Friday, April 17, 2009

From UC to a midwife

A blog reader, Emily, recently sent me this email in response to my post about not staying true to my word. I'm reposting it here with her permission. I agree with her about the need to move away from the nebulous slogan of "trusting birth" and towards "taking responsibility."

Thanks so much for writing a lot about your journey from a UC to a midwife. I also UCed my last baby, and am considering a midwife for the next, although I'm not pregnant yet. When I UCed it was definitely something I needed to do. I needed to step outside the system; to push all the boundaries, so I could know which boundaries I would like to set. Now that I've done that, I don't feel a need to do it again.

Also, having done a UC, I learned a few things: even though my husband and friends were prepared for the "what-ifs," I learned I'm not comfortable putting that pressure on them. If something were to go wrong, they had zero experience, and I'm not sure they were emotionally prepared for the fall-out in case something Really Bad were to happen. Not many people are. That's why only a few go on to be midwives/OBs, etc.

In addition to that, I found that the postpartum care offered by one of my friends was beyond valuable. If I hired someone to provide that for me, I wouldn't need to worry if my friend was unable to stay, or have to deal with her own little kids if she wanted to stay, but had to bring her little ones. And I would be guaranteed postpartum care. And the midwife would file all the paperwork for me. Not that I can't do those things myself--I already did. But honestly, it is just really really nice to have.

I find I am getting a lot of crap from my natural childbirth groups, because they all think I've become a "hypocrite" to the cause. That is completely ridiculous. It's not like I'm having a hospital birth with an epidural. It's still a HOME BIRTH! Same team! Same team! It is a symptom of a larger problem in the NCB crowd right now--the tendency to view UC as the ultimate goal; as the upper end of the NCB spectrum. But it's not. UC is not the epitome of NCB, it is the epitome of personality. UC is certainly not for everyone, and not even for every birth. It is not an indication of how much one "trusts birth."

In fact, I think we need to get rid of that phrase: "trust birth." Instead, we need to say "take responsibility." After all, if one is birthing outside the hospital at all, they must obviously trust that birth is inherently normal and safe. The point is not to have a competition over who "trusts birth" more--sort of like a game of chicken, birth-style. The point is to learn to take responsibility for your birthing choices, and decide how much responsibility one wants to have for the outcome.

I have been a subscriber to your blog for a long time now, I know you're pretty much facing the same kind of criticism. I just wanted to say I support you, and I am apparently in the same position. Good luck with your birth, and I am sure you will be happy with your experience.


  1. Wow! Great response! It's interesting that in your NCB circles UC is the 'epitome' of NCB. I don't know anyone who has UC'd and most of the NCB'ers I know gave birth at the hospital or GASP like me, at home with a midwife. Such different circles exist in different areas, huh?

  2. You know, I've been thinking a lot about the whole concept of "trusting birth" versus "taking responsibility" myself. I've come to the conclusion that while I trust birth, I also realize that there are times when things can go wrong, and for those times, I do like to have a trained professional at hand. I felt very much at peace knowing I had a midwife available who would be able to spot and handle complications. I think that when considering birth choices, taking responsibility for whatever choice you make is imperative. If that choice is UC, great, so long as there's a plan of action of how to handle the "what if's", if they do arise. If the choice is elective c/s, then the woman better be well informed of all that implies, as well. I personally find some of the reactions you've gotten pertaining to your birth choices rather disturbing. Doesn't the UC community place a lot of emphasis on trusting your instincts? Knowing your body? So if your instincts tell you that you need to have a professional at your birth, even if it's just in another room or something, how is that betraying your "true self"? Or your principles? It's not! You go, girl! Good luck with your upcoming birth! :o)

  3. I also perceive that "within the circle" there is some oneupsmanship when it comes to giving birth -- that those who UC are seen as having had the pinnacle experience, or *truly* "trust birth," and are in the upper echelons of the birth world, whereas those who have a hands-off midwife (preferably a lay midwife, or a certified midwife if necessary) are down a rung, and those who choose some CPMs or CNMs to attend their home birth are down another rung, and those who would like to give birth at home but just can't make that jump, so choose a low-intervention midwife or doc are down another rung, etc.

    I don't know why that should be, but it is, in far too many places. This could happen in a lot of different ways -- for example, people trying to be just a little more frugal or environmentally aware than the next person. It's only unhealthy when you look down on people as being somehow less than you simply because they make different choices from you.

    When I was pregnant this past time (2nd baby), I felt a strong pull towards non-intervention and UC. This "pull" wasn't from within, but because of the email groups I was on -- the ones that promoted not just home birth of any flavor, but they also specifically promoted UC as a peak experience. I felt almost like I was a sellout to want a midwife.

    Not that I think most of the contributors intended it that way, but that's the way I felt.

    Then I did end up not calling the mw in time, so had a UC, and would not want to repeat the experience. But I'm confident enough in my beliefs and experience and *myself* that I don't feel like I need to defend myself against the more vocal UCers. I merely give my experience, and they can take it or leave it as they choose. No big deal.


  4. Great post! I need to re-read it a couple of times and think about it... I was considering UCing for this birth (my 2nd homebirth) and in the end at my husbands request decided to seek a midwife. I really love my midwife but I do feel like in some eyes I'm "not as good" because I'm not going it alone/without a midwife.

    Anyway, I'm glad you posted that email. :)

  5. While I agree with most of the sentiment in the email, I really hate this line; "It's not like I'm having a hospital birth with an epidural. It's still a HOME BIRTH! Same team! Same team!"

    This type of judgment seems to be exactly what the writer dislikes about those who are critical about her choice of birth options.

    What I appreciate about you, Rixa, is that you are accepting of ALL types of birth choices as long as the women is presented with accurate information about her options and is allowed to choose what's best for herself and her baby. I don't get that impression with this e-mail.

  6. Anonymous - I do not support birth choices that are potentially harmful to the baby, and are without medical necessity. Does that mean I condemn women who choose to use an epidural? No, everyone has to make their own choices in life. But I do not support it.

    I don't ask people to support me in my choice to use a midwife either. I just ask not to be condemned.

  7. I do feel the same as Emily. I really can't say I accept or support all choices and that it's just a matter of a woman making an informed choice and that one is as good as another. I really do feel strongly that certain pathways are better than others in a general sense. Same how I think about the way we feed our babies--there is an ideal choice (exclusive breastfeeding) and not choosing that has certain consequences that you simply can't avoid. Not that women should be forced into anything--plus you can't force a woman to nurse her baby anyway--but that all choices are not equal. Anyway I really don't know what I'm saying at this point, just rambling a bit.

  8. I support almost all birth choices. It is not my birth. And I must take care of anyone who comes in the door. I don't pick and choose. Which means if you are stark raving crazy, I still have to help you through labor. So I am better off not being too attached to any one choice if I am going to be of any use to the public at large. That being said: Some things I simply cannot do if told they ARE harmful. It is a short list. But the list does exist.

    I really liked the post. The only person who has to live with your decisions is you. So make ones you are comfortable with and take responsibility for the decisions you make.

  9. I fail to understand how choice of birth attendant or not has become a contest.

    In the end I think it boils down to what makes you feel the most comfortable, and hence what sort of birthing environment would be most optimal for a healthy and spiritual birth.

    I've never met any UCers who had the "I'm on top of the birth hierarchy" attitude. I think most of us just choose it because there is very little other choice with respect to hiring a midwife. I think the truly hands off midwives are few and far in between.

    Then there are also the 4+ mamas who have just birthed so many babies that for them it is just no longer a big deal. I know of a mom of 10 whose labor lasts less than 2 I could see that for her, to hire a midwife, would be for the most part pointless and just interfering with her big family life.

  10. thank you for this discussion you've been having--it has been very valuable for me! and incredibly informative.
    I just wanted to add my 2 cents, that I'm a NCBer all the way, fully love home births, and support womens' right to choose place/attendant/etc. But I find interesting that you and the other UCers who I have heard comment on your blog desired privacy so much in labour. I really respect that! However for ME I didn't want to be alone at all. Ever. If it happened that I was alone, I couldn't relax. I guess it really is a personality thing, isn't it? I didn't want my support people to TALK, but I wanted them present :) Does that make me 'less' of a NCBer? Or 'less' committed? Totally not.
    Cool conversation, thank you for bringing it up on your blog. SO valuable!

  11. You know, come to think of it, most women WANT you in the room. I find it goes more smoothly if I sit in the room. Sometimes I don't do much talking at all. Some times we chat up a storm. Depends on what the Mother is doing. So if you don't want a Midwife you might want to have a doula. Someone who can just be present and help out.

  12. Well said. She really hit it, there. Birth is not a contest. What makes us amazing women isn't whether we uc or not. It's that we give birth!

    I've never seen uc as the epitome of birth, though. Honestly, ucers are the fringe of the fringe in the few circles I've run in. Most people, even those who are comfortable with homebirth, feel uc is a bit too "risky" and I've been told by many a homebirther that I'm "brave" for having done it. I've been told I'm "lucky" for my positive outcome, too. I think that if you are on a uc board you will find that some people definitely feel uc is the ultimate goal but I must agree that this is ridiculous.

    Trusting birth is something fundamental. And it's not birth itself you trust, it's yourself and your own ability. That's like saying I trust cars when I get in one. I don't trust the car, I am hoping against hope that the other drivers on the road are being trustworthy during the time I'm traveling. I have far more trust in my abilities to give birth than I do in people I've never met driving around several tons of machinery.

    I agree that it's more about taking responsibility. I also feel that it's about heeding our inner voice. Nobody should feel locked into a particular method of birthing based on how other people will perceive them. We should all be birthing according to how we feel led and according to how our responsibility leads us.

  13. I had a midwife for my homebirth and I really thought she would be WITH me, WITH woman. We failed to discuss exactly what that meant, but I wanted like what I saw in SPritual Midiwfery or photos online, I wanted her in my face, telling me youre ok, youre doing AMAZING, rubbing my back, reassuring me, offering suggestions, changes of position, drinks, "dont be afraid! WOmen have done this for millenia! you rock!"

    and instead I got (what felt like at the time) left alone, she sat out in the front room reading or something, light banter with my husband, me crying in the shower, hollering for a towel, puking in the fishy pool alone, finally my husband came and i whishpered "Where IS she?" and he was like "I dont know! I think shes trying to force us to do this as a couple!" and then I was like "Why did we pay 2000$ for a uc?" and it was awkward and I was sad and very very scared.

    At the end, I was like screaming her name for her to help me and she came and she helped me. We had a moderate shoulder dystocia and she had to really corkscrew under the armpit to get the baby out...the baby was white and floppy but she rubbed him and asked me to talk to him and tell him we needed him here and i was just so exhausted from the labor and trying to navigate around onto my bottom--i was on hands and knees on a bloody (slippery!) wood floor, cord dangling out of me, sore and very out of it, and i am being handed this baby who doesnt look well....

    He pinked up without formal resuscitation and she was VERY good about all the aftercare. Helping me up onto the couch, helping me deal with contraction pains from the placenta, and later, assessing me and the baby, cleaning the entire house, doing paperwork, even letting the delivery-food guy in and handling all that while i dozed.

    My story is to point out that hands on, hands off midwifery is VERY personal and you might not even know what you want until stuff happens. DISCUSS all of this with your people, every mama!

    It was very hard for me to know what I wanted until my time came. and no that wasnt my first baby.

  14. I think it really depends on the circles you're in.

    I had five natural childbirths, all in a hospital, all with minimal intervention. My 3rd was unassisted because no one, not even a nurse, was present when my son was born.

    However, I really have no one in my circle of friends and acquaintances -- and there are MANY -- who has walked the same road as me. I was thinking about it this morning, and in the last 15 years, I can count four women for a total of six babies, within my circle of friends, co-workers, church members, neighbors, and acquaintances who birthed with no medication. There was one birth center birth and one midwife-attended home birth in that group -- at least 200 women, by rough estimate, who I have known at least as well to know how she births. In my world, I have to be careful to whom I say that I've birthed without medication, because even that is seen as bragging, or "better birther than thou," or whatever, since in my circle, epidurals are the norm, and c-sections are common.

    My homebirthing friend chose a hospital birth after her home birth, and had an epidural. One friend, similar to me, has had two unmedicated hospital births. IOW, in my world, with maybe the exception of my acquaintance that had two birth center births, I am the most daring and persistent of natural birthers. Yet, according to the ladder mentioned above, I wouldn't even register, by many accounts, as a natural birther, because I gave birth in a hospital, attended (by three of the five) by a doctor.

    I LOVE your blog because you, Rixa, are really a sane voice in the world of natural birth. I have sent several people to this blog, who are investigating the idea of natural birth. You are clear in your stance, but not judgmental, nor unkind.

    Those within the relatively tiny world of UCers might view your choice to birth baby #2 with a midwife as apostasy to the UC cause. But, there are THOUSANDS, maybe MILLIONS of women who haven't even approached the success you've had with birthing, and for whom your experiences, as chronicled in your blog, can be an encouragement, and to spur them on to an, "I can do it!" attitude.

    It HIGHLY disturbs me that you're receiving flak from the most extreme of the UCing world, when, really, you're a light to so many women, just doing what you're doing.

    (My hubby and I are not planning any more children, but I can't see myself NOT involved in birth any more... I'm considering becoming at least a doula, or something to that effect, which is one reason why I find your blog so beneficial.)

  15. She's right. "Take responsibility" should be a the tag line :)

    I think it's interesting that you've both had UC's and you no longer feel the need to prove yourselves.

    I wonder if things would have been different had I been more set on a UC last time, rather than an NHS homebirth... I still feel that I need to prove myself in some way... I'd love to be able to trust a MW and know she was there purely for my and my childs' benefit, but it doesn't seem to be the way it works... I'm not the MWs boss for a start :)

    I'm glad you're following your promptings for this birth regardless of any outside influences. It takes a strong person to do that.

    Thanks for your blog and your thoughts. I always enjoy reading.

  16. Good for you for making the choice that's right for YOU!

  17. That is so perfect! Shifting the tag line from "trust birth" to "take responsibility." Ultimately that is what we do when we choose to birth outside the hospital. And like I said recently (don't remember if it was here or on Barb's blog), I DO trust birth. I trust that it is uncontrollable and has a mind of its own and can go rogue at any moment. For me to NOT hire a midwife would NOT be taking responsibility!

    It is foolish to just say, "trust birth!" and expect that all will be well. Utterly foolish. Yes, positive thinking goes a LONG way, but you need something more than just good vibes. So "taking responsibility" - whether that means educating and preparing yourself enough to have a UC, or hiring a midwife - is what needs to be done. Not just "trusting birth." Perfect.

  18. I think the slogan 'trust birth' has simply grown out of context in many circles. I think that 'trust birth' is said in the context of births being over medicalized, where attendants don't trust birth and birth is seen as a dangerous undertaking. When I hear 'trust birth', I simply take it to understand that, yes, we should have a lot more faith in it and no base our decisions on fear alone. A woman needs to take the exact same amount of responsibility whether her birth is at home or not. It is foolish to give oneself over to a doctor without doing your homework.

    To me, it has never meant that only if choose x, y and z, a woman trusts birth. Let alone UC being this ultimate goal of 'perfection'. Like you, I also don't approve of all choices though, so I find it hard to be totally open to all choices women make, but in the end we are all where we are.

    Having said this, I could never have made the decision to UC if I did not trust birth. There has to be a basic faith in one's knowledge and education about birth, as well as in our inner guidance and higher power to feel a certain level of comfort in doing it alone. But I don't understand how anyone can give birth in a hospital and not come to that same place of trusting the process. To face birth being scared to death and wanting someone else to take charge is just so foreign to me. I feel that where ever we give birth, we have to trust the process to some degree in order to have a smooth birth. It scares me when women go to the hospital to give birth with more faith in the medical system than in their own bodies. So yes, trust birth as opposed to trust non evidence based practices as in most hospitals.
    I guess I am saying take responsibility? LOL
    I don't know, rambling too, but I appreciate all these posts about this issue as well :)

  19. I am curious, who are these UCers who think they are the all mighty godesses of birth?

    I have never met a UCer so full of themselves.

    But so many others put down UCers as feeling superior, but I have yet to meet a UCer who feels superior to other birthing women.

  20. I think the ultimate example of "trusting birth" is knowing when an UC is NOT for you, even if it had been in the past. It's more important to trust yourself.
    There are so many 'less important' things in life that I trust an expert to do. No matter how much I can educate myself, I could never know as much as a professional birth attendant. Sure, I'm doing the birth myself, and I can still trust the natural process, but I can't trust that I'd know the right thing to do in ANY possible situation. No one should be critized for believing in themselves.

  21. I totally agree with the taking responsibility thought. That I think is the main reason I'm drawn to UC this time. I felt so deprived of responsibility for even the smallest parts of my pregnancy and birth with my two hospital births and contrasting them to my unassisted miscarriages were I made all decisions and took all responsibility and decided that is what I want for my next birth. I don't have the strength it seems drilled into my by my upbringing to stand up to my hcp and say "no, I won't do this test or that procedure." I cannot seem to stand up even to the most gentle and understanding of hcp.

  22. I have four children (2 hospital, 2 home w/ midwife), and only for my latest birth did I feel that I had "proven" myself. I finally came to a place where I trust the process, and did not fight against it. I can truly say that I had no fear during my most recent birth, but I fully embraced the labor and delivery.

    I had been drawn to UC, but DH wasn't ready, so I found midwives that agreed to remain as hands off as I needed them to. (As it turns out, they only arrived 3 minutes before he was born, so not much time to interfere anyway!) After this last time, I don't really feel the need to UC anymore. I admit that part of my drawing to UC was to "rise to the pinnacle of the birthing world", but most of all, I wanted to feel empowered that I could do this on my own. But the right midwives allowed me that empowerment anyway. I educated myself more about birth during this pregnancy than any other, and I learned what I want and what I don't want, and I learned to speak up about it.

    For those of you who have done UC and go on to use a midwife, I wonder if part of the reason you feel comfortable with this choice is because your one birth has given you the experience and confidence it took me four births to get.

  23. What a wonderful post. I, too, fully agree with the idea that the tagline should change from "trust birth" to "take responsibility" because that's truly what it's all about. I know women who have had C-sections who took as much responsibility for their births as those who had home births. I feel that I took more responsibility for my three last births (two in the hospital and one at home) than I did for my first home birth.

    I also agree that not everyone wants the same things in labor. I don't like being alone during it. I actually really liked the almost party atmosphere that I had in the last birth, and I loved that my kids were so involved, too. I am so glad my family was there and watching and being a part of it all, and I think it helped my boys take ownership for their sister. That may not work for everybody, but it certainly worked for us.

    I think that sometimes we need to ask others for advice less and listen to ourselves more. It's there in our cores that we'll find the intuition to do whatever it is we need to do, whether that is UC, a midwife-attended homebirth, or even going to the hospital for an epidural.

    Rixa, though I don't intend to have any more babies, I still appreciate everything you write about on your blog. You are so reasonable and level-headed, and that comes out in your writing.

  24. I'm always working with this little Zen Budhist quotation:

    "When I have nothing to prove, I have everything to discover."

    We all crave admiration from others but when it comes down to birth, it's important to do what your guts dictate.

  25. I think this is a great post in reference to this issue...

  26. It's interesting to me that I wrote so much of this same material last year...

    Birth is a journey "Into the Wild" and far too many young women are assuming that if something is "natural" it is "benign" as in, "harmless". Birth is not harmless. Birth is a part of nature and nature is unpredictable and beyond our control. Earlier today, we had an unexpectedly severe thunderstorm with heavy winds; our next door neighbor's roof is now resting on his front porch! Natural? Absolutely! Harmless, trustworthy,

    I served as a homebirth midwife for a long time. I saw a fair number of fairly straightforward, uncomplicated labors in women with absolutely no risk factors turn into very scary situations! Most births are uncomplicated but the fact remains that a fair number of motherbabies ( about 10% which seems about right from my experience ) will have issues requiring knowledge, awareness and skilled action. You are right, Rixa, to assume that it is too much to ask of an inexperienced person to assume the responsibility to know when something needs to be done and to then do it correctly. It took me several years of apprenticeship to develop the confidence and skill to assess and make decsions about the variety of complications that can occur during a "normal" birth. As a young woman starting out in apprenticeship, I was very sure that "birth was safe" and that I knew, from studying my textbooks and having been in Nursing school, that I would "know" what I was looking at, and what to do about it. The problem is, things aren't like they look in textbooks; often they present in highly individualized and unique ways that make one very uncertain until one has seen things over and over, and had their head, heart and hands on it often enough to be swift, and accurate in both assessment, decision making and implementation. It's not a game.....

    I have continued, since 1999, to offer my wholehearted assistance, help, encouragement and knowledge, to parents who are birthing unassisted--I've done childbirth education, labor checks when the parents were uncertain or struggling and then went home once they felt confident about continuing; lots of postpartum care afterwards, help with BC's etc. but I never hedge in telling them, up front, first call, that they can, they MIGHT, run up against something they just can't sort out and that seconds count and I tell them that they can call me 24/7 and shouldn't hesitate to reach out...I still get about 5-8 calls per year from UC families but increasingly, the women are argumentative and disbelieving when I tell them that there is a problem ( even a relatively minor issue that I am confident that they can resolve ) and will use up precious time and energy arguing with me about whether or not something could be "risky" if allowed to continue. I believe very strongly that the NCB community of which I am a part has misled women into believing that birth carries no risks, and that birth is a competitive and public vehicle for self-transformation rather than the "private, sexual event belonging to the woman and family" that we used to hold it to be. Women deserve better than what passes for "birth education" on the internet.


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