First, Do No Harm

Lately I have been bombarded by the message that women should just “trust birth.” This sentiment takes many forms and is applied to various aspects of labor and birth and I get why women gravitate to these mantras, even if I know it isn’t always as simple as just “trusting birth.” I trust that birth is one part mystery and one part science. I trust that in labor I have come to expect the unexpected. But what I don’t trust is the idea that all complications are caused by intervention or that doctors and midwives are there to manipulate birth for their convenience.

This article came across my Facebook feed today and it really blew my mind. In seven easy steps Gloria Lemay, an icon of midwifery and natural birth suggests reviewing birth tapes like game footage to determine the competency of potential midwives. She advises against having vaginal exams because “you were made to give birth.” She also encourages women to lie to their midwife about their LMP (last menstrual period) so you won’t want be induced if you go postdates (pregnancy past 40 weeks). Lemay wants you to question everything your provider says and does and then weigh this against the rules and regulations surrounding midwifery in your state. Only then will you know if your midwives advice is in your best interest or in hers. Her advice is so unwise and dangerous I had to copy the whole thing here in case you don’t read the link to the original article, please read this and know that what she is asking here is not ok. “Ask your midwife at your first visit with her who makes the rules that she works under and what the punishment is if she disobeys those rules. How does she handle complications, e.g., if your pregnancy goes 42 weeks will she operate on the principle that midwifery is a partnership, with mom having the most power in deciding whether to go to the hospital? This will give you an idea of what sort of pressures the midwife is under right from the beginning. It will guide you as to what you can and can’t tell her or ask of her.  Wow! In case you didn’t get the message in step three where she encourages you to lie about your LMP, she goes on to say,  “don’t assume that the midwife is loyal to you first. Like all human beings, her survival is important to her. If you know how to help her survive, you will be a savvier consumer of her services.” In other words, you are responsible for keeping the code of silence, to break the code means you might not only ruin the life of that midwife but make the case against all midwives. In other words the survival of midwifery depends on you keeping your mouth shut if your midwife is outside the scope of practice or doing things that aren’t allowed under her practice license. Midwifery is a partnership, but this onerous burden should not be one that the midwife or mother is willing to take on. The client shouldn’t expect the midwife to put her license on the line in order for you to have an “ideal birth,” and a midwife should never expect the client to lie in order to keep her operating under a veil of ignorance so that she can blamelessly practice outside of legal parameters.

“First, do no harm” is the motto of the healthcare profession. In essence it is meant to remind us that all decisions have risks and benefits and they must be weighed carefully. Blanket statements that encourage women to decline all interventions or ignore the fact that they have a place and are sometimes necessary. A partnership with a care provider shouldn’t begin with a lie and to encourage women to do so causes harm to mothers and babies and to the profession of midwifery.