (CS is expensive and government never allocates enough funds) but that’s something I was really afraid of when heading to hospital. Unfortunately it’s all anecdata because there is no reliable statistics about root causes of perinatal and maternal mortality, also if delivery ends badly then getting compensation takes years while case is dragged through courts (downside of government-funded healthcare where malpractice insurance is nonexistent).
I think a lot of factors come into play when the midwife makes or fails to make the decision to call the OB. There’s professional pride. There’s fear that the OB will yell at them or belittle them for calling them for something “trivial”*, especially if the hospital is understaffed and the OBs very busy. There is probably pressure from the administration to limit the number of calls to OB and/or number of c-sections. So they probably sometimes try things in the hope that those things will work and they can avoid the whole issue. This approach likely works often enough to make it seem reasonable to try it.
*One of the lessons which is hardest for fellows in internal medicine subspecialties to learn, IMHO, is that you NEVER belittle someone for consulting you. First off, it’s rude. Second, it’s bad for business. Third and most importantly, it’s very bad for patient care. Who cares how easy you think the question is: if the person consulting you doesn’t know or is uncertain then it’s a necessary consult. But that’s a hard lesson to hear when you’re the overworked fellow getting asked questions like “should I stop iron infusions on the dialysis patient whose ferritin is 5000?” or “is it ok to stop the heparin with an INR of 1.9?”**
**The answer is almost certainly “yes” to both, but there are enough potential issues to make me say the real right answer is “it depends…let me check the patient out”.
Back when I was working as a medical registrar, I developed a personal rule that I would never refuse to see a referral, no matter how ridiculous it sounded. I realised that I couldn’t always trust the information that I was given over the phone, and it was much safer to go see the patient, even if it meant unnecessary work for me.
God knows our memories are fuzzy enough when trying to explain things, expecially if the patient is the one making the call.
You know who midwives do NOT remind me of, with their “All doctors we can do, we can do as well and just as well?” An exchange I recently had with my confectioner friend. She wanted to give me the recipe of that butter cake *drooling*. And I said, “No, no, I give you the money and you make me the cake! You know I can’t do it as well as you can.” She’s like, “Well, it’s just a recipe…” And I’m like, “Well, here’s a dictionary and here’s a book. No need of me, you can read it on your own!” It’s been tried. I make a cake using a recipe and she makes one using the same. The results are vastly different. But hey, it’s just a recipe! I give her the money and she makes me the cake, just like in the confectionery! The difference is, she actually makes many of the cakes there and is a pro.
I guess we could say, “Hey, it’s just a vacuum!” In fact, we had a poster who fawned over midwives being able to (illegally) work with vacuum and such. I’m holding my breath. Soon, there will be those who claim, “Hey, it’s just a c-section! If a doctor can do it, so can I!”
Wish I were kidding.
You’re absolutely right. I remember when I was in high school and wanted to learn many of my Italian-French Nana’s recipes. I begged her to write them down for me, but she insisted that the only way for me to learn was to come over to her house and cook WITH her. Now that I’ve become a skilled cook myself, I find myself saying the exact same thing to friends who want one of my recipes.
I just had this discussion with MrC about baking. He spotted me posting my browning recipe the other day and snagged it. I kind of looked at him and said “maybe you should try something involving chocolate that’s not quite so picky first”. He scoffed at me. Now to be fair, he’s not an unskilled cook/baker, but as the cheesecake episode* earlier this month shows, there are some things that just aren’t written in the directions. You have to learn by doing, either figuring it out yourself when something bombs, or having somebody more experienced show you what to do.
*I locked myself in our bedroom while he made a cheesecake by himself. It was tasty, even if it was a little mushy and lumpy. Not bad for a first try.
I tend to start with a recipe then start changing it to suit my tastes so that in the end I get something rather different from the written down recipe. Then I try to explain what I did to people who want to replicate it and end up saying things like, “add water until the dough looks right” or “the dough should glob off the spoon at this point”. I like to think that, in general, I can be fairly articulate, at least in writing, but one thing I am just crap at is describing physical skills in words.
I am famous for being able to foul up ANY recipe, no matter how easy. Seriously. Even those cookie mixes that come in a package. I will invariably do something a little bit wrong, like not warming up the oven, not measuring something *quite* right, spilling a little extra of something crucial into the mix, not knowing enough to chill something before use…
AAAARG I’m getting stressed out just writing this. I hate cooking. Let’s just get take-out.
You should see my boyfriend trying to make those cookie mixes.
He thought softened butter meant melted butter. So it messed up the consistency of the dough
Then he randomly decided that the best solution to his problem was to add water to the mix to soften it.
Obviously he added too much of it and ended up with super liquid cookie dough that wouldn’t stay cookie shaped.
So he decided to instead do just fill the whole cookie pan and do one giant cookie.
And then he burned it…
I wish I was kidding. Obviously he’s an engineer.
I’m planning to have babies with this man…
Not a chemical engineer, I hope. Cooking is essentially applied chemistry.
Nah, he’s a civil engineer.
He did have to take a few chemistry classes. But now that you make me think about it, I was the one in our team making most of the manipulations while he wrote the report. he wan’t any better at ‘cooking’ back then.
I’ve been following a user board of homebirth midwifery students. Recently a student was dreaming aloud about her ideal practice, and doing some calculations about costs….and she dropped the little factoid that in Miami midwives charge $5000+ for pregnancy and birth. Holy Crap! Seriously? Our posted fee is $2600 but we contract for much less. Medicaid pays us money-grubbing OBs about $1300 here. In my previous state it was $900. Exactly WHO is trying to wring money out of pregnancy?
You can’t see that many patients when you have to spend days at a time in their home waiting for delivery (even if you can get a lot of knitting done) and hold hour-long prenatal visits.
What? You barely make more than the fee a home birth midwife charges to stay with a woman during a hospital transfer.
That is crazy. I spent $4000 out of pocket for my last two because of my higher deductibles but at least I am able to do a payment plan before and after I deliver. Seriously, I know they used way more materials and staffing for that amount of money than the midwives do. Plus, they are willing to work with me if we hit a snag in our financial plan and that is not bartering to build a barn for someone.
I had to add this, because you mentioned bartering. There is a midwife who accepts things in trade. This is CPM Tarah, of Foothills Midwifery “As mentioned, sometimes trading services or items is just as valuable to me as cash. If you cannot afford midwifery care but you have a service to offer, please feel free to reach out to me and see if it’s something that my family could use!
We are nearly always willing to trade for (equivalent monetary value of a full midwifery package):
Firewood
Gas for our cars
Organic food/produce
Organic meat
Medical Supplies
Currently willing to trade:
Landscaping
Home window replacement
Tree trimmings
General help with clinic renovations”
Keep in mind that she has GoFundMe sites both for renovating an old house to be a birth center and another because the tools and things that she bought with the first campaign were stolen. Wonder how much landscaping someone would have to do to equal her fee?
I remember someone writing about it in another post.
And they have professional standards and insurance, so if things don’t go so well there will be lessons learnt in a professional sense and a pool of money to help out.
Florida opted out of Medicaid expansion. For an uninsured woman who can’t get Pregnancy Medicaid, $5,000 out of pocket for an uncomplicated vaginal childbirth is conceal compared to a hospital birth.
It really pissed me off that states were allowed to opt out.
The irony of it is, opting out is a terrible fiscal decision. The states that opted in saved, literally, billions on health care. The states that opted out…didn’t. So the only reason to opt out is to screw poor people and/or Obama over. The Republicans in the US used to be thought of as the hard headed party, but that characterization appears to be out of date. If it ever was correct.
This is the reason why the Repubs opted out:
“Any health care funding plan that is just, equitable, civilized and humane must – must – redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition re-distributional.”
Said by Don Berwick, former head of CMS and the architect of Obamacare.
Sounds pretty hard headed to me.
My state did too. Now we have more uninsured people than we did before. “Thanks,” Governor LePage.
I’d probably have insurance now if my state hadn’t opted out.
The bonding thing is silly. Kids who *need* to be whisked off generally do just fine emotionally. MIL was herself a very early survivor of cancer in infancy and in tween years. Her sons were whisked away for a bit because of meconium (both 42 weekers at least.) She bonded as well with her abusive parents as possible and has good bonds with 3 generations of Demodocus males and me.
She’s also hoping for a girl this time; we are seriously outnumbered. Even the dog is male.
I know how you feel about being outnumbered. I’m the only female in the house, and that includes both birds. MrC says it’s sometimes a nice change. He had only sisters, then had twin daughters. They are only nine years younger than me, and are out of the house so they don’t count in the household population.
Another n=3 observation: I have a good, close relationship with all my boys, but the one who’s the real mama’s boy is the one who was whisked away and spent 6 months in NICU. The other two weren’t whisked away quite as fast and had significantly shorter NICU stays.
My boys were immediately gathered up by the pediatrician/nurses at birth, because they were preterm. I fully expected that and felt reassured that doctors were right there in case they were needed. Neither boy had any issues, and my husband was with them the entire time, so though they weren’t “skin to skin” or whatever, he was touching them. No one ever suggested that the babies and I couldn’t bond because I didn’t hold them for a couple hours—good thing, because that’s totally shenanigans.
My mom thinks that the fact that the midwives didn’t come when she – and the women next room who heard her – tried to call them over is criminal. Lucky for them, 1986 and Eastern Europe were so not the time and place women complained and the system tried to do something about providers who just left new mothers to bleed almost to death (she was discovered a few minutes later by a cleaning woman. She was already unconscious at that time.). She also thinks it was inhumane that they had gotten rid of the well baby nursery by then. She actually felt relieved when the nurse took the baby because she realized my mom couldn’t hold herself seated, let alone hold the biggest baby in the unit (at the time, a 10-pounder was a celebrity and not like the “meh, what’s so big about him? Your body knows how to birth him if it knew how to conceive him” crap.) She actually wanted the baby safely away because she was a danger. Poor woman didn’t know she was dooming both of them to a bondless future.
I am born in Soviet hospital in the beginning of 1980s, and standard practice there was to whisk away babies and give them to mothers only for feedings. Mandatory rooming in is absurd if mother wants/needs to rest, but this was too far in opposite direction. Nevertheless, mothers managed to bond with their babies just fine, even if their birthing experience was something truly close to “birth rape” (seriously, I recently read some stories from women who experienced the standard “care” in Soviet era birthing hospitals – meaning, they didn’t bribe doctor and didn’t have any acquaintances in hospital staff who could guard them – and it was full of intentional cruelty and humiliation). Some probably didn’t but that had more to do with nonexistent psychological care and support for new mothers, not with the fact that they didn’t have immediate skin-to-skin contact.
I was born in 1981 and at the time, the well baby nursery was a fact (that you could not escape, that’s quite right), so it was quite the nasty surprise the second time around. As my mom says, now she wonders WHY she was surprised when the things had been going pear-shaped since that moment she was informed that she could not have an ultrasound because the apparatus was broken. Next question? “Do you know the head of the unit?” My mom, “Why, would that have repaired the apparatus?” Finally, a retired midwife relative of a friend came over with her ancient “wooden spoon” and announced, “It’s a boy.” My mom, “Just one?!” Because at the time twins was a very viable possibility if her size was to be considered. Yup, just one. An elephant baby but one nonetheless. Just too big to be born naturally to a mother who would have lived naturally. So, three cheers for hospitals, I say, even if their staff included some atrocitous human beings. I’m pleased to still have a mom.
That’s horrific. Is the situation in Russia any better today?
It was not in Russia but in other country incorporated in USSR. Situation is definitely better, though sometimes you can run into health care providers who still have attitude like that, also the bribery system still exists somewhere (i.e. you have to put an envelope with money in nurse’s or doctor’s pocket to get appropriate care).
Yup. The bonding thing is horse crap. Bonding happens over time. It’s not something that happens because of one moment. It happens because of a whole bunch of moments add up. And all my kiddos were preterm, which is why they were whisked away. Not only did we not suffer from any laconic bonding, but we are close enough now that they are teenagers they they drag their friends to me when their friends are having issues. I’ve had enough teenage houseguests that I joke around that I’m running crash pad for wayward teens.
On the note of instantaneous bonding being crap and bonding actually happening over time – I honestly don’t think I “bonded” with my kid until he started going to daycare at 8 months. Suddenly time with him became special and something to look forward to, rather than a chore.
Of course, he was born by C-section and spent his newborn skin-to-skin time with his dad instead of me, so obviously our relationship was hopeless from the beginning.
“we are close enough now that they are teenagers they they drag their friends to me when their friends are having issues.
OT, but thanks for being one of “those” moms – as someone who had a horrible home life, having other “moms” to turn to was invaluable as a teenager.
It is indeed silly. Adopted children bond with their parents just fine, and not all adoptive parents are present at the birth. Bonding involves multiple factors, not just skin-to-skin contact.
Dad and Aunt Cindy bonded pretty well despite being adopted. Since Dad was born on another continent, i’m pretty sure it was a few days at least before Grandpa got to hold him. Plus, the grands were born more than 100 years ago so I’m pretty sure skin-to-skin didn’t happen in their house
I think the biggest factor is care. My daughter’s favourite teacher at day-care is the one who cleaned them both up after my daughter threw up. LO was only 2 1/2 and having a rough time the first week. The teacher took care of her and comforted her: bond created.
Two of my cousins were adopted from foster care. One was placed at 3 days old, the second at 6 months old. The six-month-old cried nonstop for the first few days, then seemed to settle in. She’s now a small, feisty 8-year-old who loves her Mom and sister (but not the cat).
I had to wait 12 hours to hold my son and 12 days to hold my daughter. I didn’t breastfeed. We managed to bond just fine.
It helps to know the right terminology as used in the field of child development:
“Bonding” is what parents do around the time of birth when they fall in love with the infant.
“Attachment” is what the child does, but it doesn’t start happening until around 6 to 8 months of age.
It’s the crazy lactivists and attachment parenting people who promote the myth that the newborn can form an emotional attachment to mother at birth or in utero.
I didn’t fall in love with him for several weeks.
That’s around the time of birth. Not unusual.