It’s all about ME!

I am feeling a bit nostalgic today because tonight is the beginning of the Fourth Annual WILD Festival.  Four years ago, I was a brand new birth advocate.  I had just given birth to my second daughter at home with a CPM who was unlicensed in my state, and was more determined than ever to change maternity care for the better!  When my second child was born, I was amazed at how my work load had suddenly doubled, but my husband’s stayed the same.  WHA???  Mothers needed to be recognized for all they do for their families and communities!  I envisioned a weeklong celebration for moms to come out and cut loose at night – a night of comedy, an outdoor concert and “Birth” by Karen Brody.  And during the day, come together at the local YWCA to discuss issues that we all faced – getting dad more involved, balancing family and work, remembering to take care of yourself.  Somehow, we pulled it off!  But right in the middle of planning this fun-fest, two Certified Nurse Midwives were fired, sending our community into crisis mode.  Oye.

It amazes me that while we were working to bring women together to celebrate being mothers, we ended up coming together for more upsetting reasons.  This idea of bringing women together has long been a weird obsession for me.  I am the oldest of four girls, and I am super close with all of three of them.  But in my twenties, I was one of those women who had more guy friends as a result of being the victim of bullying by other girls in middle school.  You know the story – there have been countless books written on the subject (Queen Bees and Wannabes, Odd Girl Out, Reviving Ophelia, etc.).  Why was it that so many women were so nasty to each other?  I longed for a sense of community with women like the one I had grown up with, the closeness I had with my sisters.  So, when I met my midwife and saw that she was going out into the world on a regular basis to serve women, I was blown away.  And all along, she was putting her entire family and livelihood in jeopardy as a result of having no license.  Here was a shining example of women supporting women!  We need more of this!  So began my personal quest for more Wise Women – women who understand that we need to be coming together, not constantly tearing each other down.

Unfortunately, I also grew up a consumate good-girl-people-pleaser who was told that any emotion other than happy was unacceptable.  So when I became a birth advocate, I liked the fact that I had found an acceptable way to be angry about something.  Here was a system that was mistreating, some would even say abusing women.  Damn right I was angry!  And when the hospital/physician’s decided to ignore our request for a meeting after the CNMs were fired, we went out in the streets to let the world know that we were not going to be abused and ignored anymore.  Quite suddenly, we were getting requests from all over the country to come tell our story.  My outrage was being encouraged.  Kind of.

On the one hand, I was being invited to speak out about the fact that midwives were being mistreated, oppressed, and so were the women.  But I was also being sent a very different message from the same community – your ‘truth-telling’ is making it uncomfortable for those of us trying to keep our heads down and make a difference.  I was hearing the same thing I had been told as a little girl – no one will listen to you if you’re angry.  What a load of poo!  How is anything going to change if we don’t point out when people are behaving badly?  But no one wants to admit their behavior may be hurtful to others.   It’s the same reason my kids tell me I’m mean when I point out that they cannot hit each other.

Four years later, after my first foray into public displays of outrage, I am ready to move in a different direction.  At times, it feels as if all of my efforts have amounted to very little locally – the midwives in our community are behaving more outrageously toward each other than before; our local organization grew and then shrunk in numbers; we are still getting reports of women being mistreated by providers (including the midwives, yall!).  But, I have made some incredible connections in other parts of the country.  Places where the midwives WORK TOGETHER!  Places where physicians speak highly of other providers!  Places where women are able to give birth in the setting of their choice, with the provider of their choice, at their own pace.  Places where the providers celebrate their differences and remember that it’s NOT ABOUT THEM.  IT’S ABOUT THE WOMEN!

Holy crap!  Birth is working in other parts of this country.  What happens if we begin shining a huge, happy spotlight on those places?!  Won’t women and providers say, “Hey. If they can do it, why can’t we?”  So, I am working on a video project with the American Association of Birth Centers Foundation to grow more birth centers:

I am serving on the board of BirthNetwork National, an organization working in communities all over the country to bring professionals and consumers together to promote the Mother Friendly Childbirth Initiative.  And I am working on a program aimed at teaching young girls about birth and the amazing power of their bodies.

“Where’s My Midwife?” will continue to be a resource for folks who want to learn about how to protect their access to midwives in their community.  We are in the process of taking all the knowledge that we have accumulated in our efforts to increase access to midwifery care and organizing it into a tool-kit that others can use.  Having this tool-kit will enable us to help more people in a more efficient way.  But I am ready to focus my time and energy on growing more healthy communities.  As a dear friend keeps telling me, “You can only lead the willing.”

Support your Sisters

This morning, I was reminded of another reason I considered quitting this whole activist thing.  A local CNM commented on my last blog post regarding our meeting with the NC OB/GYN Society:

Hi Kirsti!!!! THANKS FOR ALL YOU ARE DOING!!!!!! Is it possible to include homebirth nurse midwives in the planning stages? I appreciate all Rob and Russ and Lisa are doing-please don’t misunderstand. I just know homebirth needs support from all providers and this is another perfect opportunity for professional midwives and nurse midwives to work together.

I could not agree more.  When the CNMs in NC lost their physician back-up, WMM? immediately began blogging about it, contacting the press and organizing public events to raise awareness of the crisis facing home birth families.  The leadership of NCFOM attended a Midwifery Joint Committee meeting to testify in favor of the emergency extension of the home birth CNM’s permit to practice.  And WMM? wrote a letter to the Board of Directors of NCACNM expressing our desire for the leadership from all parties to sit down and figure out a way to work together to increase access to midwives in all settings:


After we sent this letter, the home birth CNMs and their families formed a separate Facebook group and stopped communicating with us.  Shortly there after, we received a formal response from the president of the NC chapter of ACNM reiterating their inability to support licensure of CPMs, effectively giving us the brush off.  Apparently, they did not need or want our help until they found out we had had a meeting with the physicians.

From the beginning, WMM? has consistently asked the midwives in our state and in our country to stand together.  We have always honored our mission to increase access to ALL midwives in ALL settings because in countries with best outcomes, midwives are the primary maternity care providers.  Time and again, the physicians and CNMs I have spoken with point to educational requirements as a reason for not supporting CPMs.  But in all of the years since the CPM credential was created, no state has ever reversed their decision to offer licenses to CPMs.  In fact, Washington state is now calling for more CPMs to be licensed because the increasing number of families choosing home birth are saving the state millions of dollars.

But aside from all of that, what troubles me the most is the idea that physicians and Nurse Midwives get to decide whether or not families have access to midwives trained to attend women at home.  This speaks to the heart of the problem in maternity care – women are judged by their providers to be too stupid to make decisions about their own health.  We couldn’t possibly be smart enough to decide for ourselves which provider is right for us, so the physicians and midwives will save us from all that trouble by limiting our options to the ones they feel are best.  And which settings are best.  And which procedures are best (VBACs, water birth, etc.).

But I digress. . .to answer the question from the beginning of this post, ‘yes.’ As we expressed to your organization back in June, we would love for all interested parties to sit down and discuss how to make maternity care better for the families of North Carolina.

I wanted to quit and then we sat down and talked like adults!

Yesterday, both past and current presidents of the NC OB/GYN Society sat down (at our request!) with representatives from “Where’s My Midwife?” and the North Carolina Friends of Midwives to begin a dialogue about making the environment safer for families who choose home birth in North Carolina!  We drove to Raleigh, gathered in their board room and talked like actual grown ups.  They listened, asked questions and expressed concerns.  We addressed their concerns and shared our personal stories about why this issue is important to us, and gently explained that we were not going away.

I cannot express to you how much this one meeting filled me with hope.  Eight people (six of them OBs) came to the meeting to have a conversation!  Honestly, before yesterday, I had been thinking about quitting this whole birth activist thing.  The retreat was mind-blowing – it was so nice to meet others who are as fired up as I am about truly making change happen in maternity care!  But after it was over, I got a bit overwhelmed at the task at hand. We realized that trying to get folks to work locally AND nationally was a huge undertaking.

Then, I saw this video and the awful comments posted underneath:

Here was a group of ladies who had tried to talk to their local physicians and hospital about being displeased with the type of care they had received.  When going through the appropriate channels did not work, they decided to take to the streets to raise awareness and put public pressure on the folks who had mistreated them to address their concerns. . .sound familiar?  The comments from the nurse who worked in the hospital were pretty typical, “no one is going to want talk to you if you stick with these methods.”

Then what are we going to do?  When trying to ‘do the right thing’ gets us no where, we must stand up and say “Enough!”  The whole reason nothing has changed thus far, is that the women who do speak out about being treated badly are then shamed or dismissed for telling the truth.  And, in my experience, women are far more likely to be the ones doing the shaming.  When I saw the same kind of discouraging language going on over at the Improving Birth Facebook page, I sincerely wanted to quit.  How are we ever going to come together to make things better if we keep tearing each other down?

And then, one little meeting changed everything.  If we can get a meeting with the NC OB/GYN Society to discuss home birth, anything is possible!  So, come on folks, let’s put aside the judgement about how the message is being delivered and keep telling the truth about birth.  Women and babies deserve to be treated better than they are, and we all need to work together to make that happen.

Crazy all over

“Those who profess to favor freedom, yet deprecate agitation, are men who want
crops without plowing up the ground. They want rain without thunder and
lightening. They want the ocean without the awful roar of its many waters. This
struggle may be a moral one; or it may be a physical one; or it may be both moral
and physical; but it must be a struggle. Power concedes nothing without a
demand. It never did and it never will.”
– Frederick Douglass

I was a bit surprised on Wednesday when Alan Skipper replied to our letter and voice mail with a phone call.  He said he understood we would like a meeting.  I told him we would like to discuss our desire to have access to midwives in the state of North Carolina, could we possibly get a meeting on the books by Friday?  He said he didn’t think that would be a problem, he needed to figure out who should attend from ‘their end,’ and that the meeting would likely have to take place in the late afternoon/early evening.  I told him that was fine, even if it happened next month, but we would like to have the meeting on the calendar by Friday.  He said he would get back to me. . .

When I hadn’t heard anything by Friday afternoon, I decided to call.  The secretary informed me that he was not in on Friday and sent me to his voice mail.  We experienced a similar brush off from New Hanover Regional Medical Center three years ago.  The entire exchange felt as if we were trying to talk to some nebulous ‘leader’ who didn’t have time to converse with the common folk.  So the fact that Alan Skipper called me back himself gave me hope.  But he must have known he wouldn’t be there on Friday, he could have said he needed a week.  But he didn’t say any of that.  I feel like we may need to amplify our message a bit.

Please understand that the message in our action will still be, “Can we sit down and talk like adults?” But we want them to understand how badly we want to have this discussion, and that we are a force to be respected and that we are not going away.

Frankly, it’s been a very long week.  This kind of behavior is cropping up all over right now.  WMM? was contacted by folks from the AABC about a situation brewing in Pennsylvania.  Essentially, the hospitals are trying to make it so that only physicians, podiatrists and dentists will be able to admit and treat people.  Pennsylvania, like North Carolina, still has the physician’s signature requirement for CNMs to practice.  Five of the oldest birth centers in the country (many have been operating for over 25 years) may have to close their doors.

We were also contacted by a midwife in Tennessee who worked at a 26 year old birth center until very recently.  Over the course of the two years that she worked there, they went from a team of four midwives to two midwives.  And on May 14th, when she tried to point out that they were making enough money to hire a third midwife, she was fired.  No more birth center.

Oh, and let’s not forget the women who contacted us in New York earlier this year.  They formed their own chapter of WMM? to confront a situation at Bassett Hospital.  An award winning midwifery practice went from 10 CNMs to 2 CNMs over the course of a year.  Here’s a press release we crafted for them, explaining the situation:

Now, maybe I’m crazy (always a possibility), but this all seems a bit too coincidental.  What’s going on? Has the climate always been this hostile for midwives?  We suspected it was after what happened here, after attending the ACNM Conference in 2010 and hearing first hand accounts of practice closures that happened all over the country.  We asked folks to call us and heard nothing until now.  Have physicians and hospitals suddenly become more aggressively anti-midwife, or are we just becoming aware of the scope of this problem?  Either way, clearly the time to act is now.

Let’s sit down and talk like adults

Today, we sent a letter to the NC OB/GYN Society, asking them to sit down and discuss their resistance to allowing consumers access to midwives.  If we do not get a meeting in place by next Monday, we may have to ‘kick it up a notch’ to let them know how important this issue is to the families of North Carolina.  If they are going to use anecdotal ‘bad outcome’ stories to put pressure on the legislators of our state, we will use our own tactics to help them see that we are determined to improve maternity care by increasing access to midwives in every setting.

In eleven days, we will be hosting our first annual Birth Activist Retreat at the Farm in Tennessee.  We have been blessed with the guidance of Rosemary Senjem in helping us to facilitate this meeting of the minds, and we could not be more excited about the possibilities.  In order to really begin making a difference where maternity care is concerned, we believe a national, coordinated effort is in order.  We have activists coming from over thirty states to find out how to get involved.  We intend to launch our campaign in September, on Labor Day, with the National Rally for Change organized by the lovely Dawn Thompson.

The climate in North Carolina, where access to midwives is not only difficult, but being openly resisted by the physicians, has given birth to a great desire to confront the system head on.  We invite you all to join us on this journey.  If you want to be a part of this revolution, go to the Birth Activist Collective page on Facebook and ask to become a member.  After the retreat, this is where we will be discussing our activities and making plans in communities all over the world to address the many issues surrounding maternity care.

We thank you for your continued support!  Let’s do this!

What if. . .

Last night, I sat down on the floor in my daughters’ bedroom and cried.  My heart is broken.  Reading the letter from the NC OB/GYN society was like a punch in the stomach.  Coupled with this picture I saw on Facebook,

I felt like nothing we are doing is going to be enough to truly change things.  If midwives cannot find their way to forgiveness and understanding until 2030, I don’t see how we can possibly get anywhere with improving maternity care in the US.  What will maternity care look like in 2030, when my children are thinking of having babies?  I can’t bear to think that it will still be like it is today – with care providers fighting amongst themselves over the ‘quality’ of their educations, while mothers and babies suffer the consequences of a system based largely on fear and ego.

After I wiped away the tears, I went to get out the stencil we cut out of plastic for painting our logo on car windows to prepare for Friday’s event.  In order to protect it, I had placed it between two pieces of poster board.  One of the poster boards was an original protest sign from nearly three years ago, a bit of our past.  The other was this collage, a vision of our future:

In January of 2010, a group of fed up mamas sat down in the living room of our midwife friend and flipped through a stack of magazines looking for images that spoke to us.  We were envisioning what our future birth center would be like.  And here’s what we came up with. . .

Imagine a big, wooded campus with two buildings sitting next to a stream or lake with a path that meanders next to the water.  One building is the birth center where all women go to see midwives from the time they start their period to the time they stop having one.  All pregnant women come here to see the team of CNMs and CPMs, and have the option to give birth at the birth center or at home, only seeing an obstetrician if they become too ‘high risk.’  Centering – group pre-natal exams – is also an option for everyone.

The second building is the wellness center.  A team of practitioners (social workers, massage therapists, acupuncturists, etc.) have their offices here.  There is also a large room for yoga, childbirth education classes and various support groups.  A self-esteem class for young girls is taught after school. At age 15 each girl is paired with a doula with whom they attend births. While doing this they can see what their bodies are capable of and will experience being at a birth before they, themselves, give birth for the first time.  The girls will also attend the New Parent Support Group so that they can see what having a baby is like, first hand.  Maybe they will want to sit in on the Wise Women sessions to learn from their elders. . .

What if women could go to a place like this from the time they were babies?  A place where women supported one another, where young women learned from old women?  What if we all witnessed women at the most powerful time of their lives – giving birth – and were not afraid?  What if?

A Sad Day in NC

We had heard a rumor that the North Carolina OB/GYN Society had written a letter asking their members for home birth stories that had ended in a ‘bad outcome.’  Some even said the letter was from the NC Medical Society, the lobbying organization for the physicians of our fine state.  I didn’t want to believe it to be true.  How awful for the families who had made an informed decision to have their babies at home, and then suffered the loss of a child.  To think that their personal loss is being used to bully legislators into voting against the CPM bill.

And then, we saw the letter:

We are deeply saddened by this letter and angry at the ‘professional’ organization who would behave in this manner.  Families in NC will continue to choose to have their babies at home, it is time the members of the General Assembly of North Carolina gave us licensed providers to attend us.  The legislators of our state need to stand up to the bullying tactics being used by the NC Medical Society and do what’s right for the citizens of our state.

When will it end?  What’s happening here is happening all over the country.  The major midwifery organizations finally came together and issued a joint press release yesterday asking for a move toward supporting the physiological process of birth.  It’s time for the physicians to get on board, for the sake of all families, everywhere.

Come together. . .

An open letter to all midwives:

Greetings, glorious, Wise Women!  We are your number one fans, and we want to thank you for assisting us at the most important time in our lives.  Your loving, supportive presence helped us as we transitioned from woman to Mother; from mother of one, to mother of many.  Some of us sought you out after experiencing care that was unacceptable, and your trust in our body and its natural abilities helped us to heal.  Creating such a comfortable, safe environment for our most challenging, intimate experience was an incredible gift.  Thank you.

A direct result of having this experience is the realization that we can do anything!  We realized that we do not need to settle for less; that we can ask for what we want. Our birth experience has allowed us to gain the confidence in ourselves to stand up and speak out when we see injustice.  That’s why we are writing to you all now.  We see the way your cohorts treat you, and we find it to be unacceptable.  We have seen midwifery practices closed because of physician opposition, and it has broken our hearts.  We have seen physicians condescend to you because, in their eyes, your education is somehow ‘less than.’  We could not disagree more.

However, we have also noticed that some of you are treating each other in the same manner.  Why?  If you know what it feels like to be told that you are not enough, why would you turn around and tell a sister midwife the same thing?  We love ALL midwives who practice in ALL settings.  We understand that some practitioners are not as skilled as others in the same field, and that practitioners make mistakes.  We are all human, after all.  But at this time, when so many women are dying in childbirth worldwide, we need for you to put aside your differences and stand together.  We know that the divide between midwives has a long and storied history, that emotions and egos have been wounded along the way.  But the time has come for forgiveness.  Your women need you to come to our aid.  We need you to begin standing up to the oppression that is occurring all around us, in every practice setting.  We have had enough.

Please let us give you the gift of our collective voices for all that you have done for us.  We are ready to stand with you to create a new maternity care system, one that honors and respects birthing women.

 

Let’s talk

An open letter to all physicians:

First, let me start by saying, “Thank you,” for choosing to spend so many years studying medicine and for practicing in such a demanding field. Many of you understand what it is to be a care provider and assist countless citizens in their quest to stay healthy. This letter is primarily directed at your cohorts who have chosen this profession and seem to have forgotten the oath that they took at the beginning of their careers to ‘do no harm.’

For several years now, a consumer group called North Carolina Friends of Midwives has been working to pass legislation to license Certified Professional Midwives. These skilled care providers are credentialed by a national organization and are currently licensed in 27 other states in our country. At every turn, physicians have opposed NCFOM’s legislative efforts. And now, it seems, your Board of Medicine has taken two actions that have done a great deal of harm to the families in our state who choose to give birth out of hospital. By immediately rescinding Dr. Henry Dorn’s ability to provide physician back up to six Certified Nurse Midwives in our state, nearly 200 families were abruptly left without care, many at the end of their pregnancy. This is unacceptable.

The second action that we take issue with is the call for ‘train wreck’ transfer of care stories. What could your organization possibly gain by reading one side of a story that would have potentially ended differently had there been collaboration between physicians at the hospital and midwives who practice out of hospital? There are plenty of places in our country, and in countries all over the world, where midwives are incorporated into the medical system and work in a collaborative manner with physicians. We are gathering birth stories that ended happily in order to provide you with a more accurate picture of what birth outside of a hospital typically looks like.

We are writing to appeal to your core values as care providers. We ask you to please stop trying to prevent us from receiving care from midwives. Currently, only 1 – 2% of families are choosing to give birth out of the hospital setting. We are educated, loving adults who have made this decision based on what is best for our family. Many of us also sought out the care of a midwife because midwives view birth as a natural process, and many physicians tend to be afraid of what might happen and try to control it and intervene in order to prevent possible bad outcomes. There are plenty (over 98%) of folks who want to be cared for in the hospital, with all of the technological bells and whistles. For those of us who would make a different choice, your attempts to prevent us from achieving a different type of birth are confusing and tiresome.

We invite you to sit down with us, and explain your behavior. We ask you to truly hear our stories, and to begin working with the wonderful women who seek to serve us.

If you’re not outraged, you’re not paying attention. . .

Right now, all over the state of North Carolina, families are in pain.  They have been excitedly awaiting the arrival of a new family member, maybe expecting their first baby.  All of the joy that they have been feeling surrounding their upcoming birth has now turned to fear, for the women they have come to know and trust as care providers are no longer able to practice.  Maybe they interviewed several providers before choosing the Certified Nurse Midwife (CNM) they felt most comfortable with; maybe they have had the pleasure of having her attend a previous birth and were thrilled at the thought of having her present at the birth of their next child.  That’s what makes this situation so painfully sad – the kind of care midwives provide goes above and beyond what most folks expect from a health care practitioner.  To have experienced such personal, attentive care and then be asked to accept anything less at such an important time is unthinkable.  But due to the actions of the North Carolina Board of Medicine, many families will now have to find someone else to assist them at their birth.  Many will now have to give up the option of having their baby at home, because there are so few CNMs left practicing out of hospital.

How is it that our state is so out of touch with what the families who live here want?  The North Carolina Friends of Midwives (NCFOM) have been working tirelessly for the last several years to get legislation passed that would allow Certified Professional Midwives (CPMs) to obtain licenses to attend home birth.  With HB522 poised to be heard in the House Health Committee, they are closer than they have ever been to seeing that come to fruition.  It is no coincidence that the Board of Medicine rescinded Dr. Dorn’s ability to back CNMs who want to practice at home at this time.  The physicians in this state have made it clear how they feel about home birth.  Not only have they vocally opposed NCFOM’s legislative efforts at every turn, now they are closing the home birth practices of CNMs as well.  If you are a family who has chosen to give birth outside of a hospital – at home or in a birth center – or if you simply want to see others have that option, you must stand up and let your voice be heard.

Go to NCFOM.org and find out who your local legislators are, and give them a call.  Let them know that the families of our state deserve to give birth at home with the care provider that they choose.  Ask your friends and families to take a few minutes out of their day to do the same.  There has never been a more important time to act.