When I was born in the living room of my parents’ old Victorian 25 years ago, my mother was attended by three lay midwives. These women, whose training had probably been through apprenticeship, had a tremendous understanding of, and respect for, the physiological, emotional and spiritual processes of childbirth. As far as clinical skills, they were by no means experts (my aunt, in fact, had to show them an embroidery stitch as they undertook a complicated suturing job). They had no licensure, no nursing credentials, and no malpractice insurance. What they did have – the knowledge, faith and insight inherent to women in communities where childbirth is still considered a women-centered, natural process – was enough. The birth was uncomplicated, and after staying just long enough to establish that mother and child were healthy, the placenta intact, the embroidery holding, and the bed clean and warm, the midwives left us in the safety and comfort of our own home.
Although a lifetime of commitment to the midwifery model of care made homebirth a natural choice as I awaited my first child in 2000, history was not (yet) to repeat itself. My midwife, a licensed practitioner with extensive training, medical equipment, malpractice insurance, and all the bells and whistles required of birth attendants these days, identified my daughter’s breech position early in labor. Homebirth for a correctly positioned fetus is one thing – a baby coming out feet first, though, is another matter. Although there are midwives who will confidently attend such a birth at home, they are a rare breed. The chances of harm to mother or child are slim, but greater than they would be if the birth is conducted by cesarean section. I had done my homework, and when my midwife suggested consulting an obstetrician, I remembered the numbers and agreed. Although I advocate for homebirth in most cases, I have always acknowledged the hospital’s role in handling difficult births. We trundled off to the maternity ward, where I elected to have the recommended surgery. Mia was born by cesarean section just a few hours after our initial discovery.
Five years later, as I awaited the birth of my second child, I once again found myself in a midwifery clinic. Although there are potential complications with vaginal births after cesarean sections (VBACs), I knew that the much-hyped phenomenon of uterine rupture was unlikely in a woman laboring naturally without the additional muscular stress of artificial induction. I had read the studies, and I knew that our outcome was still more likely to be good at home than in the operating room, despite my history. It was a sad day, therefore, when a midwife informed me that VBACs just weren’t done at home anymore. In Washington State, it seems, malpractice suits have created a backlash by insurers against the practice, despite the evidence that supports the safety of natural VBACs. A few phone calls, filled with impassioned pleas and desperate interrogations, confirmed that not only were there no midwives willing (or able, for reasons of professional risk) to attend a home VBAC, but there were very few options for me even if I were willing to give birth in a hospital.
By the second trimester of my pregnancy, I had a game plan. Although my local hospital would not allow a VBAC (or what is commonly called a “trial of labor,” evidence of the fact that the expectation is of a surgical outcome), I did find a hospital several hours away which was willing to allow a midwife to attend me in their facility. The birth was on – until, around the beginning of my third trimester, they changed their policy and forbade first-time VBACs within their walls.
By the time I was down to the last 10 weeks of pregnancy, I was frantic. There was a midwife near the Canadian border, said the receptionist manning the phones at the International Cesarean Awareness Network (ICAN), who might attend a VBAC at home. If she was out of jail, he said. There was a military hospital two towns over, I heard, that was still doing VBACs for the wives of enlisted men. (This was wartime – my husband was not about to join up just to get us into that facility!) There was my old friend the midwife’s apprentice, a well-read student with a couple of home-births of her own under her belt. Could I remember her number? Would she come?
I started to speak boldly, to family and friends, about my intention to give birth unattended if it came to that. I had knowledge, faith, and insight – hadn’t that gotten my mom and her lay-midwives through? I had a sound body, a clear mind, a healthy fetus, and tens of thousands of years of biology behind me. I trusted my instinctive ability to give birth . . . without complications. But there was a murmuring voice in the back of my head that shook my confidence. “Cord compression. Fetal distress. Placenta Previa. Uterine hemorrhage. Cephalopelvic disproportion. Uterine rupture.” I could probably do it, and I still had confidence (supported by facts) in the relative safety of the natural birth process over the surgical alternative, but I desperately wanted not to be in the position of choosing one less than ideal situation over another. I wanted a skilled attendant, and it was purely the economic politics of the insurance providers and the American Medical Association that was standing in the way of my having one.
In the end, it was the selfless offer of my former midwife – the woman who was to have delivered Mia – that saved me from my dilemma. There was the professional risk, which she was willing to accept, that she would be faced with investigation or at least asked some very tough questions, if we ended up in the hospital with any complications. There was the economic risk, of practicing in a manner not covered by her malpractice insurance, but we had some of that old-fashioned stuff called trustbetween us. And there was the knowledge, the faith, and the insight. She understood my dilemma and shared my beliefs.
When my second daughter, Dylann, was born at home last October, the repercussions were broad. It was part of our family history – my mom was there, witnessing the second significant homebirth of her life, my five year-old daughter was present, finally experiencing birth as a family-centered event, and my husband was involved in a way that may not have been possible with a repeat C-section. It was, just as strongly, part of a social story – proof that birth is a natural process, ready to be reclaimed.