Friday, December 21, 2007

Q&A with Carla Hartley

Carla Hartley, founder and director of the Ancient Art Midwifery Institute, gave me permission to repost this recent email correspondence.


Dear Carla,

I am really confused by the unassisted birth movement within your midwifery study course. Why do we study all of this stuff to be educated midwives and right along side of this tell moms to just trust birth and have no one there?

Thanks for any time you can take to answer this for me.

Here is where I am coming from:

A: My course is really really really hard. It is comprehensive because I want midwives to KNOW more, so they are comfortable doing less. I saw a lot of midwives meddling with birth because many of them did not know enough to recognize variations of normal. Their education was based on EXPERIENCE only. Now in my grandmother’s day, experience was enough because it was NOT fear-laden. Birth was, as Sheila Kitzinger says, domestic, part of life. The experience of most of the midwives I had any contact with in my early days was based on fear. They did not start going to births because they believed in birth, so much as they wanted to help women avoid the hospital. Yet their lack of knowledge and trust of the birthing process meant that a LOT of women who started out at home ended up in the hospital anyway.

I recognized early on that because I had studied sooooooooooo much before I started apprenticing, things that panicked experienced midwives did not at all panic me. I understood the physiology. I knew that there were many possible birth scenarios that were NORMAL. I also saw that clients almost always depended on the midwife's knowledge and trusted her opinion on almost everything. That made me uncomfortable. One of the things that I believe people gain having a home birth is a sense of their own ability to make decisions about their children. If we as midwives don’t leave families CHANGED then I think we have missed a great opportunity to affect society in a very positive way. MUCH of what my students do is client education and the constant reminder that parents are their own authorities and the rest of us (doctors, midwives, doulas, childbirth educators) are merely paid consultants. Once that resonates with a couple, and they accept the responsibility that comes with authority, they change. They believe in their ability to make good decisions. That is HUGE!

B. I trust birth. Birth is inherently safe. Messing with it in any way compromises safety. It is an innate biological capability for most women to grow a baby and then EJECT a baby with no help from anyone. Midwives are NOT the guardians of normal birth. Birth is normal with or without midwives. But what midwives should be doing is acting as the guardian of the mother and baby's space, so they can do what they were made to do. Most women want that--but some don't. They just want to be in their own little world with no intrusion. That doesn't mean that birth is any less safe.

Midwives know a lot of things that can go wrong. That is why I think we do have to study and prepare to an extreme degree. We have to be sure that we don't CAUSE anything to go wrong. I think much of what we do has the potential to cause problems. I don't have time today to list those but they start with what we say, our own body language, what we wear (I hate scrubs in a home birth) and the things we think we have to measure, poke and prod.

Have you read my blog and the site? I trust birth—not birth attendants—for if you only trust birth that is attended then you really don't trust birth at all. You trust the attendant. And then you start over. Who? Doctor, surgeon, CNM, CPM, SIM*? And it goes on and on....NO, the truth is that women and their babies are quite capable for the most part to do it without anyone. Most women who chose home birth want a midwife and my goal is to help there be MORE midwives for them to choose from and midwives who are truly WITH WOMAN midwives and not birth managers.

I don't want to insult you in any way and I am glad to have the opportunity to help you understand what seems to many a real mystery but look at what you said in your post to me:

"Why do we study all of this stuff to be educated midwives and right along side of this tell moms to just trust birth and have no one there?"

Doesn't that sound a LOT like what docs believe about birth? Doctors don't own birth. Midwives don't own birth. Just because you study and sacrifice and put yourself in debt to become a midwife or doctor does not mean you own a woman's experience. It also does not mean that you are necessary. (OUCH!) Women and babies know how, if we will step back and let them. And we understand that our job is to serve them.

And I don't like the word "support" here because she is not a table we are holding up. I like "SERVE" because I think that is what midwives—well, everyone involved in birth—should be doing. SERVING.

In that framework—servant, consultant—it is quite possible to be a midwife who trusts birth and trust the woman and her baby. It is possible to be a midwife whose client calls AFTER the birth and says it just never occurred to me to call you, that the midwife would not be offended.

My very first official paying clients decided a couple months before the birth that they were going to DIY, as we called it back then, because I was uncomfortable about something I thought might present a problem. I was a rookie and was ultra cautious. Not afraid; I just wanted them to know that there could be a problem. After talking about it for a while they came to see me and said, “Carla, we are going to let you off the hook. We know you are concerned, but we really are not. So we are not going to call you when labor starts.” I cried. They said, “Oh no, don't be sad. You helped us realize that birth is safe and that few things go wrong if you don't mess with. You encouraged us to listen to our own instincts about birth and we know everything is going to be fine.. But YOU don't. And we understand that and we don't want to put you in a position of being concerned. We will call you when the baby is born and you can come see for yourself that we were right!!!!”

I quickly corrected them that my tears were not of rejection but absolute humble appreciation for what they were telling me. Just because I did not go to the birth (I went a few hours after) did not mean I did not serve them well as their midwife. I did not have to be the one to catch the baby. I did not have to watch or guard a perineum in order for her to have a baby without tearing. I helped them believe in themselves and THEIR ability to parent this child before, during and after birth. I did good! In my dictionary, I WAS their midwife.

If this doesn't answer your questions, please, please feel free to write again or call me. I am honored that you asked, actually. I do not see my job helping women become midwives and also supporting women who want to have their babies alone as a contradiction in any way because of what I believe that midwifery should be in the first place.

Carla Hartley

*SIM (Self-Identified Midwife) is a term used (often derogatorily) to describe midwives who choose not to become certified through a professional organization.


  1. Thank you for this, I wish there were more midwives like you- I am gave birth unassisted 4 months ago, and am in the process of starting midwifery training and I have faced a bit more opposition than I am comfortable with... anyway this was an interesting read for me. Thanks again!

  2. This is a great explanation of birth. Thank you for posting this.

  3. As usual, Carla nails it. I so needed to read this right now, thank you for posting it.


  4. HI Rixa: Kneelingwoman here. I love this! Carla Hartley's work/program have been an amazing support for me, and for many, through the years! I loved it when she started the Trust Birth Initiative and it's been truly helpful for me in articulating ( although I don't think I did the best job of it of late ) my position on UC--that while I have concerns about it's effect on midwifery/homebirth long term; I continue to provide support, education, help, encouragement, to UC couples because I am a "birth servant" not a "health care provider" or interested in being anyone's "bottom line". I want to see more women and families really take responsbility for their birth and life choices and this is an essential part of the conversation. Thank you for printing this!

  5. rixa, i love this, thank you for sharing it. it sums up a lot for me right now. have you heard of The Matrona?


  6. beautiful.
    what every woman deserves.
    thank you, Carla.
    thank you, Rixa.

  7. I haven't heard of The Matrona--care to fill me in?

  8. In a culture with a 30% cesarean rate, the fear around birth escalates exponentially. What Carla opens up with this letter is the radical idea that bringing more fear into a home birth is counter productive. Not only are many midwives trained deeply in fearful beliefs, but they belong to organizations that will punish them severely if they ever make a mistake. That adds to the fear ball they bring to every birth.
    We could ask these questions of ourselves: "Will I be supportive of a midwife who has made a mistake?" "Will I judge and condemn if a baby dies at a homebirth?" "Will I support the m.w. who is a hero when she's there for a woman @ 44 weeks gest age when things go well, but is considered a devil if the baby dies?"

    These are the underpinnings of the fear. Fear of rejection of society. Fear of the magnitude of grief. Fear of the power of the doctors, insurance people, etc. Fear of losing everything you have worked for. It's no wonder to me that so few midwives trust birth when they've seen the tide that turns against a mw in trouble. Despite all that, some mws do serve simply. That's a miracle. Gloria

  9. Thankful to have come across this post while searching Carla Hartley. Does anyone know what she's up to lately? Is she still hostessing her birth conference? Hope I haven't missed one in Atlanta!


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