Why I’m Guilty

None of my births ever really ended badly. There were some complications, of course. A heaping handful of c-sections, a few severe tears. A couple of babies who needed brief hospitalization. But when it was all said and done, I could always rest secure in the knowledge that everyone was alive and no one was permanently damaged. Yet, I do feel some serious guilt about one thing in particular.

When we opened the birth center, we were jumping on a trend. Ricki Lake’s documentary The Business of Being Born had come out the previous year, and interest in nonhospital birth was on the upswing. The concept behind the birth center was that everything about it should look professional and polished. We intended for couples to feel as if having their baby at our birth center was only one tiny step, safety-wise, away from giving birth in a hospital.

75% of our clientele came from North Carolina, where a home birth would have been illegal for a midwife to attend. Would these same couples have sought out an illegal midwife to have a home birth? Probably not. Our siren’s song from a mile over the border was that of legitimacy: we are legal, we are licensed by the state, we can accept your insurance, we are dressed business-casual and have short, clean fingernails. Come for a free tour, stay for the free classes.

The problem is that it was all part of a ploy to trick people who would have had hospital births into having birth center births without giving them full informed consent.

Neither our sales pitch nor our informed consent forms spoke of the increased risk to babies that every study of nonhospital birth in the U.S. indicates. Many of the couples who came to us likely did not realize that there was no substantive difference between the birth center and a home.  Did any of them choose us with full knowledge that using our facility was statistically riskier than going to the hospital? I would guess not. I think almost everyone felt they were safer with us. They read books that told them so. They heard it from moms at local breastfeeding support meetings or at the farmer’s market. They saw it on The Business of Being Born. They read it on multiple websites and heard it echoed again and again in childbirth class, in blogs, even in newspaper editorials.

But it wasn’t true.

People who picked the birth center, like most people who choose home birth, believed that nonhospital birth was “at least as safe” as giving birth in the hospital. We went to great lengths to keep up that appearance. When the department of health tried to make midwives insert language into our informed consent forms about the “risks of midwifery care,” I remember one of my partners indignantly claiming that midwifery care didn’t have risks. It only had benefits.

Here is an excerpt from my original Informed Consent form. I think it illustrates how we created the illusion of informed consent while still sugarcoating the facts. We told the technical truth, but in a manipulative way:

Childbearing is a normal human function. However, unpredictable medical problems may arise during pregnancy or childbirth. Because some of these problems may place my child or myself at risk, transfer to a physician or hospital may be necessary. Delay in treatment may increase the degree of complication(s). Conditions listed that may be life threatening and/or require transfer to a hospital include but are not limited to: symptoms of fetal distress, severe tears of the perineal area, excessive blood loss, seizures, abruption of the placenta, prolapsed cord, or uterine rupture. 

I am also aware of the benefits of natural childbirth relating to avoidance of potential injury resulting from invasive procedures, anesthesia, or surgical intervention.

Here is an excerpt from the last Informed Consent document I ever made. It was part of my attempt to practice with true honesty:

Birth is an intrinsically risky event for both mother and baby. [Midwife] has made no claims or assurances to the contrary.  
[Midwife] has informed me that a hospital is the safest place for my baby and me during labor, birth, and immediate postpartum.  
[Midwife] has informed me of the statistical risks of giving birth at home based on her understanding and research. I have been informed that the chances of death or significant injury to myself and/or to my baby are at least four times higher than the chances of death or significant injury within a hospital setting.
[Midwife] has in no way attempted to persuade me to give birth at home, nor has she made any assurances as to the safety or advisability of giving birth at home.

In the end, I found it wasn’t possible for me to really be a safe midwife. Even with everything I knew, I still had the instinct to let worrisome signs or symptoms slip by in order to please my clients. I still wanted my clients to like me more than I wanted to keep them totally safe. I wanted them to have a beautiful birth even if it meant taking a foolish chance. And that wasn’t fair to them, and it was going to hurt someone.

I’m glad that I got out before I directly caused any family permanent, severe damage. I just wish that I’d never helped construct and maintain the beautiful lie that ended up doing exactly that when I wasn’t there.