Midwifery Today 2001.
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It’s a situation every homebirth family dreads, but one all too many will have to face: Your midwife is under investigation or, worse, has been charged with a crime. In the vast majority of cases, midwives find themselves threatened by legal action not because they’ve provided substandard care but because local political, legal or medical authorities have identified midwifery and homebirth as a public health “threat.” Marsden Wagner, MD, former director of the Office for Maternal and Child Health for the European office of the World Health Organization and a world-renowned expert on childbirth issues, sees the growing number of largely unfounded cases against midwives as the result of a modern-day witch hunt. “This witch hunt,” he argues, “is part of a global struggle for control of maternity services, the key underlying issues being money, power, sex and choice.”
What can homebirth families do to fight this trend? Plenty! While the job ahead of you may seem intimidating at first, remember that all of us have the basic skills it takes to help a midwife facing a legal crisis: the ability to organize resources within your own community, to network with midwives and homebirth families in other states, to raise funds, to court the press, and to become attentive to the roles and responsibilities that concerned consumers must assume. Above all, remember the power behind your voice. The single greatest threat facing any midwife undergoing a legal crisis is a silent community of supporters.
Your midwife will need people in her community willing to provide the kind of support that neither her attorney nor those closest to her will be in a position to offer: a large-scale public relations defense. Nearly every midwife facing a legal challenge is at a disadvantage before her case or hearing even begins, prey to a medical and legal system that views midwifery as substandard care and to a media all too eager to provide the public with stereotyped images of untrained, reckless midwives victimizing innocent mothers and babies. It’s up to you to counterbalance these forces by assuring that she enjoys the presumption of innocence and by seeing to it that her case isn’t simply being used for political gain. Not only will you be working for the good of midwifery generally, but you’ll also be protecting your own right to seek health care services outside the medical monopoly.
Step One: Organize Community Resources
Remember that if you don’t take the initiative to organize people and resources on behalf of your midwife, chances are no one will—often people want to help but have no idea where to begin. So it’s up to you to take the first step. Identify people in your community who can be counted on to offer a consistent level of commitment and support, who know your midwife, and who strongly believe that she is innocent until proved otherwise. Call these individuals and explain the situation your midwife is facing. Tell them you’re in the early phases of organizing community resources and you need their help. Put together a private e-mail list of supporters with whom you can freely exchange information, discuss strategy and develop consensus before calling on broader support.
Once you’ve established an e-mail list among a core group of supporters, it’s time to begin publicizing your efforts within the larger homebirth community in your region. It’s essential that you have a large group of supporters to call on should the case result in a hearing or a trial. The prosecution and the press need to be made aware that midwifery and homebirth aren’t simply “fringe” issues and that your midwife enjoys widespread support. Such occasions are also invaluable opportunities for offering positive “sound bites” to reporters; personal testimony from former clients is a particularly effective strategy for countering negative press.
Next you’ll want to gather as much pertinent legal and medical information as you can. For example, what are the laws in your state governing the practice of midwifery? The practice of medicine? Is informed consent an issue in this case? If so, does your state have any case law pertaining to issues of informed consent or parental choice? What’s happened to other midwives who have been investigated or charged? Have other alternative health care practitioners in your region been targeted? Investigate the practices at local hospitals: What happens to physicians who experience bad outcomes or are accused of practicing recklessly?
To obtain the information you need, you can research library and Internet databases and turn to local homebirth families for help. Fortunately, most homebirth communities are full of researchers of all stripes, and many will already have established their own database of articles, references and other information concerning midwifery and homebirth. Others will have useful contacts within the local medical system.
There’s also a good chance someone within your broader community of contacts either is an attorney or knows one. These more casual contacts can be invaluable sources of basic legal information. For more in-depth questions, go to your nearest law school and talk to professors there, particularly those who might specialize in health care, women’s issues or civil rights. Explain the nature of your midwife’s case, present them with background information on the broader issues at work and ask for their help. Perhaps they have a student willing to work as a research assistant. Even better, they might be willing to work on your case personally, either to use for their own research purposes or as a class project. They may also be able to refer you to legal aid resources or to community organizers in your region.
The most important legal question you will need to answer concerns any documents that may have been filed in your midwife’s case. For example, if she’s undergoing investigation by health department authorities, do you have access to the original complaint placed against her? Is it on file? What about any medical records submitted in support of a complaint? Or autopsy reports relating to a bad outcome? If your midwife has been charged with a crime, can you obtain court records relating to her indictment? Whatever you do, don’t take no for an answer. Public officials aren’t used to consumers demanding access to information. Often they will mistakenly believe that all documents relating to the case are to be kept private. So be persistent, and remember that the information you uncover may prove crucial to your public relations efforts.
Step Two: Network With Midwives and Consumers in Other States
One of the earliest tasks you’ll want to undertake in supporting your midwife is to address the rumors circulating about her case. Often the initial reaction among sister midwives is skepticism. Speculation abounds about what could have been done differently to avoid the charges, and questions are often raised about the extent to which a midwife’s actions may have contributed to a bad outcome.
It’s your job to address these questions and ensure that your midwife enjoys the support of her colleagues. If she’s facing a hearing or a trial, she’ll need other midwives to testify on her behalf, if only to provide an overview of protocols and the ways they differ from the protocols governing physicians and certified nurse-midwives. Without this support, your midwife will be in serious legal trouble. Your job isn’t to defend her actions at all costs but simply to remind her colleagues that everyone is entitled to the presumption of innocence and to a fair defense. Remind them that they don’t have to condone her actions to offer support—they only have to believe in her right to an unbiased hearing of evidence.
If you don’t know any other midwives, the best way to learn what rumors might be circulating and how best to address them is by joining midwifery-related e-mail lists at www.yahoogroups.com and elsewhere. These lists are central sources of information exchange among midwives. It’s essential that you keep track of what’s being said there about your midwife’s case and that you remain prepared to answer any misinformation you can. If the press has been covering the case, send articles to midwifery e-mail lists, along with detailed responses explaining inaccuracies and pointing out biases. Once her colleagues become aware of how the press is portraying your midwife and the issues surrounding homebirth, they’ll be more likely to offer her the benefit of the doubt.
Your next step is to reach out to a national network of contacts and potential supporters. Valuable resources here include the Midwives Alliance of North America, Citizens for Midwifery, and Virginia Birthing Freedom. Each of these organizations has members who are highly experienced in midwifery advocacy and can offer advice as well as assistance in publicizing your efforts. On a regional level, Friends of Midwives organizations often will have contacts with activists and lobbyists whose expertise may prove helpful to you. They might also be able to refer you to local midwives and physicians willing to write letters of support or act as expert witnesses on behalf of your midwife.
Be creative, and make attempts to contact virtually every organization you can that might have experience in midwifery or alternative health care advocacy. Each group you contact is likely to have some helpful knowledge to pass along, particularly on the subject of fund raising, a topic far too broad to address in detail here. But suffice it to say that at some point in your effort to support your midwife, you will have to determine who will be responsible for raising funds. Ideally, this person’s sole responsibility should be fund raising, since the research and networking involved will be intensive and should constitute a separate and distinct aspect of your general support effort. The costs involved in mounting a legal defense can easily climb to $100,000, so you’re going to need someone who’s willing to learn the fundraising ropes beyond the bake sale and silent auction basics.
More important, you’re going to need to find someone willing to undertake the effort necessary to establish not-for-profit status. This can be done through a variety of routes, from establishing your own nonprofit corporation to finding an established not-for-profit organization willing to sponsor your efforts. However you choose to do it, it’s important to remember that without not-for-profit status and the tax break that goes with it, you will find it exceedingly difficult to raise the funds required for competent legal counsel.
Step Three: Meet the Press
Probably the most essential task you can undertake in supporting your midwife is to learn how to work with the press. First, bombard local and regional newspapers with letters to the editor about the case. Use your e-mail list to discuss possible angles: Some writers may want to focus on countering misrepresentations about the case, while others might want to focus on the safety of midwifery and homebirth in general. Still others might want to offer information about cases involving physicians in the region who have experienced similar outcomes. Send as many letters as you can and do it regularly. You’ll be pleasantly surprised by how many will actually get published if you send enough.
Your next, and more important, step is to cultivate relationships with local editors and reporters. This effort will take time, but it will be well worth it. Here’s where your early research efforts will prove essential; especially helpful is any information you have regarding the safety of midwifery and homebirth, the role midwives play in health care internationally, and the history of physician and government harassment of midwives. Often people unfamiliar with the politics of homebirth understand that financial competition and the overarching reach of the medical monopoly might play a role in midwifery cases.
It also pays to identify local reporters or columnists who might be inclined to present a balanced viewpoint on midwifery issues. Many newspapers carry columns by local writers interested in offering in-depth analyses of current issues and court cases. And if your midwife has been the victim of bad press at the hands of a particular reporter, find another reporter in your region who might be interested in scooping the competition. Often an effective strategy is to speak to reporters off the record, providing them with details and angles to the case they might not otherwise have access to; any legal documents related to the case will prove especially helpful here. If you can offer reporters enough of a “tease,” they might become interested in further investigation.
Press releases are also a highly effective means of encouraging the media to present more objective information about a case. Any number of the organizations you’ve contacted earlier in your organizing efforts might be willing to act as the official source and distributor of press releases that you write about the case. Many of these organizations will also be able to provide you with useful information about how to write an effective press release and how to approach reporters.
The best way to encourage the press to take a serious look at all angles of a midwifery case is through face-to-face meetings with editors and reporters. Try first to schedule an appointment. If that doesn’t get you a meeting, find out when they’ll be in the office and show up, and keep coming back until they agree to meet with you. Once you’ve met and presented reporters with information you’d like to see included, follow up. If their next article includes a fact or two that came from you, thank them in person or by phone. Then remind them of all of the other information they neglected to include and ask them to do better next time. Most important, present your press release whenever possible. Like everyone else, reporters are short on time, and if you’re persistent and can present a convincing case, you may very well find them happy to include the information you prepare for them.
Step Four: Roles and Responsibilities
Because of confidentiality concerns, neither your midwife nor her attorney will likely be in a position to offer you much in the way of clear-cut advice or guidance regarding your organizing efforts. In fact, your midwife may be required to cut off all contact with former clients or potential witnesses, while her attorney and closest associates may fear that your efforts on her behalf could jeopardize the case. In their efforts to support her, they may discourage your efforts. Listen to their concerns. Explain that your role in organizing a public relations defense is a separate and distinct effort from your midwife’s legal defense. Let them know that it’s your responsibility as a concerned consumer to help ensure that your midwife’s case is treated fairly in the public arena and to call attention to the implications her case holds for consumers and for midwifery as a whole.
Your responsibilities also extend to the family whose birth was the catalyst for any complaint or charges filed against your midwife. In the vast majority of cases, the parents know and trust their midwife’s work and remain convinced that she did everything possible to prevent a bad outcome. But if legal charges have been filed, chances are your midwife has been ordered to cease all contact with the family. This situation is certainly difficult for any midwife; for the family involved, it can be devastating. Not only have they experienced a loss, but also they have been denied the support of their midwife and forced to relive their tragedy as the legal case unfolds. They will need emotional, financial and, often, practical support in the weeks and months following a death. When a baby dies during or after a homebirth, those outside the homebirth and midwifery community will often add to their pain by blaming them for not having had the “safest” care possible. The family is going to need people around them who understand the choices they made and who firmly believe in their right to make these choices. Ideally, homebirthing families in your region have already extended their support and assistance to anyone experiencing a bad outcome. But if this isn’t the case, then you should take the initiative to do so now.
When a midwife is charged, those who want to help are likely to believe that there’s little the average person can do. In illegal states, former clients may hesitate to come forth for fear that it will simply give authorities an excuse to bring additional charges, while others may fear that if they identify themselves as a homebirth family they themselves will face legal charges for child abuse or neglect. Part of your job will involve educating your local homebirth community about issues such as the statute of limitations involved and helping them to understand that, in all but the most extreme circumstances, their silence can only do harm.
Many people in your community will continue to make excuses about why they can’t become involved. But the best way to guarantee that homebirth will no longer remain a viable option is to stand idly by while midwives are harassed by legal, medical and political authorities. It’s therefore all the more urgent for concerned consumers such as yourself to stand up and fight when midwives are made to pay for your right to make informed decisions about where and how you give birth.
For information about networking on a national level:
- IAM (International Alliance of Midwives): midwiferytoday.com/iam/
- Midwives Alliance of North America: www.mana.org
- Citizens for Midwifery: www.cfmidwifery.org
- Virginia Birthing Freedom: vbfree.org
Many of these organizations will also be able to provide you with useful information about how to write an effective press release and how to approach reporters.