My first day as a midwifery student at my preceptors birth center I was informed that they did not accept clients who were not planning to exclusively breastfeed. Being the breastfeeding advocate that I am and the doe eye’d student I was, I became the booby Gestapo. Our intake forms questioned mothers about their feeding plans, not for the chance to educate them as to choices, but rather to eliminate them as candidates for care. That is right. The owner of the birth center deemed those who would or could not breastfeed unworthy of the opportunity to have a midwife attended birth. As one of the largest practices in South Florida this decision often meant mother’s were doomed to have a hospital birth, which in South Florida meant an almost 50% chance of cesarean.
As I moved into my own practice I adopted the same policy. No boobs, No Birth. I watched women walk out my door and couldn’t help but wonder what became of those mothers and babies. Suddenly one day it dawned on me that I was playing birth god, judge and jury, and all around know it all midwife. Who was I to say who deserved a good birth? These families had sought out midwifery care, only to be told they didn’t deserve it.
More recently I have noticed such practices run rampant in midwifery. Not limited to breastfeeding however, families are judged on their decision about vaccinations, western medicine, carnivorous diets, and so many other personal life decisions. It seems that midwives are at a loss when a Meat eating YUPPIE chooses a homebirth.
Was good birth intended only for certain people? Who made the criteria?
While it is the obligation of the midwife to inform her clients as to the risks and benefits each choice they make holds, is it really their place to impose their system of belief on her clients? Is that not the very reason we home birthers avoid hospital birth? Perhaps we can make them understand our point of view, and us theirs.
It is time we all re-examine our image of who is an out of hospital birther. I can’t tell you how many times I have been told I don’t “look” like one.
When I have a client who from the beginning I learn she does not plan on breastfeeding and wants to circumcise (the 2 biggies for me), I take it as a challenge. No one gets turned away for their views. She is seeking midwifery care for some kind of reason. As she learns of the beauty of natural pregnancy, birth and parenting, I can’t tell you how many women have had their minds turned around. At a birth center they see other women, peers who are breastfeeding, they are attended by midwifes who also have done it…. OK, so I can’t change all of them, but I have changed many. I welcome that challenge and feel joy at having made a difference.
Very good post- loved it.
The title of the post, “Who Deserves a Good Birth?” makes me also wonder at how many under-privileged families there are who don’t have the option to birth at home with a midwife simply because they cannot afford to. Medicaid also often will not cover midwives/homebirth.
So I have to ask, are homebirths only for a certain demographic of people?
Just to clarify, I don’t begrudge midwives their fees -they have to live, too- but think that in light of current statistics, Medicaid should give people the freedom to choose who they want to provide prenatal care and attend the birth of their child.
I get told all the time that I don’t look like a home birther! I just want to say, “Hold on a minute while I grab my gauze skirt and Birkenstocks…”
Safiyah – Medicaid does cover homebirth and midwives in Florida. The birth center where I trained for two years had about a 30% Medicaid clientele. I agree, it is very important.
I learned that lesson at the second delivery I precepted. The mom was smoking cigarettes and drinking Cuban coffee in labor (and was a Medicaid mom). When I freaked out (privately) to the midwife, she pointed out that this was her third baby. If she didn’t quit by this point, all we would do would be judging her when she needed us.
Incidentally, she did breastfeed and cosleep. We all make our compromises and have our priorities as parents. We also all deserve the best births we cam have.
If my midwife turned me away because I had planned to circumcise my baby, I would have ended up in the hospital with a repeat cesarean section. Thank goodness she didn’t do that to me. She smiled politely at me, asked me, “Do you know what the baby’s foreskin is for?” I couldn’t answer. She asked me to at least read some literature and watch a video about what I was doing so that I was fully informed.
Needless to say, thanks to that midwife, my sons are both intact and I can’t thank her enough for helping to educate an uneducated person like myself. She was a midwife that educated her clients and truly supported them in their decisions. As a midwife I don’t see how we can do it any other way and be true to the title of midwifery.
I have seen and even been a apart of doulas who will only accept clients who want a natural birth and who will even LEAVE THEIR CLIENTS in the middle of labor if the woman gets an epidural because they {believe that a doula is redundant to an epidural and no longer needed- please}!
I know midwives who will only take women who eat a certain diet or require their clients to eat the way that they want them to. Now, nutrition is important for prevention so I understand the focus on that but there as many opinions as there are belly buttons about what constitutes a healthy diet. There are the obvious ones and then there are gray areas. I can see a midwife not taking a client because she is eating nothing but TV dinners and refuses to make changes. I can’t see how a midwife would not accept someone because she eats meat. Again, ridiculous. Personal lifestyle choices should not be up for judgment like that.
Florida is one of the few states where medicaid does reimburses LMs for home and birth center clients. Pennies on the dollar of course of our usual fees.
Obiviously as midwives we have to determine that a client is expected to have a normal pregnancy and birth through screening. So a client hooked on heroin is making a choice I don’t agree with AND is risking out for actual health reasons. But turning away clients based soley on a choice such as breastfeeding is limiting to both midwifery and women. Other countries have high Breast feeding rates not through force but through education and better births. By offering a better birth and lowering sections we will increase BF rates. We have to see the big picture.
Pingback: Tweets that mention » Who deserves a good birth? -- Topsy.com
I’m doing my midwifery training at the moment and my mentor has taught me not to judge. Even when she believes a woman is not really ready or capable of having a homebirth she still allows them to try at home until she judges that a hospital is necessary. I love her approach. People can not only change their perspective but people who’s hips don’t seem big enough to birth can open up and their bodies change, and even if things don’t change attempting a homebirth can be life enhancing for both baby and mommy. I can’t imagine turning a woman away simply because she doesn’t plan on breast-feeding or plan to cercomsize. does that mean that jewish women are not entitled to have the birth they want? or that a woman who’s had a breast reduction when they were 18 can’t have a homebirth because they can’t breast fead?
As a midwife, I see our job is to help women make the best choices for themselves and that means laying aside our own prejudices and trusting that the baby picked their parents for a reason and we are there to assist both in a loving way.
I know exactly what you’re talking about! I am a midwifery student myself, so my family never questioned me about my decision to birth at home (or maybe I just didn’t hear them?) but I was the first person in my family to do so and I KNOW a lot of them were talking behind my back about my choice. I am always so excited to find people who support the home birth choice!
I’ve had four children, all born at home and b’fed, so please forgive me if I get the details fuzzy
One of my midwives said something to me about requiring mothers to breastfeed and I was very surprised. Her explanation was that breastfeeding after birth was important to help the uterus clamp down and prevent excessive bleeding, that if the mothers were unwilling to do that, she would not feel safe working with her at home. It made sense to me, and IMO was not judgmental at all.
Yes, I have also seen midwives requiring breastfeeding after birth for the same reasons mentioned by Sandra Mort. This makes sense to me too. Yeah, they carry pitocin shots to help stop bleeding, but it seems better to not have to rely on the pitocin if possible.
I found this to be a little outrageous. I have never ever heard of a midwife turning down a client for not breastfeeding. That is completely mind boggling to me. What is extra surprising is that this was happening in Florida where they apparently hate midwives, free standing birth centers and VBACs.
I guess that is not the practice here in my state.
Wow. Still just shocked by this.
Why is circumcision taken as a challenge? It’s so nice that in the days of equality for everybody, people who circumcise for religious reasons are discriminated against. So that takes care of Jews & Muslims who have to birth in the hospital (And no, I would not watch a video about my son’s foreskin. I find it insulting. Should I show my homosexual patients AIDS videos?) Anybody else who is disqualified? Do I have to be a democrat too?
I thought being a healthcare worker was to remain impartial and non judgmental. What if the an healthcare system was allowed to refuse to take care of alcoholics, IV drug users, homosexuals, homeless people, child abusers, rapists, people of a conflicting religion & anyone else they didn’t like or disagreed with their lifestyle choices. Like it or not, midwives are licensed health care workers & there is a code of ethics. That a midwife would turn a prospective client down because they don’t breastfeed or they circumcise for religious reasons is beyond shocking.
I agree… however, I still reserve the right to refuse service to those families who choose to circumcise. I just can’t bring myself to abide.
Wow I think that midwives and practices that only take certain “types” of moms are really missing a great opportunity to educate them more about the importance of breastfeeding. In saying that… I had both my babies at home, in the water and had ALOT and I mean ALOT of trouble breastfeeding them. I was blessed to have been able to push through almost 4 months with each of them but then decided to give them formula. Does that make me a bad mother? I don’t think so. I was in so much pain that I was starting to dread feeding my first born. Once I realized how bad that feeling was for both of us I chose to pump and feed. Eventually I didn’t have enough milk. The same thing happened with our second baby. I didn’t want to go through a deep depression and if I had kept going, because of other circumstances in my life that were affecting me, I would have fallen easily into a depression. Yes, I miss them nursing on me. But I don’t miss the pain, I don’t miss dreading each feed. I love and enjoy my babies every second of every day knowing I made the wisest choice I could at the time. By the way, my midwife stood by me helping me the whole time and once I shared my decision with her, never made me feel bad about it. Even today, almost two years after my first birth we keep in touch and she visits our family.
I don’t think any of the midwives I’ve seen requiring breastfeeding after birth require a longterm commitment. They’ve presented it from the point of a higher risk of post-partum hemhorrage in women who don’t breastfeed immediately after birth. I never felt like it was a judgment against women who choose to pump or use formula, or who have to out of necessity.
Homebirth midwives often are unable to get malpractice insurance so I can understand a homebirth midwife wishing to protect herself and her family by careful screening of clients. I think perhaps some of us are forgetting that homebirth is safe for healthy, LOW-RISK women. I will not judge a midwife who is uncomfortable providing homebirth care to women she feels are too high-risk medically speaking.
if some of you dislike the thought of screening women for risk factors, well, go to midwifery school, become a midwife, and decide for yourself which clients you will and won’t take. :shrug
This is a great post introducing an interesting idea.
I agree with @Rachel in that I live in NY in an area with many orthodox and hasidic jews, a large percentage of whom homebirth, and all of whom will circumcise. I feel quite strongly that despite this practice – which is done with purpose (albeit religious purpose), they should have access to the same quality of midwives that I do.
I disagree with Rachel that watching an educational video about the downside of circumcision is insulting. How is education/information from & discussion with a midwife about these choices insulting? Education that flies in the face of religious practice is not an insult.
Breastfeeding is another ball game. I can’t fathom why someone would want to homebirth, but not breastfeed (even though I do know someone who did exactly this – I’m still flummoxed)- the two seem to go hand in hand. Artificial feeding by choice (excepting women who are not medically able to bf, adoption, etc.) seems like a decent reason to question a client’s reasoning at the very least.
I think being a midwife meeting with a potential client who doesn’t want to breastfeed or does want to circumcize for non-religious reasons is a tremendous opportunity.
On the other hand, as other posters have mentioned, midwives usually can’t afford to be insured, and have little protection from lawsuits so of course who her clients are should be at her discretion. To suggest she OWES her services against her judgement to any particular individual would be to seriously curtail the midwife’s rights.
To those suggesting otherwise: would you offer to pay her legal bills should things go sour with the client in one way or another?