There is a subset of the mainstream midwifery world that believes that if we simply follow the rules, make sure people’s blood pressure, and blood glucose, and blood-borne pathogens and number of centimeters the placenta is away from the cervix are all well within “the box”, that we can do no wrong. We are told that this is what minimizing risk looks like. Responsible caregiving. Respectable midwifery that the insurance men and ACOG can get behind (and then screw). This is all an elaborate myth held up by puppet researchers, people in the field parroting each other, and ignoring any information that is contrary to the party line. Stories of women going to 43, 44, perhaps 45 weeks in their pregnancies with lovely outcomes. Women whose blood sugars are not “in the box” but birth healthy 7-pound babies. Pieces of research that demonstrate the everything is not quite as it seems – the babies we think might be doing badly based on their fetal heart tones more often than not come out fine – women with pre-eclampsia often don’t have protein in their urine or a rising BP prior to the onset of eclampsia – women with chronic high blood pressure have, in some studies, been shown to actually have better outcomes than normotensive women if there are no other signs of pathology – that women can birth their own placentas, and very rarely need anti-hemorrhagic drugs when this stage is allowed the space to unfold physiologically.
I can see the disillusion in so many of the young midwives (my age!) coming out of MEAC accredited programs especially, but also some traditional midwives who have trained in this medical midwifery model. I spoke to a lovely old friend this week who was fired by her unlicensed midwife at 42 weeks. This midwife had either never heard of an AAT (acceleration accusation test) or didn’t think it was a worthy option for assessing baby’s wellbeing. She wasn’t even willing to look at an NST/BPP and give this mom a few more days, when her dates were wildly shaky at best, and likely very wrong at worst (like, she could be more like 38 or 39 weeks!). This lack of creativity and flexibility is not acceptable and women are saying NO MORE to this nonsense. I happily did an AAT with this mama by Facetime and hope to hear her awesome birth story sometime this week when baby decides to be born.
These are issues of fear and a desire for control over a process which cannot be controlled. It is mythical thinking, akin to me thinking that if I just do the right activities in the right order I will be guaranteed (at least reasonably so) to be happy in my life. Or, if I advertise the right way, the right places, with the right amount of money put in, my business will be successful. We all know that isn’t how it works. There is no recipe to get the exact outcome we want in any arena in life, although many of us do fall into this trap if we aren’t mindful of it.
There is not a right way to midwife. But there is a wrong way, and that is to be ruled entirely by fear, trying to make the decisions of pregnancy and birth black and white, right and wrong, both for you as the midwife as well as the client. If we take that on, we will lose our minds and burn out, or worse, inadvertently make a lot of peoples’ experiences really stressful and disempowering. We need to become comfortable in the messiness, be ok with changing our minds, staying open, and learning from these incredible families we support. We need a big ass piece of humble pie, that even the most seasoned among us might not know the answer for a specific person, might guess wrong about some aspect of their care, and might not make the right call every time, regardless of how conservatively you err in your decision making. I would also put forth the notion that erring on the conservative side and turning to the medical model prematurely can be just as egregious an error in so many ways.
So here is to the creative, heart-centered midwives who find themselves breaking these rules (and especially to those who never agreed to the rules to start with), not because breaking the rules is inherently awesome (although Alisha the apprentice recently helped me break a traffic cone rule so we could get to a plate of nachos faster, which was awesome in every possible way) but because honoring the path of each human we care for and support IS inherently awesome.