So I walked for midwives, with a message written very clearly across my very pregnant belly. Let me tell you, I never expected such strong reactions! I expected some raised eyebrows and rolled eyes along with the hoorahs, but wow - talk about a split reaction! However, I never set out with the intent to upset anyone, just to make people go "Hmmm, what is such a big deal that she is willing to go to this length to get her point across?" I wanted to get people talking, but I thought those would be the people in the park, those who visit ABC's website and some of the folks on Facebook. I had no idea I would be in the newspaper and all over al.com! Wondering what all the fuss is about? Here it is. Some people absolutely love that I did this and they are cheering like it's fourth quarter and we are going for it on fourth and one. Some people are completely disgusted and some people are downright angry. My personal thoughts? I feel like the statements that were omitted from the article are of far greater importance. Everyone is perfectly entitled to their opinions and I don't hold the least bit of a grudge if you don't like what I did. It's totally your prerogative. But let's focus on the issues - or I did it all for naught.
Now, I do feel that most of what I said was left out and I want to get that message across loud and clear. Apparently, there are some obstetricians in town who took offense to my words, thinking that I was attacking them and the hospital. This is NOT the case at all. I just made clear that the hospital model of care was not the right choice for us and that we wanted to have options. I can see how it was a little unclear, so I am taking the opportunity to rectify this NOW. I don't want any venom shed on my family from my message being misunderstood and I certainly want only positive light shed on ABC itself!
Here is the full original text of the letter to the editor I wrote before having to condense it to 250 words:
In the article covering the Walk for Midwives on Sunday, there were some omissions from the interview I was a part of that are critical to the issue. I would like to take the opportunity to clarify what all was said, as I feel the article may have left some room for speculation.
First we must acknowledge that while I did state that I was unsatisfied with the birth of my first child, it was the disconnect between my personal desires for birth and the medical model of care that was the problem. Birth is intensely personal and individual to each family, and the model of care chosen by each family should reflect that. I had an obstetrician that I highly respect both as a physician and a person, who even showed up at nearly midnight when she wasn’t on call to deliver my baby. Though she was compassionate and respected my wishes, I learned that the hospital is simply not the right birth setting for me. The standard policies and procedures conflicted with my personal views on birth, but I want to make it clear that it was not a matter of abuse or neglect. I feel that the original article possibly left room for conjecture that I was being accusatory of the hospital and providers themselves, which was not the case. I was just personally disappointed in what the medical model of care had to offer. However, I have family members and close friends who are only comfortable with this model of care and would not feel comfortable choosing to birth anywhere but the hospital. This is what we are fighting for – options.
I also want it to be very clear that I was, and remain, highly complementary of obstetricians. They are essential to our health care system, but the current Alabama system places unfair demands upon them and the licensing of midwives is a benefit to everyone involved.
Obstetricians practice in possibly the most demanding medical specialty, and certainly the highest legal risk. It’s been said many times by obstetricians that “the one intervention or cesarean I didn’t do was the one I was sued for, but I’ve never been sued for taking action”. This is an unfortunate truth that forces their hands in even perfectly healthy, normally progressing deliveries to take action at minor “bumps in the road” if you will. The constant threat of lawsuit hangs over their heads, narrowing the definition of normal birth until almost no mother fits it and they are required to take action to avoid legal repercussions. This is extremely unfair to both the doctors and the patients as this leads to a host of unnecessary interventions, which is what many women wish to avoid. This puts the obstetricians in a difficult situation. Collaborative practice between doctors and midwives would relieve a great deal of this pressure. By allowing midwives to care for low risk women, which is the majority, obstetricians would have more time and energy to devote to the higher risk women who truly need their services, without having to attempt to be all things to all women. Women who wish to birth in an out-of-hospital setting could do so safely, with a licensed birth professional trained to handle minor emergencies and with ability to transfer them to a hospital and the care of physician in more critical situations – which, it is important to point out, are still rather rare in low-risk women employing the midwifery model. It would also open the doors to the implementation of both free-standing and hospital-adjacent birth centers where Certified Professional Midwives and Certified Nurse Midwives could deliver babies in a setting that provides a ‘happy medium’ between the hospital modality and home birth setting.
The biggest problem with the current situation in Alabama is that by refusing to license midwives we are actually perpetuating greater danger to those who wish to birth out of hospital. Alabama women are not going to simply give up, and by not having a standardization of credentialing, they risk falling victim to those who claim to be midwives, but lack proper training or certification. With no governing body, such as the Alabama Board of Nursing provides for nurses or the Alabama Medical Association provides for doctors, there is no regulation of midwifery care, despite its continued practice. Some women even risk driving to neighboring states that license midwives, risking giving birth en route with no access to emergency care if necessary. Even worse, many women are forced to birth at home unassisted, either out of lack of access to care in rural areas, or out of fear of hospitals with no alternatives. The greatest conundrum lies in the fact that while home birth itself is perfectly legal, employing the services of a licensed professional is not. This is creates highly unsafe situations. In a home birth setting a minor routine complication, such as a cord around the baby’s neck, could be easily resolved by an experienced midwife in mere moments. However, it could be disastrous or even fatal for someone with no training or knowledge of how to handle the situation. It’s also important to note that midwives carry emergency equipment and medications which they are well trained to use in order to handle a wide variety of situations, further making them a very safe and practical alternative. Licensure of Certified Professional Midwives and the slackening of the unrealistic restraints placed on Certified Nurse Midwives would be a welcome and needed resolution to all of these issues, while providing the doctors with a reprieve in their overextended schedules.
The ultimate goal is a system in which doctors and midwives can work collaboratively to provide the best care and birth options for the women of Alabama. These systems are implemented all over the world with great success for both the health of the mothers and babies. They also reduce the financial burdens on many families and even benefit insurance companies, as the cost of midwifery care is significantly lower than obstetrical care. Also, over time this would, as it has in many other states and countries, actually improve birth outcomes for both mothers and babies, potentially lowering the currently outrageous malpractice insurance premiums for obstetricians, further driving down the cost of obstetrical care.
The state of Alabama provides its citizens with excellent, evidence based care in almost every other area of medicine. Isn’t it high time that we examined the evidence and made the decision to join the ranks of other states licensing midwives and reaping the benefits? It’s both a health care and financial win-win situation.
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