How incredible is this?! Singing Tree Midwifery was named Best Midwife in North Texas in the February issue of North Texas Child. There are so many dedicated and gifted midwives in our area. It is an honor to be counted among them.
Despite all the training that prepares midwives to spring into action for any number of reasons (the kersplash of your water breaking, the 2 a.m. phone call, the absence of coffee) we spend a lot of time just, well, waiting. It’s a bit reminiscent of pregnancy itself.
It can be hard to wait patiently. It can feel as though, as you wait, nothing is happening. But so much is happening. There are worlds spinning and suns rising, all in the spaces in between our noticing. Midwifery, in many ways, is about learning to notice all that is happening in those in-between spaces.
You feel a movement and breathe deeply, taking a step closer, inside your mind, to being ready. Your baby hiccups and wiggles, growing. You prepare your nest with diapers and receiving blankets and a digital thermometer. You think about ring slings and car seats and wonder what breastfeeding will feel like.
I pack my birth bag with all the supplies we will need to keep things clean and safe and quiet(ish) for your birth. I read over your chart. I replace the batteries in my flashlight. I check the bag again.
You dream about your baby’s face. I say a silent prayer for you to feel strong and ready. We both plan, and wait, each in our own way. And when the time comes, we will also wait together.
You will rest in between contractions, sometimes almost sleeping. I will sit beside you, or maybe in the next room. Long minutes will pass. Even long hours may pass as you labor, and even in the activity of this final part of the waiting, we will both still be waiting.
What a build-up! What suspense! There are few occurrences in life that are so poignantly and excruciatingly anticipated.
It takes a long time to have a baby – months of prenatal appointments, weeks of discomfort, hours or even days of labor. Perhaps, aside from the obvious biological reasons, this is because in order to experience a life change so magnificently great, we must also experience great changes within ourselves.
Because during all that time that we weren’t doing much, while I was waiting with you, I was also keeping an eye on you. And in that time, you changed as much as your tiny baby changed while growing inside of you. You became even stronger, wiser, more intentional, more informed, calmer, and ready. During the spaces in-between work days, appointments, meals, and laundry, you became a mother.
And when my time of waiting with you comes to an end, I will send you off with so many hopes and dreams and blessings. As you wait for your baby to sleep through the night, may time go fast enough for you, but not too fast. As you wait for just enough independence to have a date night or a day off, may the waiting be short enough but not too short. As your child grows and the years begin to slip by, through the spaces in-between, may you notice those spaces sometimes, and slow down, and really taste, no, savor, the waiting.
Perhaps it is in the spaces between events, in the waiting, that the sacredness of creation resides, breathing and being and making life. May we be blessed to glimpse it sometimes, but especially when creation is happening within us. And may each of us have a patient soul with a keen eye fixed upon us, so that we never wait alone.
Redefining Maternity care Within the Natural Birth Movement
It’s tempting for midwives, in a world where anesthetized and often surgical childbirth is the norm, to promise mothers an empowering birth experience. Midwives would love to ensure that all their clients’ needs and wants, both physical and emotional, will be met, and that their sweet babies will slide out of their bodies and blink up at them as choirs of angels sing and their partners tear up in wonder at their strength, power, and pure beauty. We want to say that natural childbirth is going to be incredibly empowering. It’s so very tempting.
Why? Because midwives see all the brutal things that happen to women within the high-tech, high-volume medical model, and we know that it rarely needs to be that way. We want women to know that they can mitigate the risk of what writer Sarah Blackwood calls a monstrous birth (“Monstrous Births: Pushing back against empowerment in childbirth,” The Hairpin, Aug. 10. https://thehairpin.com/monstrous-births-3d666cda5030#.chdyb2a2o) by carefully choosing their birth setting and attendants. We want them to know that their bodies are actually miraculous, and that birth can be transformative. But the promise of a transformative experience does not guarantee any particular or expected outcome. Transformative means that it will change you, not necessarily that it will bring you any kind of heightened sense of power over your experience.
Here’s the truth. Childbirth is grueling. No matter how many times you read Orgasmic Birth (by Elizabeth Davis – I recommend it!) and visualize giving birth in an outdoor hot tub beside a rustic mountain chalet while the sunrise peeks over a distant, pastoral meadow and unicorns frolic in the yard, childbirth is going to take everything you’ve got.
Normal, perfect childbirth, which occurs on its own in a large majority of healthy low-risk women, is intensely challenging, both physically and otherwise. And once in a while, things go sideways and everything in the birth plan slips through your fingers like sand. Hospital transfers happen, emergency C-sections happen, and birth can be “monstrous.” Even at its best, it is gritty, messy, and exhausting.
I don’t say this to scare pregnant women, but rather to prepare us all for the wide array of possibilities. In life, and perhaps especially at the beginning of life, there are no guarantees. Midwives cannot make your birth go the way you want. We so much wish that we could, but that is not the way of nature.
However, here’s what we can do. We can help you prepare for whatever might come. We can listen to you, and hear you, and respect your informed choices. We can show you through our words and actions that you are wondrous and powerful (in the way of perseverance, not in the way of controlling the outcome) regardless of how things play out. We can encourage you to make healthful choices that will increase your likelihood of having - dare I say it - an empowering birth experience. But what does that really mean?
Blackwood cautions us to beware of the moralizing nature of words like “empowering.” When we equate the natural, mountaintop birth with empowerment, we put a judgement on births that don’t turn out that way. The ones that need an epidural, or “worse”, surgery, are treated as births gone bad. But are these situations really failed experiences at the least, if not failed bodies and failed mothers? When we moralize birth by assuming everyone should try for a natural birth, we assume that there is a right or wrong way to do it, and that if you do it the wrong way, or your birth turns out “bad”, you are perhaps less of a mother, or less of a woman.
Every birth is intensely important and potentially transformative for the mother and those close to her, and the range of experiences is wide. It is possible to accept them all with wonder and awe and appreciation, without judgment. Birth just is, and a large part of its transformative nature is purely the act of letting go of our uniquely human desire to control it.
Of course we can and should be strong, as healthy as possible, and armed with a positive attitude, and if we are going for a natural birth, an arsenal of labor coping techniques. This is one of the places midwives can positively affect the outcome. But we cannot ultimately wield much power over how birth unfolds. Often it’s sweet and lovely, even within the gritty, messy part of it, and once in a while it is a monstrous, injurious thing. When birth is grisly, we should be free enough of notions like “empowerment” to be able to carry our scars like Olympic gold medals.
So I am going to try to steer clear of words that put a positive or negative judgment on birth or the women who give birth. Birth will come, and women are strong enough and brave enough to experience it, whatever it might be. Birth, even mountaintop birth, takes you down to your core, and it likely transforms you into someone you didn’t know before. Someone stronger, wiser, maybe more jaded, depending on how it went down, and hopefully someone more confident and ready for all the trials and joys of motherhood.
I don’t know in advance which births will be a wild ride and which births will be a float down the lazy river. But I believe in women. And I believe that if we embrace the unknowns and make our informed choices with intention and acceptance, we will gain something precious in the process. Your midwife cannot guarantee any particular course for your labor. But she can look into your eyes and know that how you are treated during this journey matters. She can employ her knowledge and skills to make course corrections along the way that will probably decrease the need for interventions. She can respect your informed choices and stay with you as the outcomes of those choices and the mysteries of your birth unfold.
What are your thoughts on empowerment in childbirth? I welcome your comments!
It has been a busy summer preparing Singing Tree Midwifery for its new home at the NEST in Addison. I am so happy to have a beautiful place to hang my shingle and provide parents with choices for where they receive care (my office or their homes).
The NEST is like nothing else available in DFW, because pregnant mamas and families at all stages can find so many resources under one roof: midwifery care, prenatal and newborn chiropractic care (and chiropractic care for the whole family), doulas, ultrasonography, prenatal massage, birth pool rentals, belly binding, placenta encapsulation, and the best natural parenting retail store in DFW, the Nappy Shoppe!
There will be classes for the community on childbirth, breastfeeding, parenting, car seat safety, baby wearing, and all kinds of things. So many resources in one place is a sure fire way to build community for and with the families that I serve, and I could not be more excited.
Please stay tuned for pictures and updates as we begin our remodel/office set-up in early August. Singing Tree Midwifery will soon be ready to see clients at the NEST!
I have a cousin who is very dear to me who is a wonderful obstetrician. Back when I was first working as a doula, fresh-faced and mesmerized by the magic of birth, I would pummel her with questions and beg her for stories every time I saw her.
Since then, I have completed over three years of midwifery school, including clinical training with three Certified Professional Midwives and one Certified Nurse Midwife. I have attended well over 100 births and caught dozens of babies. I have led or participated in a handful of infant resuscitations, two of them being difficult. I have assisted with a handful of shoulder dystocias, all successfully resolved. I have seen lots of variations of normal, and I have not yet been involved in a bad outcome. It’s not a lot of experience, but I feel that it is a respectable level of experience on which to build, for a licensed midwife such as me, who practices carefully and thoughtfully, and who only attends births in the company of two licensed midwives, as do most midwives in my area.
I have held hands with mothers, hugged dads, cried with grandmas, sung with sisters, done middle-of-the-night food runs, and given gifts to big sisters and brothers. I have watched SO. MANY. MOTHERS. realize that they are so much stronger than they knew. I have seen them discover their babies and fall in love, knowing that they have everything they will need already within themselves. I am a new midwife, with a brain full of the latest obstetrical information on normal birth, variations of normal, and complications. My hands are confident but not yet lined and softened with the memory of a thousand babies. I am still fresh-faced and mesmerized by the magic of birth, and I still have much to learn.
Recently my cousin posted some comments in support of an article written by a non-practicing OB, which claims that birth is dangerous, that home birth in the US is unsafe, and that the Certified Professional Midwife designation (my designation) should be categorically abolished. Most of the assertions in the article are actually untrue. It hurts me, because it attempts to negate everything I have been doing with my life, everything I have believed in and fought for, and my future life’s work.
But misunderstandings between OBs and midwives are a common theme in the divisive, never ending discussion over birth choice in our country.
Why am I writing about this here? Because I really believe there are good points on both sides of this tiresome debate, and I love my cousin and want to promote mutual understanding rather than disharmony in a profession that should exist to promote safety, informed consent, and justice for women, babies and families, in a unified way.
Some OBs may think midwives practice unsafely because they only see them when the birth process goes awry. It is human nature not to think about the other 90% of births attended by that midwife that the OB never even knows about. But the fact that a midwife comes in with a mom who is having late decelerations is not a knock on the safety of home birth. It is, in fact an example of a system that is working.
How so? Well, even though birth is generally safe and usually doesn’t require much intervention, sometimes things go wrong. Mothers who birth outside of hospitals know that, and choose out-of-hospital birth anyway, because they know the risk is small, and they trust their midwives to transport them to safety if something does go wrong. (They also know there are tremendous potential benefits to birthing outside the hospital for them and for their babies, and they have also been meticulously pre-screened and judged to be at low risk.)
But since complications can still arise, it is critical that midwives recognize problems and decisively initiate the next level of care when indicated. The next level of care is likely a highly trained physician, such as my brilliant cousin, who specializes in just this type of thing. I have no doubt that my cousin has saved lives with her expertise. I am so grateful for her and the work that she does. Without OBs like her, without such a safety net, out-of-hospital birth, and all birth, would NOT be as safe.
I think we could all agree that the systems within a community that support a seamless transition from birth center or home to hospital are critical to home birth safety. Midwives need to know when to transport and all involved caregivers – midwives, EMTs, charge nurses, and OBs - need to communicate effectively about the situation without wasting time blaming, accusing, defending, or refusing to listen.
Knowing that there will always be families who choose out-of-hospital birth, we should all be making sure we have a system in place to maximize their safety. We should all be working to improve communication and understanding between midwives and the experts to whom we need to transfer care at times.
Most midwives I know, and I know many, respect obstetricians and urgently desire more positive relationships with them. We know we will need to transport in labor at some point, and we will do so when the time comes, but it would be really nice if we could do so without the OB or hospital filing a complaint against our licenses and without risking our families’ livelihoods and our professional reputations. Needing the next level of care happens. It’s part of birth. It doesn’t mean the midwife did something wrong; rather her recognition of the problem and her decisive action shows that she did exactly the right thing.
The OB who wrote the article my cousin posted doesn’t respect Certified Professional Midwives and really wishes they would go away and we could all just go back to having our babies in the hospital where it is “safe.” She is well known and generally ignored, and she devotes much of her life to attempting to destroy the midwifery profession. But here’s the thing. We can debate forever about where women should give birth and what the benefits and risks of out-of-hospital birth might be. But there will always be women who just don’t want to have their babies in the hospital.
Calling for the abolition of an entire professional designation and making divisive, inflammatory statements about other people’s choices is surely not helping. Citing only studies that support one’s point without mentioning all the other studies that support the opposite view is deceitful. Propagating distortions of fact for the apparent cause of removing women’s choices is hurtful. Claiming that there is only one right answer and that you are on the right side is hubristic.
I think there is a better way.
I am not a surgeon (although I do suture minor perineal or labial tears.) I am not the expert at resolving major complications of pregnancy and birth. If I had wanted to be, I would have needed to devote many more years to study and practice, as my cousin has done. And so I thank all the OBs out there who have devoted their careers to this excellent and necessary cause.
I would just ask that in turn I might be allowed to exist without persecution. That my fellow CPMs who also care about women and babies and safety in birth might receive a warm welcome for our clients’ sake, when we come in for that inevitable transport. We can work toward building a level of mutual respect, for the sake of smooth and safe transitions, if not for the midwife, at least for the birthing mothers.
I get that it is exasperating to receive last-minute, problematic patients. I get that sometimes the midwife should have moved faster. I’m sorry for that, but I know that happens from inside the hospital, too. We are all human. Nevertheless, it probably feels like being expected to clean up somebody else’s mess. I wish it didn’t feel that way. But couldn’t we all improve this scenario by talking with each other a little more? Let’s create availability for consultation and the potential for midwife/OB co-care in certain, appropriate cases.
We may never all agree on how birth should happen. After all, the traditional medical model of obstetrics is born out of a very different world view from the Midwives Model of Care. Maybe that’s okay, because we are all necessary for the mothers and babies and families. We are not in competition, after all. We serve very different patients with very different needs, except for those rare times when our two worlds meet. There are enough mothers and babies for all of us. Let’s coexist without negativity and slandering, at the very least. And perhaps we could consider working together more.
Here are some studies on home birth safety that provide an alternative viewpoint from those cited in the article.
Oucomes of Care for 16,924 Planned Home Births in the United States: The Midwives of North America Statistics Project, 2004-2009
Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America
Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada, 2003–2006: A Retrospective Cohort Study
If you are an obstetrician or a medical doctor who cares for women during the childbearing year, please consider attending a few out-of-hospital births as an observer. Please go out to lunch with some midwives. Ask them about their experiences and tell them about yours. Explain what you need from them in a transfer situation. Promote understanding and mutual respect.
CPMs are real people, with families and a deep passion for their work. They want to do right. If you are worried they aren’t succeeding, then be part of the solution. This forever debate doesn’t have to be persecutory. It can become a place of learning and ever improving patient care.
The phrase “each one, teach one” is an African proverb that was used in the United States during slavery, when Africans were denied education. When an enslaved person got the unusual opportunity to learn to read, it became his duty to teach someone else. This is one of the things the early African-Americans did to lift themselves out of the oppression in which they found themselves following their mass abduction and enslavement.
Today, a small percentage of Certified Professional Midwives or Licensed Midwives are African American, but African midwives predate the country itself (the first African midwife came here in 1619.) Black midwives assisted women in labor throughout the slavery period of U.S. history. They were called “granny” midwives, or grand midwives, and they were much needed and highly respected within their communities.
Today’s midwives have inherited a rich tradition of caring for women and communities from the African-American midwives who came before us. Perhaps this legacy is related to the “each one, teach one,” approach that is still widely used, with the apprenticeship model, in midwifery education today.
I owe much of my knowledge and all of my skills to the dedicated midwives who taught me during my apprenticeships. Someday, when the time is right, I bet I will feel a duty to pass the torch in turn.
It’s a lovely thing to share the art and science of this important work with others. So when I had the chance to help teach a class on birth assisting with a fellow midwife last weekend, I was thrilled. The fresh, lovely faces of these dedicated new birth workers were inspiring to behold. They gave me a pretty sweet gift - a chance to be on the giving side of each one, teach one. I wish them all a wondrous journey in this work.
Housecalls are lovely, and when you’re pregnant, it can be such a relief to know that your midwife will come to you for your prenatal visits. No need to get dressed in “leaving the house” clothes, and no gathering up kids, packing up all the stuff, or fighting the clock. You can just relax and enjoy a friendly, no-judgement-about-the-stains-on-the-couch talk, with your super supportive midwife.
But even though your prenatal home visits definitely don’t count as “company,” sometimes you really don’t want ANYONE coming over, am I right? And sometimes you are on your way home from work or errands, and it’s just easier to stop by your midwife’s office while you are out.
I’ve been setting up a little space for you so that you can have options for where you receive care. Swing by my office and I’ll put the tea kettle on!
Or if you’d rather, stay home in pajamas and I’ll come see you. I have three messy boys of my own, so if you have clutter, sticky counters, or dust bunnies, I truly won’t even notice. Midwifery care is all about having choices. So, my place, or yours?
My son has this little stuffed bear. He’s been through some rough times. By rough, I mean that the dog has savagely attacked him and torn out his eyes, on multiple occasions. Every time this happens, my son brings the bear to me, and when I eventually get around to it between working, feeding children, and walking the savage dog, I sew on some new button eyes. This bear must be on his fourth set of eyes. This is a broken little bear.
Recently a dear friend of mine had an experience like that – the kind of experience that leaves you broken. My heart has been aching for her, as I’ve struggled for words of comfort to help her begin to heal. You see, the whole idea of actually healing from an injury this terrible can seem like a cruel lie. When you have been hurt so deeply that you feel as though your very fibers are torn asunder and you are plunged into darkness, the truth is, you can never be the same.
For example, you know how when mothers have miscarriages, sometimes well-meaning loved ones will say “It will be okay. You can try for another baby.” Yeah. No.
Loss is loss, whether it's losing a baby or experiencing any other trauma. It cannot be erased, or made up for, or made “good as new.” These experiences change us. I don’t want to lie to my friend by telling her otherwise.
But here’s the thing. In time, the darkness will fade, as we are somehow given new eyes to see. They will not be the eyes we started with, and this may cause us to see things differently.
This funny little bear came with shiny, spherical eyes, complete with pupils, in a warm golden brown color. Now his eyes, at least for this month, are a very bright robin’s egg blue. He has also had his face reconstructed with some tan felt. We will never be the same as we were.
But here’s the other thing: my son has a 3DS, an empire of Legos, and several other things that modern kids love, but it’s the bear he loves the most. This worn old bear gets tucked tenderly into his own special spot to the side of my son’s pillow every night. I doubt that any level of injury could change that. My son is pretty steadfast.
I think it’s the same for my friend, and for all of us. The goal is not to claw our way back to where we were before tragedy befell us. The goal is to wait in the darkness, and, eventually, learn a new way of living and being, as changed people.
Many of us are broken bears. Brave, soft, broken, repaired, broken again bears, who are deeply, unwaveringly, loved.
The notion that midwives like herb gardens (and gardens in general) is kind of a stereotype. I don’t know if it’s really true. I will say this though: I was never really into gardening of any kind, until I became a midwife.
As the trees leaf out and flowers pop up in front yards around the neighborhood this time of year, I find myself taking, and really savoring, more deep breaths. I also find that the more I work with mamas, dads, babies, and families – the more time I spend around pregnant women and the potential and wonder of their growing babes - the more gardening feels really good, and, well, meaningful.
I’m not actually knowledgeable about gardening at all. And while I’ve taken classes and read books about growing, harvesting, and using medicinal herbs, I’m still mostly a beginner. But even though more knowledge and experience will hopefully increase my success in the future, it’s really more about the process for me.
For now, it is quite astounding to put a seed into some soil and see green, tiny shoots push themselves up into the air and light.
It’s such a simple thing: a seed, dirt, water, and sunshine. And yet it creates magic. I guess simple things can sometimes be the most inspiring. It’s clearly a metaphor for midwifery. From the careful tending, to the waiting and more waiting, to the purposeful and loving harvesting of a mature herb, growing herbs (or vegetables, or whatever) calls to me just as a laboring mom draws me like a magnet, to soothe her with a cool cloth, to squeeze her hand, to reassure her.
I know that I won't, and could not, make these plants grow anymore that I can do the work of labor and birth for a mother. They do all the work of growing. But I can tend, guard, nurture and wait with them. You see, even though midwives do know an awful lot about physiology, pregnancy, labor, birth, postpartum care, newborn care, and lots of other things related to the childbearing year, most of what we do is the simple stuff: nurturing, tending, and waiting. These things come fairly naturally to many midwives, perhaps because midwives love their clients the way a gardener loves his plants. Not in a weird, lack of professional client-caregiver boundaries kind of way, but rather in a deeper, love for humanity and respect for the sacredness of motherhood kind of way.
Anyway, tending herbs and other plants is good practice for midwives. The flowers are beautiful and uplifting. The culinary herbs are fragrant and sustaining. The medicinal herbs are nurturing and supportive. If you are one of my clients, I'm sure at some point I will offer you a nourishing pregnancy tea. Hopefully it will be made from herbs that I've grown for you and harvested myself.
It’s difficult not to feel optimistic for the future when you are working outside with plants, just as it’s hard not to feel blessed to hold the fresh, delicious beauty of a newborn baby in your own hands, or to feel grateful and humbled when a dear client says, “I did it!”
All birth is astounding. May we all be restored by the verdant new life that surrounds us now. Happy spring, everyone!
Kassia Walcott is a Texas Licensed Midwife, Certified Professional Midwife, and lover of mothers, babies, children, animals and nature. A homeschooling mother of three, she lives in Plano with her family, pets, and herb garden, where she loves to read and drink too much coffee.