Midwives Keep Birth Wild and Sacred
by Mary Lou Singleton
The phone rings. My three-year-old son sleeps snug and naked between myself and his daddy. I look at the clock (2:17 a.m.) as I stagger out of bed to answer the phone.
It's Kelly*, my teenage client, calling. Her water just broke and she sounds scared. I tell her how wonderful it is that her water has broken. This is what she wants, I remind her: to have her baby. I ask her the usual questions and determine that she and her baby are well. The baby is kicking right now, she tells me. We both stop talking to breathe through a contraction.
We decide that Kelly will take a warm bath, drink some tea, and try to relax. She will call me when the contractions are four to five minutes apart.
I take the phone with me and go lie down in my son's unoccupied bed. I'm dreaming when the phone rings again. 4:10 a.m. It's Kelly's partner, Brett, telling me the contractions are stronger, closer together. Could I come? Now. Please? I tell him I am on my way.
I brush my teeth and hair, pull on clothes, leave my husband a love note, and I'm off. Driving, I ground and center. I pray to Hecate to bless Kelly and to inspire me to serve her in the best way possible.
I arrive at Kelly's house and gather my equipment. When I walk through the door, I sense fear. Kelly is in the midst of a contraction. Pink mucous and fluid trickle down her legs. She makes a loud, high-pitched noise. The contraction ends and I walk over to hug Kelly. "What a beautiful job you're doing," I tell her as I rub her shoulders and let her weight fall onto mine. I think back to my own births and remember the relief I felt when my midwives arrived. I remember relaxing into the knowledge that they could hold the tension while I focused on birthing. I am honored that Kelly allows me to hold this space for her as I feel some of the stress and fear fade from her body.
I listen to the baby's heartbeat, which sounds strong and steady. I give Kelly sips of juice. Her contractions come every three minutes and last more than one minute each. She relaxes well between them but still fights during the pain. I encourage her to make her voice low during the contractions, to vocalize from a place deep within herself. "Let your voice merge with the pain. Let the baby move through you. Let yourself open," I tell her.
The sun rises. Brett goes to fill the birth tub. Kelly and I walk and breathe. We dance and breathe. I sing, Kelly moans, and we breathe. Kelly moves through fear, through frustration, through tears. The pain is bigger than anything she could have imagined. "I can't do it," she says. "You are doing it," I say.
Kelly has reached her max. She's done, she says. She doesn't want to do this anymore. The pain is too much. She can't handle one more contraction. And just as she finishes telling me that she wants out, the next contraction brings the urge to bear down. It's time to push. Hope fills the room that only moments ago was soaked in Kelly's despair.
Kelly moves to the birth tub (an inflatable kiddie pool filled with hot water). I call Julia, my midwifery partner, and ask her to join me at this birth. I set up my equipment and return to Kelly's side. She pushes beautifully. She pushes so hard she vomits. "Good," I tell her. "That's good."
She pushes and a small flower of blood blooms in the water between her legs. I nod my head and smile.
Julia walks in, kisses Kelly gently on the forehead, and sits quietly beside the tub. She takes over the job of listening to the baby's heart rate. We can see a bit of the baby's head with the next push. Ten pushes later, Kelly is crowning. Her eyes are wild. "It burns," she screams. Julia takes Kelly's hands and directs them to her yoni, which bulges hugely with the baby's head. Kelly instantly relaxes and smiles. She shifts from trying to escape to committing to move through this experience. "Ease your baby's head out," I say. "Easy."
Six minutes later the baby's head slides gently into Kelly's hands. I carefully reach into Kelly's body to feel for a cord around the baby's neck. Finding none, I sit back and breathe and smile. The room pulses as we wait for the next contraction. After a very long two minutes, the expulsive life force surges again and Kelly releases her baby into her waiting hands and the hands of her partner. She instinctively pulls the baby out of the water and onto her chest.
Julia and I are quiet and very alert. I feel the baby's umbilical cord, which pulses strongly. Julia gently lays a hand on the baby and feels the chest expanding. This baby doesn't need to cry to breathe. Everyone else in the room, however, does cry. Through tears, I watch the baby's womb-blue color fade to pink. The baby is between the worlds: still genderless, breathing air and being fed by the placenta. The new parents are ecstatic, falling fast and hard in love with their baby.
Kelly glows with her own power. She has been transformed from maiden into mother and there is no going back.
Kelly is lucky. She lives in a state where midwifery is licensed and accessible. New Mexico's Medicaid program paid for her homebirth. Most women in the United States are less fortunate. The freedom to choose where and with whom to give birth is a rare privilege. Medicaid covers out-of-hospital birth in only three states, and women and midwives in these areas must constantly fight to maintain this coverage. Homebirth midwifery remains illegal in 16 states. All around the country midwives stand trial and serve jail time for "practicing medicine without a license." Many women who desire a homebirth cannot find a midwife in their area to attend them. Even in the most midwifery-friendly areas of the nation, women must fight strong anti-homebirth attitudes to choose to birth their babies at home.
On a biological level, birthing represents our reason for living, the pinnacle of the life cycle. And yet in our society, birth is experienced by most families as a technological and medical event, fraught with the possibility of disaster. Currently, 25 percent of babies born in the United States are surgically cut from their mothers' bodies. Another 60 percent are born to mothers who are numb from the waist down and tangled in a web of tubes and wires. In the midst of all of this technology, the United States maintains one of the highest rates of neonatal mortality among all developed nations. Even more horrifically, the U.S. is the only industrialized country in which maternal mortality (the number of women dying from pregnancy-related causes) has increased over the past 20 years.
How we give birth reflects how we live. We are all members of a culture steeped in technological excess; a culture built on the tenet that nature is dangerous and must be controlled. We eat food grown through the use of biological, chemical, and mechanical engineering. We live in cities where the sky glows all night and the temperature inside our buildings is a constant 72 degrees. Our homes are powered with the energy of dammed rivers and split atoms. Most of us feel completely removed from the sources which sustain our lives and upon which we are forever dependent: the sun, the soil, the flowing waters. Is it any wonder that we believe we cannot bring forth our babies without technological assistance?
In 1900, the majority of American women gave birth at home, usually attended by midwives. By 1960, 99 percent of women gave birth in hospitals, nearly all of them attended by doctors. This societal change in place of birth didn't happen because hospital birth was safer and resulted in better outcomes than homebirth. No study at any time period has shown hospital birth to be safer than homebirth for healthy women. In fact, when women started birthing en masse in the hospital, maternal and neonatal mortality both skyrocketed. The cultural move toward hospitalized birth happened due to an orchestrated campaign by the medical establishment to eradicate the profession of midwifery and turn normal pregnancy and birth into pathological conditions.
In the late 1800's, doctors already had decided that they could expand their practices and power by turning normal childbirth into a medical event. Faculty members at medical schools publicly lamented that young doctors were not receiving training in attending childbirth because the "teaching material" was missing from the hospital learning sites. Obstetricians expressed outrage that their profession did not receive its due respect because of public acceptance of midwifery. One prominent obstetrician writing in 1915 summarized the problem as such: "Obstetrics is held in disdain by the profession and the public. The public reason correctly. If uneducated women of the lowest class may practice obstetrics... attendance at a birth must require very little knowledge and skill — surely it cannot belong to the science and art of medicine." 1
Doctors developed a calculated plan to eliminate midwifery. During the years between 1910 and 1920, a time when women did not yet have the right to vote, obstetricians pressured states to pass laws criminalizing the profession of midwifery. Many of these laws remain in effect today. The medical establishment also began a public education campaign aimed at convincing people that pregnancy and birth were inherently dangerous medical conditions best managed by physicians. No evidence existed to support this position. In fact, doctors at this time possessed a large body of literature showing that women and their babies died far more frequently when treated by doctors than when cared for by midwives. The campaign to eliminate midwifery happened to improve the positition of obstetricians, not to better the lives of women and children. Unfortunately, the campaign succeeded. By 1920, only 15 percent of women birthed their babies with the help of midwives. 2
Obstetricians had successfully convinced women that their bodies couldn't be trusted to birth their babies safely. Worse yet, they had convinced themselves the same thing. Because of their disdain for midwives, doctors were not interested in learning about normal birth from the women who knew the most about it. With the eradication of midwifery, immeasurable amounts of birth wisdom were lost. Obstetricians were left trying to medically manage a wild process. They began relying more and more on technology because of their inherent fear and distrust of birth. Women no longer gave birth. Doctors "delivered babies." By the 1950s, obstetricians routinely anaesthetized all laboring women and pulled their babies out with forceps. Women experienced themselves as passive participants in what could have been the most empowering events of their lives.
The medicalization of birth has probably done more to increase the power of the medical-industrial complex than any other development. Dr. Marsden Wagner, the former director of the World Health Organization's Maternal and Child Medicine Department, explained the issue well when he said, "The first time I attended a homebirth, it scared the hell out of me. I had never seen a woman so powerful. Birth is power. And if you take that power away from a woman and put it on the doctors, you've got her for life. She's going to come to you every time she has menstrual cramps, every time her kid has the sniffles."
In the late 1960s and early 1970s many women around the country began organizing to reclaim the power of birth. People began to inform themselves about the benefits of unmedicated childbirth and breastfeeding. Fathers fought for the right to be included at the births of their children after decades of being arbitrarily alienated from the process. Questioning not just medicated birth but the wisdom of routinely hospitalizing healthy women, thousands of women decided to birth their babies in their own homes attended by women who had relearned the art of midwifery. The modern natural birth movement was born.
It may appear as though great progress has been made toward humanizing hospital birth in the past several decades. Today, most hospitals offer pretty-looking birth rooms where mothers can be accompanied by their partners. Care providers offer to read women's "birth plans" and hospitals purchase squatting bars and birthing balls. If you look below the surface, though, it becomes evident that modern hospital birth rarely empowers women. Very few women manage to avoid drugs and interventions during their births. Hospital protocols still hold mothers to standardized ideas of "normal" progress and women who deviate from these standards receive artificial hormones to speed up their labors. More women are seriously injured during the birth process today than were 30 years ago. In 1970, the caesarean section rate in the U.S. was less than 5 percent. Today, 25 percent of women experience birth as major abdominal surgery. This five-fold increase in the cesarean rate has done nothing to improve our country's abyssmally high rate of neonatal mortality. Factoring out technlogical advances that save many severely premature infants, the same number of babies and more mothers die during and soon after childbirth as did 20 years ago.
Every expectant family desires the safest possible passage through birth for both mother and child. These families are often shocked to learn that giving birth in a hospital environment designed to monitor and control the birth process does not improve the quality or safety of birth. In fact, study after study conducted on the issue has shown that for healthy women with low- to moderate-risk pregnancies, giving birth in a hospital is actually less safe than giving birth at home with a trained midwife. One comparitive study matched more than 1000 women planning to birth at home with the same number of women planning hospital births. The women were matched for age, number of previous births, economic status, and medical risk factors. Women in the homebirth group who transfered to the hospital due to complications remained in the homebirth group for analysis. The results of the study showed that planned hospital birth resulted in greater numbers of birth injuries, maternal and infant infections, hemmorhages, and low apgar scores than planned, midwife-attended homebirth. 3 Many other studies support these findings and no study has ever proven hospital birth to be safer than planned, midwife-attended homebirth. 4
Anyone observing other mammals giving birth can intuit why homebirth results in better outcomes than hospital birth for healthy women. Imagine taking your laboring cat on a car ride to the vet to give birth. In nature mammals instinctively seek out quiet, dark, familiar places to give birth; their labors stop if their space is disturbed. Humans also birth best in privacy, and a woman's own home is often the ideal place to create such surroundings. Most women innately choose to move around during labor, finding the most comfortable positions in which to give birth. At a homebirth, midwives encourage such position changes and a woman's freedom of movement is limited only by the size of her house and yard. Midwives offer women the choices of laboring and birthing in water, delivering their babies with their own hands, or having the father catch. After the birth, mother and infant may bond without interruption. Homebirth also allows for greater sibling involvement in the birth process. If the parents desire, older children can be present at the births of their new siblings.
From an ecological perspective, homebirth presents a sustainable alternative to hospital birthing. The medical industry produces some of the most toxic waste currently poisoning our environment. Nearly all of the supplies used in the hospital, including the gowns worn by the doctor or midwife attending the birth, are made of plastic and thrown away after one use. The plastic bags and tubing used to administer the IV fluids that most birthing women receive contain pthalates which are known carcinogens and endocrine disrupters. These chemicals enter the environment when waste is incinerated or buried in landfills. Additionally, millions of women are given antibiotics during their labors. These antibiotics and other drugs are then released into the water supply through urination. The overuse of antibiotics leads to the development of antibiotic-resistant bacteria, an increasingly deadly problem in modern society. In addition to these ecological issues, our nation's limited medical resources could better be put to use serving the millions of people without access to basic medical care if our doctors and nurses were not busy attending healthy women unnecessarily birthing in hospitals.
Giving birth at home helps bring our lives into greater balance with nature. As living creatures, we can trust that nature has designed the process of birth to be beneficial rather than harmful to us and our offspring. Women who birth at home and the midwives who attend them understand that birth is as safe as life ever gets, and that attempts to control birth usually cause more complications than they prevent. Far from being a medical event which must be suffered in order to receive a baby, a midwife-attended homebirth is a sacred rite of passage where a woman turns into a mother and a baby enters the world.
1 Gibson, Faith. "The 100-Year War to Eliminate the Midwife." Presented at the Midwives Alliance of North America Annual Conference, 1999.
3 Mehl, Lewis, et al. "Outcomes of Elective Homebirths." Journal of Reproductive Medicine. November, 1977: 281-290.
4 Olsen, Ole. "Meta-analysis of the Safety of Homebirth." Birth. Volume 24, Issue 1, March 1997.