This was quite good. Catherine decided, between pregnancies, to write a book on midwifery, so devoted a year to following some midwives around and documenting her observations. Hospital-based midwives, homebirth midwives, lay midwives, certified nurse-midwives, midwives of all types and personalities. During the course of her research, she got pregnant, and she weaves in the story of her own pregnancy and birth with the stories of the women she’s observing.
The most interesting part of the book for me was how Ms Taylor herself changed over the course of her year of research. She started out very pro-hospital birth. A midwife in a hospital working under a doctor is the best of both worlds, she thought. (And I know many who share this opinion.) But by the end of the book, she’s decided to have her own baby at home, in the water, with two CNMs onhand, and seems convinced that, for women who are comfortable at home, it’s the best place for a normal delivery. The book’s purpose is not to convince anyone of anything, but rather to give some insight into the world of midwifery, the variety of midwives out there, how they are similar to and different from one another and from OBs, the different settings in which they practice, and their differing beliefs about how birth should progress.
It’s a very easy read, written in a leisurely narrative. I finished it off in just over one day.
I marked a few particularly interesting (to me) passages.
1) Ms. Taylor has just asked one of the hospital midwives about the increased use of epidurals. After commenting on a few other things, the midwife says “I think increased epidural use might have something to do with the fact that we don’t think that we should have pain in this modern world. Most of the women we see don’t generally challenge themselves physically. They are sedentary, and they aren’t familiar with physical pain. But I think a lot of it is that we’re all so stressed out that we just can’t handle any more pain. It’s funny, at a time when there are so many conveniences, why are we all so stressed out?” Then later, she comments, “The increase in analgesia and anesthesia use may be related to our own pain as midwives as careivers. It would be interesting to do a study that tried to see if epidural use was in part because we, and the nurses too, don’t want to deal with mothers’ pain. I’m not proud of this, but it’s true. When you’re with a laboring woman, sometimes it is hard to bear her pain. And we see so much, volume-wise. It gets to you. So now, with epidurals, we don’t have to bear their pain.” (p59)
2) Ms. Taylor is now talking to a homebirth midwife, who says, “The moms come out with these stories like ‘Oh, my birth was so great. They let me walk around.’ And I mean who’s in charge here? Look at where the power is in that sentence. ‘They let me use the bathroom.’ ‘They let me hold my baby.’ But to the women, that was a wondeful birth experience, because in their last one maybe they got cut with no one asking her permission, or they weren’t allowed out of bed, or they had to be catheterized, or their baby was taken away immediately. For me, it’s hard. I know in one part of my heart that that’s progress, but I’m also kind of sickened by how little progress that is, and I’m sad that women put up with it.”
3) Ms. Taylor is at this point visiting at a women’s clinic in Taos, NM. (which was interesting since I finished this book the day before heading to Taos myself!) The midwife in charge at the clinic has fought tirelessly for years to improve the birthing woman’s experience in her community, and she has made progress, but it’s been difficult. In a twist on the usual, her midwifery clinic has recently hired two OBs to work for them. (Normally, of course, doctors hire midwifes to work under them.) Her name is Elizabeth. “Elizabeth insists that, as a nation, we need to be asking some basic, logical questions. ‘Why don’t we care that mothers and babies are dying at greater rates in the United States than in so many other places? If we know that outcome-based care does reduce maternal and infant mortality, can we talk about why we refuse to go there? Do we care about mothers and babies?’
“Elizabeth is confident that change will come, slowly but surely, through education, saying that it isn’t a matter of opinion vs science, but of making the data known. ‘I mean, obviously, the science isn’t improving across the board,’ she says. ‘In 1989, our maternal mortality rate in the United States was around 8 deaths per 100,000; it has actually risen to 10 per 100,000! Some people would argue that we’re counting it better, but in any case, we haven’t improved. Not only have we not improved, but nobody’s objecting. Maybe they don’t know. Maybe they don’t know that, statistically, you should have your baby in Japan or Spain if you want a better outcome.'”
I really liked this book, but it does have one major hole in it – there is hardly any mention of certified nurse midwives who practice independently at hospitals and in homes. Ms. Taylor follows CNMs who work for hospitals and HMOs, and she follows lay midwives who work independently. But there is no mention of CNMs who work independently, beyond Elizabeth and her clinic in Taos. Maybe Des Moines is unique in this aspect, that we can choose among CNMs who are employed by a hospital, CNMs who work independently and do primarily homebirth, CNMs who work independently and do primarily hospital birth, and lay midwives who do only home birth. We have a wealth of choices here, when you stop to think about it. (The only thing we don’t have, that they do have in the book, is lay midwifes who are acknowledged by the state and allowed to practice legally.)
If you want to get a copy of this book, our local chapter of ICAN is selling it as a fundraiser.
Another good book, an easy read, written in a gentle narrative format and very short chapters. And another story of a woman’s transition from preferring birth in a hospital setting to seeing birth as normal and uneventful and perfectly suited to a home setting. Penny Armstrong completed her midwifery training in Scotland and worked there for a while before coming back to the US and completing a training program here to obtain her US credentials. After looking down at homebirth for a number of years, one day a call came to the hospital where she worked that a rural doctor wanted to hire a midwife for his clinic. On a whim, she took the job, which involved helping the largely Amish population of the rural Lancaster County, PA deliver their babies at home.
The book is largely just what the title suggests – the story of one midwife, and also of the women whose babies she delivers. It also provides wonderful insight into the world of the Amish as Ms. Armstrong slowly adapts to their ways and comes to admire and respect the Amish people with whom she works.
One of my favorite passages in the book has really nothing to do with birth. Ms. Armstrong is explaining about how the Amish think about technology. (Her story will then relate to a situation that arose with the birth of one of her clients.) She says “Most of all, an Amishman wants to protect his faith, keep his family close, keep his ways, keep humble before God, be a steward of the land, and make a living. If ne needs a technology to allow him to continue, then maybe, he’ll say, taking a long time to decide – debating the matter with his brethren – maybe he’ll use it; but if it gets in the way of faith, family, and stewardship, then he’ll stop thinking about it.”
We could all stand to put technology in that light, I think.
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