An Honorable Peace ~ Learning to “love the bomb” as Cb women, midwives and obstetricians eventually enjoy a ‘workable’ peace

by faithgibson on April 14, 2017

in Midwifery Politics, Now & Then


Never forget: Our immediate goal for any legislation affecting healthy childbearing women and midwives is an “honest bill“. Our long-term goal is an “Honorable Peace” btw women (as mothers & midwives) and 21st-century obstetrics as a surgical specialty.

Learning to ‘Love the Bomb’ while working for an ‘Honorable Peace’ with obstetrical medicine

Unfortunately for midwives, becoming a legalized profession does not let us dispense with the thorny issues of mfry licensing or organized medicine’s eternal hostility towards PHB midwives and physiologic childbirth. These contentious issues will remain relevant, which means we must “persist”.

Eventually, we all — midwives, mothers, and obstetricians — will have to ‘learn to love the bomb‘, because none of us are going away  — not childbearing women, not midwives, not obstetrically-trained doctors. Come back in 10 or 20 or 30 years and there will still be childbearing women, midwives, and doctors. Occasional controversies will still occur, but my prayer is that 10 or 20 years from now, they won’t lead to the same threats of legal action against parents or professional midwives that have been the norm for more than a 100 years in many parts of the US.

“Normal” childbirth under obstetrics management from the mother’s perspective

But whatever the cost and inconvenience, we can’t continue to tolerate or live with a dysfunctional maternity system that simultaneously refuses to care for some childbearing women (many high risk who greatly need such care), while the system routinely performs medical treatments and surgical procedures on perfectly healthy childbearing women, even when they don’t want or need the interventions and have said “no!” several times.

The consequences of unwanted and medically-unnecessary interventions, as compounded by the hospital’s ‘defensive medicine’ protocols, is generally to the detriment (and often the regret) of the laboring woman.

Nonetheless, she persisted . . . .

We too must “stay the course” until the maternity care system in the United States no longer refuses to care for childbearing women seeking physiologically-based childbirth services or insists on performing medical treatments and procedures to women who don’t want, need or benefit from such non-consensual care. Sooner or later, we simply must end the Hundred Years War against normal childbearing and the experienced midwives who had been trained to attend normal births.

Like all the millions of other “laboring women” throughout time, (to be female is to be a laborer), we laboring midwives must stretch ourselves a centimeter at a time, while looking for ways that we each can personally further the action — no matter how small — toward an honorable peace btw midwifery and medicine.

A respected philosopher of centuries past defined morality with this brief, yet profound, statement: “No one may be harmed without their consent.

We can’t stop our political efforts at rehabilitation until our dysfunctional maternity care system officially acknowledges the physiological management of normal labor and birth as the universal standard of care for healthy women with a normal pregnancy at term.

That means teaching the principles of physiologic childbirth in medical schools, employing experienced midwives to teach the hands-on skills to obstetrical residents during their clinical training, and that physicians will practice them after graduation as the science-based standard for healthy childbearing populations.

It also means staffing hospital L&D units with professional midwives for those occasions when obstetrical providers are not able to be physically present throughout the active labor, birth, and the first hour after the baby is born as the birth attendant is helping the mother breastfeed for the first time. Care by hospital-employed midwives would also apply when obstetricians simply choose not to “labor sit”.

However, birth attendants (of whatever background) that don’tlabor sit” also don’t get tocatch’.

As mothers and midwives, we learned the hard way (i.e. earned) the right to claim that much-cherished quality characterized in the media as “nonetheless, she persisted…“.

Eventually, both sides will figure out that the ‘nuclear option’ is not an option.  Mutual survival requires “civilized behavior”.

It behooves us NOT to name-call or ridicule anyone in public. Equally important,  we continuously seek out those areas of compatibility, where we, the human species (i.e. we ‘THE PEOPLE’) are already in agreement. This can happen in a tiny corner of time when we talk candidly to each other and walk away a little bit smarter, a tad more tolerant, a bit more understanding of the other person’s viewpoint, and able (mostly) to greatly lengthen the distance btw the spark and the match.

In this case, we consciously choose NOT to jump to conclusions or assume the very worst of the other side. And when our best intentions fail us (as they always do), we climb down off our high-horse, apologize, and do our best to fix whatever problem we have created for ourselves and others.

PHB of healthy mother as attended by Heather Demare Moll, California

MIDWIFE CALLING: I am personally asking Ca LMs to go the “extra mile” by reading an extraordinary paper on the ethics of informed consent and refusal of unwanted obstetrical intervention by maternity patients. It will allow you to quote knowledgeable, peer-reviewed sources when talking to Legislators and their office staff.

This very timely paper was written by a family practice physician that provides hospital-based maternity care in Yellowknife, BC, Canada and published this month in the journal BIRTH.

LINK to a PDF copy: Informed-Consnt&Refusal_Kotaska BIRTH 2017

Dr. Andrew Kolaska is obviously very familiar with ACOG’s Committee Opinions on informed refusal, as he uses both the language and impeccable theory from ACOG’s Committee Opinions #166 and #214. He uses ACOG’s own official policies as the foundation for factual statements and his recommendations.

Since there are so many papers and other documents on the topic of “informed Consent” and maternity care, and I found this one is so special, I have been referring to it as the “Yellowknife Paper“ to make it more memorable and be sure that it gets distributed as widely as possible.

Dr. Andrew Kolska is also a long-time contributor to the Canadian MCDG (a list-serv for family practice physicians who attend births & midwives. The Maternity Care Discussion Group has been moderated by midwife-friendly Dr. Michael Klein for 20-plus years. For those of us who read his MCDG posts, we think of him as ‘Andrew’ and are very grateful for the helpful information he so freely shares.



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