ImprovingBirth.org is made up of mothers and those who care for us. Many of our members have received excellent care from all kinds of care providers—obstetricians, family doctors, and midwives. But today, we’d like to talk about our appreciation for midwives, who attend 8.4% of U.S. births. This article is from ImprovingBirth.org Secretary Rebecca Dekker, PhD, RN, APRN.
So how did a midwife change my life? Eight weeks pregnant with my second child, I was desperately looking for something, for someone different. I had had a somewhat traumatic experience with my first birth. During that birth, I was pressured into a host of medical interventions, none of which were necessary, and some of which led to complications. Unfortunately, I was not given full, accurate information about these interventions beforehand. In other words, I did not give true consent for what was done to my body and my baby.
At first, in the glow of new motherhood, I was satisfied with my care. But afterwards, I began to wonder– was the care that I received evidence-based? I am a nurse researcher, and I already knew that evidence-based practice is the gold standard in medicine and nursing. But I wondered…what was the evidence for everything that was done to me during labor? So I started looking it up. I was shocked when I found that almost all aspects of the care that I received have been shown by solid research evidence to be harmful to healthy women who are giving birth.
So you see, this time around, I was determined to find someone who could offer me high-quality care that was based on research evidence… someone who would give me my best shot at an evidence-based birth. I knew, instinctively, that at least for me, that person would be a midwife.
A midwife! Do you know what? My healthcare insurance did not cover a single midwife to attend births or provide prenatal care! It was astonishing to me, that I lived in the state that is considered the birthplace of nurse-midwifery in the U.S., and yet there were very few midwives available to serve the women living there. Can anyone guess what state I lived in?
You guessed it, Kentucky.
In 1925, Mary Breckinridge founded the Frontier Nursing Service in Kentucky. This was the first organized midwifery service in America. Back then, these midwives were known as “angels on horseback,” because they traveled to serve rural Kentuckian women by horseback. I found a Chicago Tribune article about the Frontier Nursing Service and the history of nurse midwifery in Kentucky. When Kitty Ernst (former president of the American College of Nurse Midwives) first joined the Frontier Nursing program back in 1951, she was quoted by the Tribune as saying, “When do I get my horse?” Apparently they told her that if she wanted to get a horse, she had to become a nurse midwife and get her own district. And that’s what she ended up doing!
Back in 1925, when Mary Breckinridge started the Frontier Nursing Service, this was a very difficult time in Kentucky in the lives of the people. These nurse midwives filled a need we had for healthcare in a way no other profession could have. But today, nearly 90 years later, there are only 85 licensed midwives practicing in the entire state of Kentucky, who attend just 5.8% of Kentuckian births (below the U.S. average rate of 8.4%).
In fact, Kentucky has a climate that can only be described as hostile to midwives:
- Out of 120 counties in Kentucky, women only have access to licensed midwives in 34 counties. In Leslie County, where Frontier Nursing Service was started and where Frontier Nursing University is still located, there is only one licensed midwife living there.
- The Kentucky Medical Association has actively fought to keep tighter prescription restrictions on nurse practitioners, which limits the ability of nurse-midwives to practice in rural, underserved areas.
- This spring, Mary Carol Akers, a highly respected nurse midwife who has delivered more than 6,000 babies, sought approval to open Kentucky’s first birth center. Yet 3 local hospitals and physicians testified in court against the proposed birth center. They said in media interviews that they don’t want to collaborate, deal with any emergency transfers, or have competition. The case is still being deliberated by the court.
- Currently, Kentucky does not issue licenses to Certified Professional Midwives, who attend most of the home births in our state. There are only 2 licensed nurse-midwives in Kentucky who attend home births… so most families who choose home birth end up hiring unlicensed midwives. Families in Kentucky are trying to change this situation for the better, but they face an uphill battle and need our help.
It was in this climate in Kentucky that I was determined to find a midwife to attend my second birth, and find her I did. It was a search that ended up changing my life.
With my midwife’s encouragement, I took a Hypnobabies class to prepare from my birth. I ended up having an almost completely pain-free birth in the water at home, attended by 2 midwives. No, I’m not making this up: pain-free labor for 11 hours, with only about 15 minutes of pain at the end.
I was so inspired by my birth experience—made possible by my midwife and achieved by me—that 4 months afterwards, with a baby in my arms, I started blogging at Evidence Based Birth. My goal was to simply get the research evidence out there so that other moms could read it, understand it, and use it. Over the past year, through the power of social media, the web traffic to my fledging little blog grew more than 3,000 percent so that now, 12 months later, I have 6,000 followers on Facebook—mostly moms who are trying to figure out the research evidence for their birth options. Much of this came from the simple fact that a midwife helped me get the evidence-based care that I wanted and needed.
And so if you are a midwife reading this, I want to thank you, to thank all of you, for entering this profession, for serving mothers and babies and families.
To my own midwife, I would like to tell her “Thank you for giving me options. Thank you for giving me and my baby evidence-based care. Thank you for giving me accurate information so that I could make my own, empowered healthcare decisions. Thank you for helping me to believe in myself, to believe that if I can birth a 9 pound 2 ounce baby, then I can do anything!”
And yet, I felt like my simple thank you needed more. So I asked my friends on Evidence Based Birth Facebook page what THEY would say to thank you, if they could be here today, as a mom, speaking to midwives. This is what they said:
“Thank you for caring for me and my baby during my pregnancy and delivery. You not only helped to bring a precious new life into the world, but also held my hand through my right of passage into motherhood. For this, I will be eternally grateful.”
“Thank you for not making me feel like a diseased freak. Pregnancy is not an illness!
Midwives understand that.”
“Thank you to your families, who share you with us during family dinner, birthday parties, holidays, anniversaries, and any number of special moments. We recognize the great commitment you and your loved ones make together to enable you to bless us with your skill, compassion, and presence.”
“Thank you for being the cheerleaders for women, thank you for telling us ‘you can do it,’ ‘not long now’; thank you for believing that our bodies were designed to give birth,
thank you for making birth ‘woman centered.'”
“Thank you for your light. Your love. The energy and gentle touches. Thank you for seeing me, believing in me, and trusting me, my body, and my baby. Thank you for your intuition. For holding my sacred space.
I love you.”
So that is my thank you to midwives. And now, for the second part of my message… What can we, as mothers, do for midwives?
As you all know, we have reached a full-scale crisis in maternity care. And as a country, we are beginning to realize that we spend a lot of money on maternity care, with not very good outcomes. Midwives are a part of the solution. And yet… midwives can’t do this on their own. Midwives can’t fix this broken system… no single care provider could do it, no single healthcare profession could do it. Midwives can’t save the maternity care system, and they can’t save American women FROM our broken system. And yet, the conversation always seems to be in this framework of “What’s best for women?” and “How can midwives preserve the profession of midwifery for women?” and “The word midwife means ‘with woman,’ what can midwives do for women?”
But what if that’s the wrong conversation? What if we had a paradigm shift in the way we think? What if in addition to midwives being with women, women stood up to be with their midwives?? What if mothers in the U.S. stood up for themselves, all together, all at once? What if women decided to preserve and promote midwifery? What if women began asking, “How can I stand up for myself? How can I stand up for my midwife? How can I support her, and stand up with her, so that she can support me? How can I demand access to midwifery care, demand evidence-based care, and demand my right to be the decision-maker in my own birth?”
That, beloved midwives, is what the mothers at ImprovingBirth.org are doing. We are gathering together, all over the country, to stand up together on Labor Day, to say, “We have a problem in this country, and we believe that we can do better. We want evidence-based care at our births. We want respectful, humane maternity care. We want access to Vaginal Birth after Cesarean. We want our care providers to give us accurate, unbiased information about benefits and harms, so that we can be the decision-makers at our births.
Last year, Dawn Thompson, a mother of six, organized the first annual Rally to Improve Birth on Labor Day. She was flying by the seat of her pants. With just a few short months of planning, she got nearly 10,000 women and those who cared for them—fathers, children, doulas, midwives, and others—out on the streets all at the same time, all over the country in 110 cities, to spread a unified message: We need to improve birth. We can do better.
I was so impressed by this Rally and its message that I jumped at the chance to join the board of directors when Dawn asked me to be a part of ImprovingBirth.org. This year, the energy is palpable. Using the power of social media, we plan to double the number of participants at this year’s Labor Day Rally. You really cannot underestimate the power of social media. As Amy Romano, an amazing nurse-midwife, once said about social media, “This massive, complex, unplanned, unprecedented, and spontaneous medical empowerment of our lay citizens may turn out to be the most important medical transformation of our lifetimes.”
So yes, massive, unprecedented, spontaneous. That is how ImprovingBirth.org got started. It was a little helter-skelter at first, and a little crazy trying to get a national event on that scale organized without any money, and on such a short time-frame. Thankfully, we’re just a little bit more organized this year!
But one of the reasons that I wanted to talk with you today, is to let midwives know what is going on, so that you can be aware that mothers are beginning to stand up for themselves, en masse. And to let you know that we need help! We would love for you to attend your local rally on Labor Day—to stand with us. Please, donate to sponsor a rally site (it costs $75 to cover the basic costs of one rally site). Please, serve as a local sponsor—by doing this you will help a great cause while at the same time promoting your practice!
The purpose of our rally is to bring awareness to a system-wide problem that affects most of the people in this country—moms, moms-to-be, babies, and the people who care about moms and babies. We need more people, more mainstream moms, to become aware of this problem. We’re also rallying to bring awareness to a solution. A big part of the solution is to have the people who are the end-users of care to stand up and demand the better care that they deserve.
What midwives such as you do is unique in that you support women in their right to make their own decisions. Women, in turn, need to support midwives, to support their own rights. If women could just figure this out—and I think we’re on the verge of this—then, we’d have a whole new ball-game.
To midwives—thank you for what you do. Thank you for the profession you have entered. Thank you for caring for us. You have been with us, as midwives.
And now, it’s time for us to give something in return. It’s our turn, as mothers, to be with you.
Rebecca Dekker, PhD, RN, APRN, is a mother of 2, a member of the board of directors of ImprovingBirth.org, and founder of www.EvidenceBasedBirth.com. You can follow Rebecca on Facebook here and donate to support the Rally here!
(A prior version of this article was given by the author as a speech at the 2013 American College of Nurse Midwives conference. The views and opinions expressed by the author of this article do not necessarily state or reflect those of the ACNM.)