The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Homebirth After Birth Center

Birth is a momentous life event, and as such is deserving of critical examination and intense planning. My recent experience with two distinctly different models of labor and delivery management compels me to write this critique. I want to preface this story with the acknowledgment that all women in labor need individualized care and that for some that means a higher level of intervention than I required. However, the point of telling this story is twofold. First, I intend to show that birth caregivers stand in a precarious position, with the ability to abuse the power of their expertise by taking away the decision-making abilities and responsibility of parents. And secondly, that birth attendants' perceptions can be tainted by experiences of past births that they can unintentionally bring, along with personal troubles, to their clients' births. I hope I can influence midwives to realize that all families should be fully in control of the decisions that affect the birth of their children, regardless of whether those families feel most comfortable in a hospital setting or at home, and to consider critically what it is they are bringing to birth, before accepting clients.

My first daughter was born, with 5 midwives attending, in a free standing Birth Center. While I was originally happy with that first birth because I was inexperienced at the time, and wanted to be guided, I have since done a lot of soul searching and healing, and become a great deal more educated about birth. Having someone attend me who doubted my knowledge this time would have been asking for complications. For example, the simple suggestion that I might have to have pain, when I was in a vulnerable stage of labor, could cause me to doubt and trigger the fear/pain cycle that I suffered from terribly in my first birth. So, for my second birth, I was absolutely against having all that intervention again.

Yes, I used intervention and midwife in the same paragraph. Most midwives claim to be against intervention, but when it comes down to it, they want you to lie a certain way so they can see, stop what you're doing so they can check how far you've progressed, let them tell you when to push, and on and on. It's a shame, and it's also unnecessary. A lot of gentle birth advocates mistakenly put midwives on a pedestal because their reputation is so much better than Obstetricians'. The truth is that they are human like the rest of us and as such are not above scrutiny. After my recent experiences, I am convinced that there is a lot more to having the best possible birth than simply finding a well-trained midwife.

On January 29th, '97, I had such a beautiful homebirth that I've wanted to tell the world. This time, I birthed with only my husband, 22 month old daughter, and best friend attending, and it was mind-blowingly wonderful! The key difference from the last time was that I only invited people to help me that totally trusted in my ability to birth and whom I could trust not to interfere. I had my girlfriend rub my back, swoosh water over me in the bath, make dinner, play with my daughter, dispose of the placenta, wash my towels and sheets and then leave me alone. No one put their hands in me. No one told me how to behave. No one told me where or how to sit/lie. No one doubted me when I felt I was in labor. No one else needed to know how far along I was because my body knew. No one needed to tell me to pee or poop, eat or drink, because I did those things when I needed to. I knew I could birth safely in my bathtub and no one tried to change my mind about what my instincts told me to do. No one tried to instill in me a fear of tearing and I did not tear. When my urge to push came after only thirty minutes of visible labor, no one insisted that I must be checked internally before proceeding because that would be silly. No one could have known better that I was ready to push at that moment than I. The cord was around my daughter's neck, but because my labor was not artificially inhibited, she birthed quickly through it, and was fine. I believed that I would labor without pain, and I did. No one ever gave a second thought about my placenta and it came out naturally about thirty minutes after my birth. All this and my daughter was born safely into her father's loving hands.

None of this would have been acceptable to the Birth Center midwives who pushed and pulled at my first daughter's placenta only minutes after the birth, causing me to bleed and require three days bed rest, denying me the right to relax and enjoy my new baby. They actually gave me pitocin and put their hands inside me to get my placenta, because they refused to wait more than five minutes for nature to do her work! During labor, I was told constantly that the noise I was making was inappropriate. I was frequently checked vaginally and treated for an unruly cervical lip. I was made to get out of the bathtub, which was the only thing that had made my intense labor bearable, to suffer an excruciating second stage. Despite all of the talk during prenatals of finding comfortable labor positions, I ended up pushing my baby out while lying on my back. While I pushed, one of the midwives stuck her finger under my clitoris as my baby's head crowned. I screamed at her, Stop! You're burning me so bad! And she had the balls to say, in a patronizing tone, Don't push my hand away! After all that, I was persuaded to endure stitches for a minor tear. Those stitches, whose insertion stole even more time and peace from my daughter's first hours, popped out three days after the birth. Ironically, my poor bottom healed perfectly without them.

Two weeks prior to the arrival of my second child, I was faced with the decision of whether or not to discontinue service with the midwife who had provided me with prenatal care and whom I had planned to invite to my birth (we'll call her Donna). At my very first prenatal I had brought in a written birth plan explaining my wishes in detail. My husband and I made clear in conversations with Donna that we were interested in a hands-off approach to our birth. I was so confident that I would birth quickly and painlessly that I expressed doubt that I would even need to call her, going so far as to ask about her refund policy, in the case of precipitous labor.

For eight months Donna appeared fully supportive and respectful of our wishes, but as my due date drew near, it became clear to me that she truly felt otherwise. She began to state frequently that she would feel responsible for anything that went wrong during my birth if she could not arrive in time to fix it. She also hinted that she was not comfortable letting me be responsible for my own decisions. When my car broke down and I was casual about rescheduling a prenatal, Donna treated me like a child, making comments like, You have to have a prenatal soon! Her tone implying that she felt I was being irresponsible by not letting the expert assess how I was doing. I realized later that this was a red flag, signaling to me that she would feel free to use the same condescending attitude to influence me while I was in labor, too. The straw that broke the camel's back was when midwife friends of mine began revealing things Donna had said behind my back. She was telling the local midwife community that I had the crazy idea that I was going to birth alone, but that she was confident that I would wimp out when the pain of labor became unbearable and call upon her to deliver me.

The day before I actually fired her, I called Donna to try to resolve our apparent differences. In a fit of desperation, Donna went so far as to lie, trying to convince me that I had had a partially accreted placenta with my first daughter, and that I was therefore more likely to require assistance this next time. I have since been reassured that an accreta is actually an obstetrical disaster (according to medical manuals) that requires hysterectomy in most cases. Donna also told me that she felt I would need someone to remind me to pee, poop, eat and drink during labor. I told her I would remember myself, and she countered that most women forget in the heat of the moment. She was not wrong in her statement: she was simply wrong to insist that I could not be different from other women and be aware enough to know it in advance. At first I tried to resolve the whole matter by suggesting that I could sign something claiming full responsibility for our birth choices. What I eventually came to realize was that a signed paper could not keep her from bringing her destructive attitudes to my birth, and so I fired her.

To be fair, it turns out that Donna had not exactly been in top form. She revealed to me after my birth that she had been going through a divorce. I also found out later that her past three clients had needed transportation to the hospital for post birth complications, which explains why she was so focused on my placenta. Donna once insisted that she had, complete faith in (my) ability and other women's ability to give birth. This common attitude is one of the things that make midwives so desirable, but such a statement is only paying lip-service if birth attendants don't also trust women's ability to know their own limitations.

Some people may consider my experiences unfortunate exceptions to the rule, but I must disagree. The only difference between myself and millions of other women is that I accepted the mistakes the midwives at the Birth Center made, instead of glorifying them as necessities, and took the required, though unpleasant, measures to ensure that my second birth was not hindered in becoming the birth of my dreams. Many midwives truly believe that they know better than their clients how birth should proceed. The trouble is that some therefore feel obligated to manipulate the event according to their training. In the middle of labor, women are very vulnerable, and simply suggesting to a client that she is not competent enough to know her own needs at such a time can easily disempower her. Besides being a hindrance to the entire birth process, this also constitutes a serious breach of trust, and exactly typifies what most women hope to avoid in the first place by choosing the care of a midwife instead of an OB

In this culture healthy labor and delivery is seen by almost everyone as an illness which needs fixing by an expert. A burning building is an emergency situation in which expert management is often truly necessary. In comparison, a healthy woman's labor is not an emergency but is often seen as such. Surprisingly, midwives are known for professing that birth is not an illness, and yet, somehow they are still prone to be controlling.

A midwife friend asked me, If a woman wanted to birth alone, then why would she call a midwife? At first, I thought, well, maybe she's right. Why would she? But then it occurred to me that a woman who wished to birth as nature intended might call upon a midwife in order to reassure herself that she had extra help and expertise available for the asking. Then she could feel confident that she was totally prepared and safe for the very purpose of allowing herself to relax enough to birth safely and naturally without help. The assumption is that the midwife is there to be a reference and assistant, rather than deliverer and manipulator in labor.

One might wonder if there would be any point at which I would accept intervention in my birth. My answer is that, were I to become fearful, I would monitor my own baby's heart rate and agree to non invasive tests with the guidance of a trusted midwife or doctor to reassure myself. If those tests proved convincingly that we were in trouble, I would agree to life-saving intervention as the situation required. Even though I advocate complete parental acceptance of responsibility in birth, a high level of education is advantageous in enabling parents to differentiate between necessary and frivolous intervention. No human ever comes to a point where they qualify as an absolute authority on anything, so there also comes a time at which we must rely on faith. My feeling is simply that earthly experts don't qualify for the amount of faith so frequently placed upon them by the average American parent.

Midwives and medical professionals alike should serve as no more than consultants to their clients. Any time midwives or doctors insist on doing anything their client finds unwelcome, they are overstepping their bounds. The reason my husband and I are comfortable accepting our full responsibility in birth is that we are both highly educated about birth and complications (though not formally trained). My girlfriend happened to be a trained midwife and childbirth educator as well; however, she never acted in that capacity in my birth as per my wishes. I think that if my type of homebirth sounded attractive to someone else, they could also easily gain the proper education. After all, midwives are human, just like the rest of us, with training. Parents can ask their midwife to train them during their prenatals. All childbirth attendants should prepare their clients for emergency delivery anyway, since sometimes they don't get there in time. Most midwives have someone come rub their backs etc. when they are in labor. The difference is that their attendants trust their abilities and knowledge.

Birth attendants should not wait to change until women begin demanding their rights, however. When a woman in labor timidly asks, Is this procedure necessary? the truthful answer should be No. It is unethical misrepresentation for any caregiver to presume to be able to decide for a family the necessity of any intervention. In birth and medicine there are many life or death decisions. Morally, those decisions should be left to the families who will be living with the consequences for the rest of their lives. Midwives who assert that they must do anything to or for their clients are accepting more responsibility than is right. Any hesitation on the part of caregivers to explain their proposed actions should call their motives into question. If a caregiver has legitimate reasons for her suggestions, she should have no trouble convincing parents to follow her recommendations, and any caregiver who is uncomfortable with her client's wishes should politely resign from that client's service. For obvious legal reasons, release forms should be used more frequently to remind parents of their responsibility and emergency protocols should be set and agreed upon early on in pregnancy.

The field of healing arts would be no less noble if caregivers of all kinds would subscribe to the philosophy, The customer is always right. The consequences of ignoring this notion are great. When a woman has her legs spread out before you and you do anything that makes her uncomfortable, that is sexual misconduct. When you do something that makes her scream, that is sexual assault.