Nasty homebirth midwives - a taboo?

[MittensKittens]

My daughter was born at home, with a midwife in attendance. I wasn't as educated about birth as I am now. My second was a UC, and so different. My midwife is the only homebirth midwife in the country we live in, and the more stories I hear from other women who birthed with her, the more horrified I become.

BUT... I feel bad talking about my experience, as if saying I had a less than ideal homebirth somehow harms the case for homebirth in general. Especially when people who are thinking about homebirth can only choose her, if they want a midwife.

Some of the things my midwife did to me and others who birthed with her, that I am more and more angry about, include:

1) Cutting episiotomies after saying she doesn't "do" them, with no notice at all, and at random times, no necessarily during a contraction.

2) Shouting at laboring mothers and telling them they are putting their babies' lives at risk if they don't push them out "right now", and telling them it is all their fault. This happened to each and every of the women who gave birth with her in attendance that I spoke to.

3) Applying fundal pressure to push the baby out manually if two pushes don't do it. Being in the birth canal for longer than ten minutes is dangerous, she says. (Really! Wow!)

4) Not showing up until many hours after a mom calls to say she is about to give birth (didn't happen to me personally), and leaving right after the birth.

Now the question is, what do I tell others who want a homebirth? What do I tell her, when I run into her again? I feel that, in the natural birthing community at large, saying negative things about your midwife is a taboo. I see the reason behind not saying negative things about midwives, but what if their practices are truly harmful?

[Amanda L]

It does feel taboo to speak ill of any choice made that goes against the current "norm" of society. But there are plenty of people who went with the "norm" and had bad experiences. They are probably wondering if they should say anything about their experiences, since everyone else seems to have had no problems going through the same thing!

In your situation I would have to ask myself - If I had spoken with all of the women who have told me about their experiences with this midwife before I actually dealt with her, would I have still chosen to sigh up with her? Do I wish somebody would have spoken up to me? And then base my responses on that, not the fact that there isn't another midwife in the community.

[Magali]

So it's ok to call Dr.s on their bad practices, but not midwives? I disagree. It doesn't sound like that midwife is even part of the natural birth community anyways.

[Surfacing]

I haven't read the other responses.

You are commenting on specific practices, or the behaviour of the midwife, not on midwifery in general.

There may be midwives in the surrounding area/towns/counties/villages that have a better reputation. You can sing the praises of their practices.

If one midwife has behaved in an inappropriate, abusive way, that doesn't have to be a criticism of midwifery in general. It's criticism and commentary on one specific person's behaviour.

Sorry, I'm repeating myself I know. I think it's important to speak the truth.

You are wondering what to say to the MW herself. Is she governed by a licensing board?

[MittensKittens]

Thanks for your responses. At the moment, this midwife is literally the one and only homebirth midwife is the WHOLE COUNTRY (in Eastern Europe). There are government plans to start subsidizing homebirths by 2014, but judging by the way government proposals are implemented here, that may or may not happen. I hate to think that all other midwives attending homebirths will have similar practices, which ultimately come from local maternity hospitals, where they also happen.

Everything considered, I still believe that birthing with this midwife is better than birthing in the hospital here. After all, she won't take your baby to the nurseries for days on end without your consent, she won't vaccinate, and won't supplement your baby with formula without your knowledge. At least when she leaves your home, the malpractice ends.

[MittensKittens]

And no, she isn't licensed or scrutinized other than by mothers themselves.

[jennica]

I have known women who have been traumatized by their homebirth midwives and have a very difficult time getting support. The NCB community doesn't want to hear of it, and does not want her talking about it. Women like to feel a sense of protection in their choices. Choosing a homebirth is supposed to protect women from these kinds of practices, and is supposed to leave the woman feeling wonderful about her birth - not traumatized or assaulted (not that you feel that way, but others I know of do). I have some sense of what this is like, as I chose a hospital based CNM practice in a hospital birth center with birthing suites and birth tubs for my first birth. I was assaulted in this hospital by these midwives and they were not natural birth friendly at all. The midwives and the hospital are promoted in my local community by NCB activists, even though they have plenty of info about how they really practice. I feel that if I say something in these circles my experience is dismissed as unusual and uncommon, even though I've read of other stories like mine out of the same hospital. It's a really difficult position to be in and I don't have any answers.

[AutumnAir]

Hey MK - I was in a similar situation with my bad MW in the Czech Republic. While there are a few more than just her (I think maybe 6-7 altogether in the country of 10 million) she is the best known of the lot of them, frequently making public appearances to try to raise awareness about HB and the terrible birth practices in the hospitals.

But, she was pretty useless to me as a MW - not as bad as the one you've had the misfortune to encounter - but certainly not what I would expect from a decent MW. She was rude and threatening to me, totally unsupportive, and despite my having classic signs of a malpositioned baby did absolutely nothing to help get the baby in a better position. Finally coerced me into going to the hospital, which was an even worse experience, but I honestly believe that if she'd done her job properly we wouldn't have had to go there in the first place - not to mention that our contract said that in the case of a transfer she would come and act as a doula - which she didn't. She basically just abandoned us at the front door of the hospital.

But I had a sense of not wanting to publicly criticise her, because really in that whole country she's pretty much the only one who speaks up for choice in maternity services and for a woman's right to HB. And I'm sure if you had a nice easy totally uncomplicated labour and birth she would be fine - she just didn't seem prepared/willing/able to help a mother through a more difficult or complicated labour. Plus, as you said, the treatment you get in the hospital is so much worse that it seems unfair to point the finger at the 'crunchy' option.

You know, thinking about it, if I were still living there, and my choices were either birthing at home with the same MW or going into the hospital, I'd definitely take my chances with the MW again. I mean, I might be luckier this time around and have an easier labour, and even if not, now I know what she's like I could have contingency plans in place for coping with her. I know from experience that there's absolutely no way to prevent things happening in the hospital - you have absolutely no rights there - whereas at least in my own home I could kick her out/ have DH physically stop her from doing something to me if necessary.

So, in answer to your question, I think if you hear about someone planning to HB with this MW you should let them know what she's like. At least that way, even if they decide to go ahead and HB with her (which might still be the better option as you've rightly pointed out) they are more prepared / better informed about the kinds of things she might do/say and so will have the opportunity to plan accordingly. Make sense? I don't think you need to feel guilty about it - you're not dissing HB, you're simply pointing out that one specific MW is not very 'natural-minded', to put it mildly!

[CherryBomb]

Originally Posted by Magali

So it's ok to call Dr.s on their bad practices, but not midwives? I disagree. It doesn't sound like that midwife is even part of the natural birth community anyways.

I don't know that I'd go on a crusade against her, or anything like that, but I'd definitely be very honest if someone asked me about her.

[rparker]

Originally Posted by CherryBomb

I don't know that I'd go on a crusade against her, or anything like that, but I'd definitely be very honest if someone asked me about her.

I live in a rural area with only one midwife within 3 hours. When I was considering hiring her a former doula who is extremely pro-homebirth (and anti hospital birth) took me aside and told me about some of the frankly dangerous things that she had witnessed THAT particular midwife do at births. (Information which other people in the community later verified.) It was enough info to convince me to opt for a hospital birth with a NCB friendly doctor instead... there are aspects of my upcoming hospital birth that I view as less than ideal, but I can manage/mitigate them better than I could the bad judgment of this particular midwife. (And if I lived in an area with hospital options as bad as the ones the OP describes I'd probably be opting for a UC!)

I think that it's always better to be honest about your experiences so that other women can make truly informed choices.

[mwherbs]

give her some direct feed back about your birth experience- include the things you liked as well as what you are critical about - I do not think I would go into the other women's experiences- but I would encourage them to talk to her too- she may or may not take it in but if no one says anything then how does she know that she is doing anything that bothers people?
other things I have done - put together small conferences , supplied info from studies , given magazine subscriptions-

[MittensKittens]

Thank you all for replying. MWherbs, you are right of course. What struck me when I talked to her when I was planning my UC was that she said, "Nowadays, I make all my laboring women walk around as much as possible. It speeds up labor, and is great for the woman." I thought, yes, if she WANTS to walk around! It was that meeting that made me decide that I would definitely go the UC route for that birth.

The thing is, this midwife has plenty of access to natural birthing resources. I know where she got her habits from - from working in the maternity hospital for so long. I also know she genuinely supports natural birth, but those practices got stuck. If she could just stop doing the things I mentioned above, she could truly be doing this country a great service. I'll talk to her next time I see her. Any tips on what to say without sounding aggressive?

AutumnAir, our experiences with midwives sound similar in some ways. I know how traumatic your hospital experience was, and I hope you'll have the birth you need in England now . Did you find a midwife you like now? How does it work in the UK?

[mwherbs]

I think lots of times info needs to be delivered in a way that someone will take it in. Some of the approach would be like the outreach teaching in other countries - the hesperian foundation has some decent concepts on teaching http://www.hesperian.org/ - I think that their ideas can be used to teach/change practices in higher resource areas.
many times midwives are hands on and not always bookish nor are they as likely to credit "studies" but trust more in person teaching from someone they can respect, peer review (in more recent years internet group support and discussion ), client's feed back if it is clear and doesn't seem to be vindictive or "punishing" and the other relationships I see helping to make a change are apprentices-usually because apprentices will be in the position to see and do all the midwife does and in turn apprentice exuberance or ideas will be taken in - I have seen some of the most solidly inflexible mws change due to apprentice influence-
even in hearing her comment to you about having everyone walk in labor- I understand probably something new she has learned that reduced her frustration level- our own highest transfer rate is for long prodromal labors where the baby is some fashion of posterior or ascyncline and walking will re-adjust the baby's position, it almost seems as if she finds a new tool and then generalizes it for everyone in order to avoid- transfer, bad outcome or long labors where everyone is worn our or maybe she has her own explaination/reasoning -- and with all that said maybe what you need is another midwife to serve the area- the primary thing that you have commented on that is of concern to me is the use of fundal pressure -
one idea may be to see if there is a midwife that might come and do some side by side work with the mw /your gal might actually have some things to teach as well as learn

[Ruthla]

I'd go ahead and warn other moms about her, as part of a larger discussion about birthing alternatives. Would the local hospital handle the birth part any better? What's the local c/s rate? At least with this midwife, you can learn to breastfeed your baby without interference and there's far less chance of a c/s (she'd have to transfer you to the hospital first.) And of course mention the option of UC!

I'm really, really wondering about the "only midwife in the country" thing. She might be the only certified midwife, or the only "official" midwife, but I just find it hard to beleive that there's nobody else who quietly attends their friends' or neighbors' "UCs" without actually calling herself a midwife.

[MittensKittens]

MWherbs, your post was very useful! I'll think about what to say to her when I see her next. I do agree that we need another homebirth midwife. That would be the case regardless of what she is like, because one midwife is hardly enough to serve a population of 8 million!

The fundal pressure is a notorious practice in this country, especially in the hospital this midwife used to work at. Amongst OBs here, the belief is that it is mortally dangerous for a baby to be in the birth canal for longer than... this part varies, I have heard anything from 10 minutes to half an hour. Regardless of personal time limits, the reason is that they believe the baby will be deprived of oxygen. That is the reason behind the fundal pressure. A friend's baby was born in five minutes straight, after being told she was complete, with one OB applying fundal pressure while the other was pulling on the other side, to get the baby out.

Originally Posted by Ruthla

I'd go ahead and warn other moms about her, as part of a larger discussion about birthing alternatives. Would the local hospital handle the birth part any better? What's the local c/s rate? At least with this midwife, you can learn to breastfeed your baby without interference and there's far less chance of a c/s (she'd have to transfer you to the hospital first.) And of course mention the option of UC!

I'm really, really wondering about the "only midwife in the country" thing. She might be the only certified midwife, or the only "official" midwife, but I just find it hard to beleive that there's nobody else who quietly attends their friends' or neighbors' "UCs" without actually calling herself a midwife.

As you see above, the birth part is no better in hospitals. What's more, they keep moms and babies for around a week. Rooming in is an option, but the "normal ward" is more popular. In the "normal ward" babies are kept at a nursery, and formula fed. They are brought to the moms several times a day to "breastfeed", usually after they were just given formula. The same friend from the story above saw her baby for the first time three days after giving birth, because of a "suspected infection".

The ONLY good thing is the low c-section rate. I guess it is because c-sections are expensive. They'll do a vaginal breech with no problems here, and twins are normally vaginal too. Pitocin, on the other hand, is standard for ALL birth, even if labor had started naturally and was progressing normally. They give it to you after you are done being shaven and getting an enema, often without saying what it is. Epidurals, on the other hand, have to be "scheduled" weeks before labor. But I digress...

[Banana731]

Hey Mittens- ever thought of going in midwifery? Your countrymen will thank you

[MittensKittens]

Originally Posted by Banana731

Hey Mittens- ever thought of going in midwifery? Your countrymen will thank you

I did for a while, actually . I love birth! I even went as far as to phone the midwifery school last year, as they were taking new applicants. However, midwives are not regulated for homebirths. You'd technically be "practicing medicine without a license". There aren't so many natural birthers here, and I am not sure I'd make a living wage. This midwife is a yoga and fitness instructor as well as doing births. Then, you have to work in one of the hospitals, where they teach you to shout at and humiliate laboring women. You have to cut episiotomies, pull on the cord to get the placenta out, etc, etc.

Did I mention you have to perform abortions to get your diploma? I'm not even sure they let foreign nationals in, any way. I'd be happy to be a doula at friends' births though , but even as a UC-er I am definitely not qualified to do anything that involves exercising authority.

[holothuroidea]

Anyone claiming to be a health care practitioner needs to be held to a certain level of accountability, no matter whether they are a midwife or nurse or doctor or dentist.

By speaking out against unsafe and unprofessional home birth practices you are an advocate for the natural birthing community, not a hinderance. After all, the last thing the home birth community needs is a bad midwife!!!

[mwherbs]

why is the gal doing home births? are there ways that she is trying to serve and be an ally to birthing women? can she be educated or re-directed- if so how- this is the kinds of things I think of when I think of the Hesperian foundation materials more like the general approach to dealing with established providers and giving them respect for what they know and are doing and at the same time trying to educate away from dangerous practices - how do you start that dialog - the info in many of their books are very basic and not the exact point for 1st and 2nd world countries but the ideas I want to communicate is much more the approach to helping health workers learn (in this case a midwife)
It can be very hard if you feel you have been harmed by the person to facilitate education - I have walked this path myself and it is only by example of others , time and a solid look at what can be done-and how people are people even providers- some I will never like and can not respect and I would not be effective in working with or changing things that provider does- I have a very wonderful ex-midwifery partner who just absolutely had a way with working with doctors and nurses she acted as a calming influence and basically talked them through practices they had not done before like not cut an epis or to not shout at a woman to push or... she made them feel like it was their idea and they felt good about it- that is positive change- if it were me I would not have even thought well of them to begin with so there would be no trust in what I had to say just opposition ---
so would it be legal to assist her- or atleast when you can- or to doula at the births she is at ?
since what she is doing is a country wide standard of care not as simple to change - it is sort of like addressing GBS screening or protocols in this country and it would take consumer and provider education/reform on a large scale and quite a "natural" birth movement to make that change happen country wide or some sort of provider education/change that they take on for economy or ease of action-Now you may be able to get an individual to see things differently - like this one provider - but in a way I see how/why people are worried if she is being criticized for things that she does that are common practice - and doing home births at all is not supported well you could loose the alternative she does offer- ideal or no- perhaps you could organize the other gals to talk to her frankly or maybe sponsor a movie night for people interested in "natural" birth/home birth and have her come - she may see how things are done differently and still work out-- you may know some other more culturally appropriate way to come at this problem to help solve it--

[MittensKittens]

She left the hospital she was working with because she disagreed with its practices. She then started doing homebirths, as well as becoming a yoga teacher. When I was interviewing her to become my midwife, she said the practices she disagreed with were the ones harmful to mom and baby, such as separation at birth for days on end. Now, I suspect that the way in which OBs run the show and midwives are no more than assistants that can hand instruments over and call the OB when the baby is crowning must have played a large role too.

I think she is committed to natural birth in a strange way. She has been to natural birth conferences outside of the country, and is apparently trying to learn new things all the time. I also think she is scared by anything other than a very "by her book" birth.

As far as homebirths go, something new has been evolving in the local "NCB" community - women who have had UCs and homebirths with this midwife coming to other women's births as doulas, so kind of a UC with a doula. I think, given the circumstances, this is quite positive. I don't know how this midwife feels about doulas at her birth, but I will talk to her about that.

One last note about the midwife - something that made me personally angry is that I discovered that, out of all the women who hired her that I spoke to, she charged me the largest amount. By far. She charged some people a tenth of what she charged me. Yes, I know that I am a foreigner and that she probably thinks I have lots of money, but that is simply not the reality, and I am angry about this. I can understand doing discounts for people with financial difficulties, but I doing the opposite, and assuming that foreign citizenship equals a large bank account, so foreigners should pay more.