A: I invite you to read my three-part series, How I Got In, Why I Stayed, and How I Got Out. Your question is answered in the second section, but reading all three will give you the most thorough answer. This question is also addressed in my paper, which you can download here or read in a series of blog posts, starting here.
Q: This story is only about you, not about ALL midwives. Why do you assume that all midwives practice this way just because you did?
A: I did not practice in a vacuum. I was fully immersed in the culture of midwifery. I worked under, around, with, and over midwives for about ten years and in four different states. It wasn’t just my school, my colleagues, or my state, although it certainly was all of those. It’s a nationwide problem, and there are other countries (Australia comes to mind) that have similar issues. In future blog posts I plan to share stories from others, sent to me from across the country, that will help illustrate that these issues touch everyone who accesses the care of a CPM or LM. Here is one: A Doula’s “Thrilling” Home Birth Experience.
Q: So you’re telling me that you don’t know of ANY scrupulous midwives who tell their clients the truth?!?
A: Actually, there are a few out there who do! I plan to do some writing about questions to ask midwives, but I’ll throw out a couple of ideas: Ask her if giving birth at home is just as safe as giving birth in the hospital. If she answers yes, then she either is unfamiliar with the facts and mistakenly believes it is (likely!), or she is purposely lying to you. If she answers something like, “It is more dangerous for the baby. Giving birth in the hospital is, statistically speaking, more likely to result in a living, undamaged baby. I’m here to serve women who choose nonhospital birth even though they know that it is not as safe, and my ability to manage complications is very limited compared to what she would have access to in a hospital.” If she says anything like that, you’ve found a unicorn: a truly informed and honest midwife.
Q: Are you against all home birth?
A: No. I believe that a woman has the right to bodily autonomy and should be able to choose to give birth anywhere she wants. If a woman knows all the facts and still wants a home birth, I do not take issue with her choice. However, I am staunchly against her being lied to (by commission or omission!) in order to manipulate her decision-making. She needs to have true informed consent, something that midwives say that they support but almost never actually do.
Q: Why did you review only the studies that show home birth is dangerous? Why didn’t you review the studies that show it is safe?
A: I did not select the studies to review myself; I took them straight from MANA’s website. I reviewed the studies that the Midwives Alliance of North America deigned to designate as the best evidence that home birth is safe. Their “best evidence” falls apart when you actually read the studies, something that it took me years and years to get around to actually doing. For a walkthrough of every study that MANA claims is part of the best evidence, read High Risk: Truth, Lies, & Birth.
Q: I am a midwife and I know I’m safe because I keep very careful statistics on my births and I share them with all my clients! How dare you??
A: Statistics can be tricky. You need a bigger sample size than what can possibly be provided by any individual midwife in order to draw conclusions about safety. It is totally possible to attend hundreds of births without any brain damage or death occurring. (I did!) That doesn’t actually mean anything except that birth naturally turns out ok most of the time. It doesn’t mean that you are an exception to the statistical realities: when babies are born in nonhospital settings in the U.S., they are 2-10 times more likely to either die or suffer brain damage. There are complications which can arise quickly and unexpectedly no matter how low-risk you think a mother is, and which no midwife at home can ever hope to successfully manage to the degree that almost any modern hospital can.
Q: Don’t babies die in hospitals all the time?
A: No, full-term babies do not die preventable deaths in U.S. (or other developed nation) hospitals “all the time.” It very rarely happens. The perinatal (around the time of birth) death rate of babies born in nonhospital settings is much higher than for babies born in a hospital, even though their mothers are supposedly lower-risk. For more information, please read High Risk: Truth, Lies, & Birth.