A Provider Who Cannot Provide

Midwifery Today, Issue 137, Spring 2021.
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I see myself in her. But I’ve been taught that that’s bad as a professional. I’m her prospective midwife—not her friend. I reinstate my professional role and gut my personal self out.

But I’m prancing to an indelicate dance. I’m amputating a chunk of my identity, letting the professional in me emerge preeminently, yet trying to cling to my humanity. My goal is to be professional, yet human and connected.

I sit cross legged, relaxed on a plush peach couch, professional midwife in consult. She smiles brightly at me, proudlyy pregnant and curvaceous. Simone appears ordinary, 37 weeks pregnant, Middle Eastern, and vegetarian. They’re a newlywed couple enveloped in the stratosphere of pristine, pulsing love.

“I want to birth my baby unassisted. But my husband wants me to have a midwife present. So he forced me to come to this visit.” The couple chuckles. I’m relieved that this “coercive” prenatal consult is embedded in happy humor.

“I’ve had one prenatal visit so far. Simply for the purpose of having documentation that I am my child’s mother. This way if I ever had to prove it to the government, I can.”

Wow, I am learning something new. In all the prenatal visits I’ve provided, I have never accounted for this particular benefit.

I decline lecturing her on the potential dangers of birth. Why amplify the skepticism about normal human childbirth.

“I don’t want to be stitched up if I tear. I prefer to heal naturally. I don’t plan to cut the cord—I will have a lotus birth and will bury the placenta. I would not have a c-section for anything. If this pregnancy doesn’t work out, I’m okay with that. I plan to have more children so I cannot have a c-section. I will gladly carry this pregnancy for 43 weeks. There are risks inherent in nature, and I accept those risks fully.”

She locks her eyes with mine, face square, and in an even-keeled, resolute tone asserts: “The hospital is such a dangerous place to have a baby. It is so, so dangerous, the hospital.”

I’m astonished. She is a primip. But she sounds like a survivor. I remain curious and cautious.

The wild-spirited birther in me proudly yearns to divulge that I’d birthed two babies unassisted—long before I became a midwife. I’m enticed to brag that I was an instinctive, powerful birther, fiercely self-reliant, and emancipated from socialized birthing. In my life before I transformed into a midwife, no one could tame me! I actualized Simone’s unassisted birthing fantasy twice.

Unassisted birth is self-actualization and undercover rebellion. Its vitality made me a better version of myself. I inhabit my body differently than other women do.

My mind is rambling. I’m wildly in love with wild birth. Any day, I would sooner have my baby on a NYC subway than in a NYC hospital. Wouldn’t it be more private? Most Good Samaritan commuters would grant a birthing mother her rightful privacy when she is explicitly exposed. They wouldn’t crowd around her on a train, converting her birth into a performance.

In the hospital, birth draws spectators. A circle of uniformed professionals camouflages identically uniformed students who enter for a delivery. Modesty and decency have been redefined in Labor and Delivery.

My radicalized voice is silenced. I can’t support unassisted birth in a professional context. I’d be lending well-reasoned authority to a birth choice that is unsupported by data.

“You’re right, hospitals are overly interventive and compromising. Planned, midwife-attended homebirth is the gold standard of care for risk appropriate women.” I’m playing safe and obediently to ACNM. Suppressing my personal views, I bypass my inner wild self and share only my most recent birth experience: a planned, tame, midwife-attended homebirth.

“Even as a midwife, I had a midwife present when I had my baby.” I deliberately delete my two earlier birth experiences, inescapably my most powerful ones.

But Simone is still uncomfortable with midwife-attended birth. She dares to be different. “I’d want you to come to my birth, but as a friend, not as a midwife,” she implores me.

I sigh defeatedly. She has struck at my core conflict. I’m attracted to birthers who embrace nature and are cleansed of death phobia. They’re liberated to live and birth wholeheartedly. But as a licensed midwife, how can I blindly support a mysterious birth journey that may unfold outside the rigid parameters of New York State standard of care?

We couldn’t just bury a fetus in the backyard. The government would know I had been there.

“Realistically, if you don’t want the baby monitored at all, you need to call the midwife at the last minute and be prepared to birth in your front hallway. Any licensed person will monitor the baby’s heartbeat every 30 minutes during the first stage of labor and every 15 minutes during the second.”

I observe her step into herself as she opens up to new possibilities caged within the framework of society’s designated authority on birth. Why can’t mothers own their births, though? I draw my professional boundary; I’d need to monitor a baby if I am present during labor.

We chat; I am welcomed inside the couple’s world. After an hour of talking and connecting, I offer to check the baby. I press the back of my wrist to Simone’s hand. “Are my hands warm enough? Can I feel your abdomen?”

“Yes, go ahead.”

I have explicit permission from Simone.

“Hi Baby, it is Judy, the midwife. Is it okay if I say ‘hi’ to you?”

My hands assess the fetal position and size. Together with Simone, I palpate each limb, guiding her hands within mine. I smile as she caresses and envisions her baby, inspired by the life encapsulated within her.

The fetus is perfect size, perfect position, in an imperfect world. Simone’s blood pressure is ideal; she is a conscientiously healthy mother. We auscultate the heartbeat with a fetoscope. I share my earbuds with Simone. Her baby bump whispers to her the primal hum of her baby’s healthy heart.

I admire Simone. I relate to her. She grew a beautiful baby courageously, creatively, and exquisitely independently.

The visit is ending, free of ultrasound. Simone witnesses that prenatal care is not prenatal compromise. I communicate that I am a radically unorthodox, safe provider.

“I needed to become a midwife because I wanted to have more babies. I didn’t know where I could receive care that merited trust. I opened my practice as a sanctuary for women like myself, who seek safe care.” I self-disclose, enough to be relatable, but not enough to be too human or reveal my freebirthing.

“Then please be that sanctuary,” Simone’s husband, Jona, beseeches me. He enlists me to self-fulfill my ambition, petitioning me to realize my noble role. Jona doesn’t want his wife birthing their baby unassisted. He had been the catalyst for this consult. Simone and I hug tightly as the couple heads out.

I usher in Elisheva, my next prospective client. I cleanse my mind, free my thoughts, and enter a whole new pregnant world.

My night terminates with Simone imprinted in me. Her faith in her body beckons me to attend her birth. She is so assertive that she can birth her baby if she grew it. Don’t thoughts create form?

I confront my professional limits and fiercely squelch the struggling instinct that draws me to attend Simone’s birth as a friend. I shake my mind, ripping down the notion. It is indeed rare to encounter a woman with such fervent devotion to the birth process. How could I not be there?

Three ordinary days pass. Wednesday, I get a call that I only partially expected. It’s Jona. “Would you come over now to the birth? Simone is in labor but doesn’t want to be monitored, doesn’t want a midwife. Would you sit outside, though, in case she changes her mind or has an emergency?” His fatigued voice is desperate.

In the background, I hear the guttural vocalizations of an active labor. A baby is crawling out. I’m a passive backdrop absorbing the enormity of Simone’s voyage.

The mother in me wants to mother this mother. The woman in me wants to befriend this woman. The human being in me wants to support this human being, natural-minded and fierce in her belief in birth, her deep confidence in her body, and her accepting responsibility for her choices.

I ask more questions to assess the clinical scenario. Simone’s water released days ago, her GBS status is unknown, and she won’t consider antibiotics. Her birth journey is unfolding outside of my midwifery comfort zone. “I’m sorry. I can’t be the midwife. I am not comfortable with waiting outside of a birth.” I hear my midwife voice override me. The professional in me is stomping my personal self into oblivion.

As I feel myself slipping out of my own identity, my inner voice haunts me: You know good and well, Judy, that mammals birth best when they are undisturbed and unobserved … so why can’t Simone?

My conscience is playing tricks on me. If birth is inherently self-sufficient, why am I not honoring that? Most women I attend as a midwife could have birthed just as safely without me. Have I arrogantly taken credit for “delivering” them? I respect self help and womb sovereignty. If I respect Simone, I should help her in the way she requests it.

I am forced to confront the devil in my devotion to birth: is the plaintiff-friendly environment driving me to practice defensively? Are the criticisms I callously sling at colleagues really a reflection of a cowardly part of myself that I haven’t reckoned with?

My birth faith continues to storm me. I indulged as a reader in radicalized birth works. My mentors’ voices are stinging in my ears. I try to guess how’d they respond. Is this a test of my shared humanity? Am I failing grossly? Or am I a responsible, rational provider, protecting my license. I don’t practice in a developing country. I live in New York.

The decade of my life that I donated to my education dangles before me. I hang up the phone with Jona, oblivious to my children and in a maelstrom of dicey emotions.

I became a midwife to support women like myself, yet here I am avoiding such one. I became a midwife to safeguard physiological birth, yet I am abandoning a devout physiologic birther. I became a midwife to protect women from a corrupt system, but have I, too, become corrupted?

Simone, I want to attend you as a friend. Simone, I want to whisper to you, “You can do it.” Birth is a healthy physiological fact no matter how badly it hurts. Simone, I want to cry along with you when the excruciating energy draws the magnetic love of your baby out. I want to guide you not to tear. Simone, I want to be your friend, even if I am a skilled midwife.

I sat alone on my couch as Simone labored alone. She hovered between two worlds, in her near-birth experience. But I could not be midwife. I could not be woman. I could not be friend.

Oh! How I wished to slink into the dark shadow of her laboring bedroom and hold my breath, lest I make noise. My heart to beat with her heartbeat, inhaling courage and exhaling fear. But I stayed put, right in my home, my professional license privileging my shackles.

My license stares at me with the glistening eyes of a sadistic prankster. I am privileged to be a provider, but I’m denied the privileges of a layperson. I’ve been granted autonomy as a prescriber, but in exchange I’ve donated a piece of my autonomy as a human being. My love has become professionalized, my care protocolized, and my decision making beholden to government scrutiny. I defeatedly confront the award I worked 10 years to obtain. I am no longer centered in my own agency. I am an extension of a system that I sought to subvert. Paradoxically, Simone can legally birth freely but I cannot midwife freely.

I am ignorant of Simone’s past traumas. I respect her rights to birth choice regardless of the choice itself. I safeguard her heart. I pray for her in my home. The baby is coming, but I am staying.

I abandon my friend in primal birth. I abandon my friend in rugged womanhood. I abandon my friend in fresh, raw motherhood.

I am a loyal, trusting friend, but as a licensed provider, friendship is outside my legal scope of practice.

About Author: Judy Fisher

Judy Fisher is a CNM, homebirth midwife, and mother to three homeborn children. Judy’s journey to midwifery began when she birthed her daughter powerfully and instinctively, into her own waiting, loving arms, unattended, at home.

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