Where I Stand
I stand in the gap.
I stand in the gap between midwives and their clients who have a natural birth rate of 96% and a medical culture where the majority of births in the United States are considered illness and medical procedures are used in 90% of all cases.
Don’t get me wrong. Natural childbirth doesn't appeal to everyone.
Childbirth in America is surrounded by fear. Fear of pain. Fear of injury. Fear of death. Fear of being sued. Women in America are encouraged to take advantage of all the tools that Obstetrics has to offer. Moreover, insurance will probably pay every penny. Tired of being pregnant? Sure, you can be induced a little early.
If your baby has trouble breathing because he isn’t quite ready to be born, we'll just keep him in our high tech NICU. Afraid to feel any pain? No problem, our anesthesiologist can help. Not sure you want to risk the uncertainty of laboring at all? Elective cesareans are available in many hospitals.
Those who choose out-of-hospital births are not merely lucky women, with superior pelvises and consistently smaller babies. They are, however, attended by midwives trained in different skills than woman attended in hospitals. They are allowed to give birth in an atmosphere with a more flexible understanding of the range of "normal." This results in a dramatic difference in birth outcomes. Not mortality outcomes --maternal and infant death rates are consistent for healthy women attended by skilled caregivers in either setting-- but the differences in medical interventions and associated complications are staggering.
What amazes me is that 67% of American mothers continue to birth vaginally. This is regardless of where they are or how they are treated. Most often the human body still functions, despite the obstacles. For those mothers, having personalized midwifery care would have been merely icing on the cake. She would have enjoyed the extra counseling and education that is possible when each prenatal visit lasts an hour. She would have had direct access to her midwife at any time during her pregnancy. Perhaps she might have had an intact perineum instead of a repair. Her postpartum care would have come to her at home. She would have been attended by someone whose clients all successfully breastfeed. She would have the confidence from "climbing her personal Mt. Everest" which could empower her during the challenges of motherhood she faces.
Mothers who find themselves in the gap are those who just don’t fit the textbook expectations of labor. Here is the mother whose pregnancy lasts more than 40 weeks. Here is the mother whose water breaks and her labor doesn't begin immediately. Here is the mother whose baby is posterior and her labor doesn’t “progress.” Here is the mother who needs the comfort of a birth pool or walking to aid her labor. Here is the mother with the unexpected breech presentation. Here is the mother with unresolved sexual abuse that needs a secure place and consistent relationships before she can bring her baby into the world. Here is the mother with twins who needs lots of additional nutritional counseling and encouragement in order to grow two babies. Here is the mother who wants to have a vaginal birth after a cesarean section.
For the mothers in the gap, midwifery care is even more vital. It can mean using natural remedies to get a troubled labor back on track. It can mean allowing parents full access to information regarding risks and benefits, then allowing them authority to make decisions. It can be accessing a midwife's skill in monitoring labor with her whole being instead of relying on a machine that goes "ping." It can be assessing the need for additional medical intervention and gently counseling the mother to understand why this birth needs to be different from her ideal. It can be helping her to realize that which is understandable and to accept that which is incomprehensible in the birth process.
I am a midwife that has been called to stand in the gap.
It is my debt to society. With the birth of my first child, I was given a precious gift by midwives who stood in the gap with me. Because of their training and experience, I was able to avoid a primary cesarean section and have my baby safely and naturally. I succeeded with breastfeeding. I learned about good nutrition, and my whole family is healthier for it. If I can help bridge the gap for just one mother, then I have begun to fulfill my purpose.
The beginning of life is that important.
Natural childbirth may be the hardest physical work a woman ever accomplishes. It is also one of the most potentially rewarding experiences of motherhood. The reality is that with the right caregiver and setting, natural childbirth is overwhelmingly achievable.
So, do your homework. Look at the statistics of your prospective birth attendant and the setting
in which they practice. Educate yourself about birth and “perceived” versus “actual” risks. If you're fine with a one-in-three chance of having your baby cut out of your body, you might be satisfied with mainstream medical care. After you have done your research, you may want to check out your alternatives.
You might have to drive to another state or pay more out of pocket. Some women find it worth going the extra mile. Others do not. It is your decision and I respect your right to make it.
Meanwhile, you’ll find me right here… in the gap.
(Special thanks to author Chloe Raum, 09/06/2008)
in which they practice. Educate yourself about birth and “perceived” versus “actual” risks. If you're fine with a one-in-three chance of having your baby cut out of your body, you might be satisfied with mainstream medical care. After you have done your research, you may want to check out your alternatives.
You might have to drive to another state or pay more out of pocket. Some women find it worth going the extra mile. Others do not. It is your decision and I respect your right to make it.
Meanwhile, you’ll find me right here… in the gap.
(Special thanks to author Chloe Raum, 09/06/2008)