Not staying true to my word…whatever that means

In the past few days a reader posted the following comment:

why are you using a medwife? I was a little disappointed in you for not UCing, and now it's like wow you must not really stay true to your word.

She also emailed me this message:

Are CPM's illegal in your state if not why are you [not] using one? CNM's are really dangerous and I thought every unassisted birther knows this. They are more like medwives which to me would be way too scary. So why are you using one?

I would like to respond to these two comments. I am trying really hard to keep my tone restrained. Believe me, you don’t want to fall on the wrong side of someone who taught university-level rhetoric. So pardon me if I come off a bit strong at times.

Overall, these comments epitomize dogmatism and fanaticism at their worst—blind adherence to a belief system, inability to see beyond a narrow worldview, lack of experience with the messiness and subtleties of real life (or should I say real birth?), a black-and-white perspective in which choices are either absolutely Right or Wrong regardless of context, and gross generalizations.

Now, onto some particulars:

The “medwife” comments
Without having ever met the midwife I am seeing, the poster makes sweeping assumptions about her practice style and philosophy of care, simply because of the initials behind her name. I have worked with and know both direct-entry and nurse-midwives, and I have learned that you cannot assume anything about their style of practice from their educational background. To automatically label any CNM a “medwife” (a term used disparagingly to indicate a midwife who acts more like an OB than a midwife, in other words someone who is very medically/technocratically oriented) is not only insulting to the many CNMs who are very holistically minded, it also functions as a red herring, diverting attention away from important issues. We’re not going to move forward in our effort to improve birth culture and practices if we throw around pejorative terms like these.

For an interesting examination of the ideological conflicts (perceived or real) between DEMs and CNMs, I suggest reading Mainstreaming Midwives: The Politics of Change, edited by Robbie Davis-Floyd. It is true that there is, at times, an ideological divide between DEMs and CNMs. Davis-Floyd includes these two quotes in her introduction:

CNMs think DEMs have copped out, and DEMs think CNMs have sold out.
Joyce Roberts, President of the American College of Nurse-Midwives, 1999

One group needs to tighten up, and the other group needs to lighten up!
Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005

“I was a little disappointed in you for not UCing”
I’m always a bit surprised to hear people tell me this. These comments imply that other birth choices are somehow inferior, less worthy of admiration, or indicative of weakness or lack of principle. If anyone is going to be disappointed in my birth choices, it should be me and me alone. If having an unassisted birth is right for one birth but not for another, then why should anyone be disappointed? Is there some hidden contest I’m supposed to be participating in, some Uber-Alternative-Mama medal I’m supposed to be aiming towards?

Now, this doesn’t mean that I am abandoning unassisted birth in principle or even in practice. To be more precise, my seeing a midwife this pregnancy, or my having an unassisted birth last time, goes no further than myself and my own experiences. I don’t uphold any one path to giving birth as The Only Right Way To Have A Baby. I do believe strongly in undisturbed birth, in supporting and facilitating the physiological and hormonal process whenever possible, and in gentle and empowering births that bring health and healing to mothers and babies. So yes, I do think that our national cesarean rate is atrocious, that far too many mothers and babies come out wounded and shell-shocked from their births, and that we have a lot of changes to make in both hospital and home birth culture. But I don’t for a minute believe that UC is more “pure” than having a midwife, which in turn is supposedly “better” than a birth center, which is of course preferable to a CNM-attended hospital birth. And don’t even mention those awful OBs who just want to slice & dice women, who only care about getting home for dinner…

So let’s please get beyond these trite beliefs and assumptions. I understand why some readers might be curious about why I am seeing a midwife this time, and I am more than happy to enter into a dialogue about that. But I am surprised at the inference that my actions during this pregnancy constitute a betrayal (of what? I’m not sure) or that I am “not staying true to my word.” I never remember making a vow to have unassisted births for the rest of my reproductive life. (Now granted, if I felt it was right for each pregnancy, I would gladly do so!) Did I miss something here?

I will be honest and admit that I do have some trepidations about having a midwife present. I think with any birth choice there are unknowns that can bring worry or doubt. During Zari’s pregnancy, I had moments when I wondered if I was really making the right choice, wanting to be sure my personal preferences weren’t getting in the way of what was best for me and the baby. This time around, as I have mentioned in other blog posts, I have wondered how I will be able to balance my need for privacy and autonomy with my desire to have a midwife present for her emergency skills & knowledge. I don’t know if there’s ever a perfect balance to these sometimes conflicting, sometimes converging, needs. Last time, I knew clearly that I needed to do it alone. This time, I feel more strongly the need for additional options and resources, even as I wonder if or how the midwife's presence might alter my ability to labor. Still, I feel good about continuing along the path I have chosen. A lot depends on what happens as labor unfolds—will I call her early? late? will my birth unfold quickly enough that she arrives after the fact? I don’t know—I can only say that I will be closely following the intuitive and spiritual promptings that guided me strongly and clearly during Zari’s birth. If I do that, then there is no room for doubt.

To conclude this post, I wanted to include a recent comment from another reader, Irene, in the hopes that I have answered her questions and concerns adequately. She has identified the core tensions that I, and many other women, experience between privacy, autonomy, and security. After reading my post about working through some conflicted feelings, she wrote:

Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregnancy and birth are so personal and intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy…

For myself, the only reason I would want a midwife around would be for the afterbirth--in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definitely result in more complications. (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up Pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.

Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife; I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a midwife), I realized just what a tough position you are in. In a way I think you are looking for what we all want—privacy & autonomy, but a midwife would provide the added benefit of security. Ironically, a midwife would also take away some of the privacy and autonomy so really it is such a tough call.

I look forward to reading your birth story.