One night...

She sat down at the hotel bar between two tired businessmen. This wasn't something she normally did, but she figured she should celebrate her achievement. She had wanted this all her life and had worked solidly for three years to make it happen. She ordered a martini and began to have polite conversation with the men.

As the evening went on, she began to converse more with the man to her left. They discussed career, children, marriage. He shared with her how the course of his life had went. She shared with him hers. There was not a hint of flirting between the two of them. After the second martini, she shared some of the struggles she was having in her personal life. He listened intently and asked questions. He predicted that within a year she would know what direction to go in. She didn't know what to think about that. To her, there seemed no answer.

After the effects of the third martini began to hit her, she excused herself and went to her room. She laid on the bed and thought about the conversation with the man. She couldn't remember the last time a man had listened to her with interest even though she had been married for many years. She began to sob. She felt consumed with loneliness. She cried herself to sleep.

The next morning she got on a plane and went home. She thought about her reaction to the man. Though she felt sad, she put it aside. She worked hard in the next several months to grow her business and it constantly amazed her that her dream had become a reality. Still, she dreaded going home. If it were not for her children she wouldn't have.

Some 20 months later she was painting her office while singing along with her favorite music. She was thinking back on the past couple of years and all that had happened. She remembered that night in the hotel and what the man had said. She was stunned to realize that she had made the decision to leave that unhappy marriage almost exactly to the day a year later. Her life had changed tremendously. Some struggles still remained. There were remnants of the abuse that she had suffered left. However, she was deeply happy that she had gathered the last bits of self-preservation left in her to move on. She had realized that no matter how uncertain she had been that night that within her there was a woman who was strong enough to face whatever challenges were ahead in order to have what she deserved.

Silently, she thanked the man.

I never wear Birkenstocks..Confessions of an uncrunchy midwife

I have never worn a pair of Birkenstocks. I am not attracted to them and I know that they wouldn't fit my long, narrow feet very well. I think this is surprising to folks who meet me for the first time expecting a super crunchy hippie to be welcoming them to her office (People also expect to see a very old woman because my name is Bettie-I am often a source of confusion). I am not a hippie at all, well maybe I am by the true definition of the word but I don't own anything that is tye-dyed. I don't even think I know how to spell tye-dye (tie?). Anyhow, I am just me.

This, at times, is an advantage to me as a business woman. Many women are considering out of hospital birth who are not crunchy at all. They do not fit the stigma of the homebirthing mother. They meet me and breathe a sigh of relief because they can relate to me. Other times, I admit that I feel like a fraud. What would my clients think if they knew that I keep Capri Suns and GoGurts stocked in my fridge when they are dutifully drinking Kombucha for its probiotic value? I drink Kombucha, by the way but my panty is full of inconsistencies.  I would rather drink a beer than wheatgrass. I like to shave my legs and armpits. I dye my hair and wear make-up and get pedicures. This is all sorta disappointing for the crunchy crowd, but they usually get over it. I can usually speak their language. I get where they are coming from and why. I respect it immensely.

There was a time when I could have been considered a midget crunchy. I used to cloth diaper my babies, grind my own wheat, baked all of our bread, make everything from scratch. I grew a garden and hung my clothes on a clothesline. Then, a series of illness and difficult pregnancies put an abrupt stop to all that and my days of pseudo-crunchiness were over. The kids ate Little Debbie snacks instead of homemade cookies sweetened with sucanat. I try not to think about what the health drawbacks are to that. I simply can not afford to purchase pre-made foods which are healthy and I don't have the time or energy to do all that anymore. I learned that making a wholesome dinner on the evenings I can and providing fresh fruits and veggies are probably good enough. Good enough is good enough sometimes.

Homebirth is not about being crunchy, it is about what makes sense and what works. Homebirth was a natural occurrence for all women until the last 75 years or so when women began to be convinced that being somewhere else was safer. Queens had their babies at home, perhaps they were better attended than their peasant counterparts, but probably not. They were fussed over to the point that they were unable to give birth in a natural way at all. Still, they were home. Regular housewives who never heard of a hippy had homebirths. I still meet old ladies who were born at home, it was just the way. Why do we suddenly believe that the only women who give birth at home are selfish hippies who want a "birth experience" rather than just women who sense that everything would work better if they were left alone to let their body and their baby guide the way? Homebirth works because women are comfortable and are able to allow their hormones to guide the labor process in a way that is usually impossible in a hospital setting. This interference is a risk factor any way you slice it. Of course there are benefits to having an OR nearby, but really for the 90% of women who wont need that OR it is probably not worth that interference. Only 1-2% of all complications would require an OR fast enough to make a homebirth risky. Why are we placing so much fear in women over their choice of location to birth when those risks are so low?

I have never been a hospital hater. I gladly send my clients to be evaluated by physicians. I try to never forget what I don't know. I know that I am well versed in the ways of normal birth; not high-risk birth. I am vigilant about looking for cues that a mother and baby need help beyond my expertise. In fact, sometimes I have sent ladies in who probably could have skipped that extra visit, but I would rather not take a chance. Homebirth Midwifery is not about taking chances in my book. It is about allowing pregnancy and birth to unfold the way it should and knowing that if you are careful not to become complacent you will see the red flags to alert you that medical attention is required. This is why I do all the routine lab work and monitoring prenatally. I would rather ruin a mother's dream of a beautiful homebirth than take the chance that she will regret her decision to have that homebirth against the odds. It isn't worth it. Birth can absolutely be risky at times, but I firmly believe that most women will not need medical intervention. Most women will give birth at home without incident. This is my experience and the experience of my sister midwives.

Let's remove the labels and consider homebirth as something that works and is normal. Let's not fight about it. If people are freaked out about having their baby at home and want an epidural, then let them. It isn't a competition and we are not required to police the choices that other adults make which have nothing to do with us. Instead, just quietly go about the business of having your baby in the way that works and makes sense to you. It will rub off on others without you needing to do a thing. Find yourself a midwife whose philosophy makes sense to you and in whose wisdom you trust...no matter if she is wearing a long tie-dye skirt and Birks or stilettos. Trust your body and your instincts. Let go of the perfect birth and do what works.

I may not be crunchy, but I do marvel at the beauty of birth and the women and babies who I take care of. I am amazed time and time again at how well the process works. I trust in it because I have also seen that when it isn't working we will know if we are humble enough to pay attention. I am blessed to be in this profession. Sorry about the Birkenstocks, I just like flip-flops better.

Back again...

I haven't written a post in awhile. I have been busy rebuilding a new life after leaving my marriage of 20 years. It has been bittersweet. Mostly sweet. It is good to find out that you have enough of a life left to take a huge risk. For awhile, I was treading water and didn't want to do much of anything but watch HGTV. Lately, I have ideas running through my mind again. I feel like I am coming back..changed, but for the better (I hope). Anyway...I missed this.

There is no such thing as a perfect birth

I watched; amazed at the woman in front of me. Brave. Courageous. She pushed her baby magnificently. She listened to her body. She owned the moment. It was perfect. She had worked hard for this. She had done all the research, she had read all the books, she had eaten all the right foods. She was beautiful and I was so amazed watching her that I had to fight back tears.

In spite of my awe, I also noticed that something was not quite right. In the next 20 minutes this woman and her baby suffered several complications which had us traveling to the hospital via ambulance arriving before the first hour ever passed.

Next, I stood in the tiny hospital room. Covered in her blood. Watching her on a gurney. Brave. Couragous. She calmly answered the hostile doctor's questions. She withstood the rolling eyes and the belittling comments. I fought to hold back the tears because I wanted her birth experience to be all that she had fought for it to be.

A week later I stood at her door. When it opened I braced myself. In front of me stood a woman with a baby in her arms. Shining. Strong. Vibrant. Rejoicing. She got the point of it all. She empowered herself because in that experience of her birth she learned that there is no perfect birth only imperfect ones which we learn much about ourselves in. I learned from her. I learned to grieve a little less about the complications. I learned to rejoice in the power of the journey.

Do I still have to pay you if I transfer?

I get this question pretty often at consultations. The short answer is: yes. The why of that is the content of this blog post.

Most people hire a homebirh midwife to provide prenatal, antenatal, and postpartum care. That care includes all of the really fun and crunchy stuff like preparing sitz baths and herbal teas but it also covers the midwife assessing if her client's pregnancy requires medical intervention. If a midwife transfers a client to physician care or refers for physician assessment because of a physical or emotional condition she is doing her job. She should get paid for doing her job.

I won't speak for all midwives, but I will speak for most when I say that we struggle over demanding payment for our services. We develop a relationship with our clients and usually don't have a big staff who can do all the sticky stuff for us. We know that young families struggle to pay us. We know that when birth doesn't go as expected it is an emotional blow as well as a financial blow.

Yet, midwives leave our own families to take care of our clients. We incur expenses in order to care for our clients. Most of us can't work for free. In my midwifery 'practice' I ask for full payment for care that goes past 36 weeks. Most folks don't realize that if I break down the costs I am only making about $500 for each birth, the bulk of what I do is done prenatally. So yes, even if you transfer out of my care at 36.5 weeks you will owe the whole fee. Sometimes, I will extend a courtesy discount, but I am still planning to attend your birth (if I am not leaving another laboring woman without a midwife) and give you postpartum care as long as it is appropriate to do so. I am still your midwife.

I appreciated the perspective of a family I cared for. They had to transfer out of my care late in pregnancy when complications developed. They were devastated. For awhile, our relationship took on a tense nature. I was able to stay with them through the labor, birth, and postpartum experience. While they were still somewhat disappointed about not having the birth they had prepared for in time they found peace with it and let me know later that they are grateful for the care that they had during their pregnancy and we have remained in contact. In fact, I count them as friends. It was a huge relief for me that the relationship that we had did not disintegrate over a tough decision.

Money is a difficult issue for midwives. We work from our hearts not in respect to our wallets. Yet, we live in the real world and can't provide care to women if we are expected to devote ourselves to them without compensation. I have made the mistake of being too flexible with payments. Because of this, I have yet to pay myself a wage for the work I do. I still have to pay for my rent, my assistants, my supplies..etc...so even if I work for free the work I do is not free. I have learned this lesson the hard way to the extent that my future clients will not be extended the same graces that some of my former ones benefited from. Most of my families have not taken advantage of my leniency...but some have and it only takes a few to put you in the red.

It breaks my heart to transfer clients and the few times I have had to I had to steel myself in order to do the right thing. I sought advice, researched, and searched my heart to come to the inevitable answer if it was a prenatal transfer and if it was a transfer during labor or the early postpartum hours I was doing a LOT of praying for a resolution before I called it. This is not an area to be flippant with. It is also not an area to be meek about. As a midwife, you have to make tough decisions. You have to think of the safest scenario. I am not God, I don't even work for him...but I do work for the families and I respect the position they put me in when they ask me to care for them. I also realize that I can be wrong; that is the nature of hiring a human. I realize that I may transfer someone who ends up having an uneventful experience...it may mean that I was wrong or it may mean that what could have happened didn't. Great!

All of this when the short answer should suffice. :-) Yes, pay your midwife!