The Shaming Has to Stop

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Get ready for a major soapbox post.

I get it. Those of us who choose to birth outside the box are different. We make choices that don’t necessarily follow mainstream society norms. Our choices may not be in alignment with what is embraced by the obstetrical model of care. Our choices may make medical professionals feel uncomfortable, challenged, exposed. I get it, really I do.

But…

That doesn’t give a healthcare professional the right to deny care in order to shame women and midwives, to bully us, or to punish us into submission because a laboring woman didn’t choose what the medical professional thinks we should do for ourselves, for our children, or for our clients.

Yes, this really happens. All. The. Time.

And, it never should. Ever.

For the most part, people who choose to give birth outside of the hospital feel that giving birth in a hospital is like using a sledgehammer push a thumbtack into a cork board—way too much fuss for something that most people can do on their own—and that a healthy woman having a normal birth in a hospital is asking for trouble. It isn’t that doctors have bad intentions. Most of the time, doctors and nurses have the very best of intentions. But, once a woman walks into a hospital, she will need to be “treated.” And, once a normal labor is “treated” (read, “interfere with”), risk is introduced.

People who choose to give birth outside of the hospital view the medical community as a necessary resource if the normal process doesn’t go normally. Most of us don’t hesitate to seek medical care if there is a need. Yet, why would a woman hesitate? Why do so many of home birthers/birth center birthers distrust the medical community? The lack of trust in the medical community exists because women have been burned many times, and women share their stories with each other.

As a midwife, I’ve personally seen patients yelled at, forced to have vaginal exams despite an explicit refusal, and verbally abused (put down, shamed, coerced, threatened). Doctors have yelled at me, attempted to discredit me in front of my clients, and threatened me with complaints. Why? Is it because something was done wrong? No, quite the contrary. All of these things happened because of a hospital transfer when a mom needed non-emergency help. Yes, these examples occurred during non-emergency transfer situations.

You might think, “Well, during a birth, the hospital staff acts this way because they worry about liability.” OK, let’s assume a medical professional was upset about that. Does that warrant abusive treatment of women and midwives? Quite honestly, does their bias or fear of liability even matter? Their job is to treat whoever comes through the doors of the hospital. Federal EMTALA laws protect a woman’s right to be treated in labor. ACOG supports patient autonomy even if the provider feels the woman’s choices are in conflict with the provider’s belief that her choices are unwise. A practitioner’s unprofessional behavior actually increases the provider’s liability by failing to respect patient autonomy and by refusing to provide the same level of care they would give to any other patient they serve.

This lack of professionalism experienced in the hospital sometimes extends beyond the birth. This is where I feel like the treatment is almost entirely punitive. While I can understand the frustration and stress of a provider who receives an in-labor hospital transfer, this type of post-birth discrimination seems like coercion and punishment for a family making choices that a provider does not personally support.

After a normal, healthy birth, the midwife’s scope of practice is normal newborn care throughout the first 6 weeks. The midwife conducts all of the usual assessments and then recommends the family see a pediatrician for a normal well baby visit at the end of the six-week period. The family calls to make an appointment.

Hold the phone! Wait a second, they won’t see the baby? Why not? Some practices won’t see the baby because the baby was born at home. Say what? They won’t see the baby for 6 months because they didn’t get the vitamin K shot? You’ve got to be kidding me!

Do physicians have the right to deny those people care because they disagree with their choices? For instance, is it OK for a pediatrician to refuse to accept a patient into care because the mother doesn’t breastfeed her baby? Would it be OK if a pediatrician refused care for families who homeschool? No, of course not. Yet, in many cases, with the population of families we serve, if a family has refused for their newborn anything from the mainstream model (such as a Vitamin K shot or erythromycin eye ointment or hepatitis B vaccine), they encounter judgment, fear, or a refusal of service.

It is unethical to refuse care in an attempt to coerce or bully a patient into consenting to care they have refused. It is unethical to refuse care as a way to punish families for their choice to give birth in a way that you do not agree with. It’s morally wrong.

The shame that is heaped on families who’ve chosen a path outside of the mainstream standards has created a culture of resistance and distrust, and that’s not good for anyone. Women and their families should be able to count on a multi-tiered model of care. If a woman plans to give birth at home and the labor takes a turn, she should be given a high quality of care during her transfer, and when she becomes a patient at a hospital. What if instead of shaming, a medical professional chose compassion? Understanding? And what if the medical professional were trained to see themselves as an important part of the picture for women who choose to birth at a birth center or at home?

The shaming has to stop. The punishment has to stop. Is it any wonder we don’t trust you? The distrust has been built on years of mistreatment. It rests on the shoulders of those in the medical community who lack professionalism, who don’t separate their own personal choices and/or training from the choices of the women and midwives who come to them in good faith and in order to see a labor to a successful and safe conclusion.

This dynamic needs to change. Show women that you can treat them with the same respect their midwives show them. Help women to make informed choices, and then respect their right to informed refusal (without trying to make them feel bad about the final decisions). Welcome us—the birth team and the laboring women—so we feel we can come to you for help when it’s needed. Welcome us, so we don’t feel like we want to wait a little longer to see if things get better because we’re scared of how we’ll be received when we arrive at the hospital. Welcome us, so we know we can share our stories fully and honestly with you, without fear of mocking or teasing—or retaliation against our clients.

If the goal is truly to provide good care and not to punish people whose views differ from your own, it’s time to do something to make a change for the good. Every time we interact with you, you have a golden opportunity to let the medical profession shine. Don’t blow it. Help us walk towards you instead of away from you.

If you’re a doctor or a nurse and you support families who make choices that aren’t in alignment with your protocols, this post is not about you. Or, maybe it is. Maybe this is a love story about you. You are the people who give me that glimmer of hope that change is possible and that midwives, consumers, and the medical community can work together to make outcomes better for mothers and babies, and make the experience better for all of us.

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7 Tips For Telling Your Family You’re Planning a Home Birth (and what to do if they’re not happy about it)

“You’re going to do what? A home birth? What, are you crazy??? Oh…my…what…the…are you CRAZY???”

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Yeah, I think that was the response when I first told my family I was going to have a home birth. Me, the home birth midwife. Yep, I had to break the news to my parents, too. Of course, I wasn’t a home birth midwife then. At the time, I was a stay-at-home mom who had already had 3 hospital births. They thought I’d pretty much lost it. First it was the breastfeeding and the cloth diapers. Then it was becoming a La Leche League Leader. Then it was the babywearing. But this? This??? They just couldn’t wrap their minds around this. How could their college educated daughter, the one who could afford “real” medical care, the one who demanded an epidural for her last baby (yes, that woman)… how could she take such a huge left turn and do something as “backwards” and “reckless” as give birth at home? She’s probably going to eat her placenta, too. (Umm, no, not then, but I would now!)

To be fair, I probably had similar thoughts when I was pregnant with my first baby and knew nothing about midwives and home birth. I had all of the usual misconceptions and stereotypes in my head that most people have. I had no idea that midwives really knew their stuff, and that it was generally the more educated women who made the choice to give birth at home with midwives. If I had known then what I know now, I would have given birth to all of my children at home.

This conversation with friends and family about our choice to give birth at home is a hard one. Sure, we can throw back our shoulders, put our hands on our hips, and defiantly state “If you don’t like it, tough. It’s my baby, my body and my choice.” It’s absolutely fair, truthful, and within your rights to say that. With the exception of a few Internet trolls and others who don’t know how to keep their noses out of your business, most people who feel like it’s their place to state their opinion about your choice are people you probably love. They’re your family and friends, and they’re people you’d like to be able to have in your life long after your baby is born. They’re people you probably want to have at your Thanksgiving table for many years to come. With that in mind, a little more tact and empathy is in order. Even though where and with whom you give birth isn’t anyone’s business but yours, your family’s concern generally comes from a place of love and concern for your safety. Know that their hearts are in the right place, even if their words are not. Here are some ideas that will hopefully help you as you work through the conversation with your family and friends.

  1. To thine own self be true. Know your reasons for choosing a home birth. People will ask you why, and it’s good to be able to articulate your reasons clearly and confidently. If you can’t communicate your reasons, it will be taken as a sign of uncertainty about your decision, and people who are very strongly opposed to your choice will see that as an opportunity to criticize your plan.
  2. There’s a lot of birth trauma out there. When you talk about having a home birth, you’re going to hear ALL of the horror stories. “_______ almost died because of ______. Good thing she was in a hospital.” Of course, a lot of those horror stories were caused by interventions that only happen in a hospital, but people don’t understand that. So, what’s a good response? Acknowledge how scary that situation was. It was real and it deserves to be acknowledged. One possible response could be, “Thank goodness she had such a skilled doctor! Doctors are so important for high risk births like that! My midwife is very skilled at low risk birth and has a plan for transfer if my birth becomes high risk like ______’s birth was. Her backup doctor is great, just like Dr. _____.”
  3. Consider your audience. Understand that people will already feel judged because their choices were different than yours. Don’t add to that. For example, if your sister had all of her babies by scheduled c-section, don’t say something like “babies born by c-section don’t bond with their mothers like babies born vaginally.” Conversation over. Instead, when you know you’re going to have this discussion with someone you think will feel particularly singled out or judged, it might be good to just name the elephant in the room. She might appreciate that. Maybe starting by saying something like, “I’m not sure how to have this conversation with you. I love you and I’m really excited about this and I want to share this with you, but I worry about how this is going to make you feel.”
  4. People like what they know. Less than 1% of the babies born in this country are born at home. You can’t expect all people to easily embrace something that is so far from the norm. It may be helpful for your family to know that you will be receiving regular prenatal care, including labs and ultrasounds (if that’s your plan), from a licensed health care professional. Let them know your midwife will be monitoring you and your baby during labor, making sure you continue to be low-risk and appropriate for a home birth. Words like prenatal care, labs, ultrasounds, licensed health care professional, low-risk, and monitoring, are all words of comfort for family members to hear.
  5. If you sense hostility, back off. Hostility will cause people to dig their heels in deeper. No matter what they say, you’re not changing your plans, and no matter what you say, they’re not changing their opinion. Sounds like a no-win situation. Continuing the conversation at this point will not be productive, and will only serve to cause bad feelings on both sides. Show your good judgment by ending the discussion. “It’s clear we both feel very strongly about this. I’m done discussing this with you for now.” And then, do not discuss it any further unless you feel that person is ready to have a calm conversation. If it becomes hostile again, end it. Don’t continue to take the bait.
  6. Offer information, but don’t push it. It’s not your job to educate the world about home birth. Honestly, nobody cares. If they did, they’d see how great home birth is and more people would be born at home. People are content with the status quo, and nobody likes a zealot. Be ready with answers, talk about how great your midwife is and how much you’re enjoying your visits, maybe mention how great the outcomes are in Europe in the countries where home birth with midwives is common, but then leave it alone unless people ask you for more detail. While you may be totally amazed at how low the c-section rates are with midwives, most people unfortunately care more about what color you’re planning to paint your nursery.
  7. Some people will never come around, and that’s OK. You may find that some of the people you love will remain completely opposed to your decision. This may bother you a great deal, but there isn’t a whole lot you can do about it except just set it aside. Honestly, the proof is in the pudding. After your home birth, it will be hard to dispute that your choice was a good one for your family.