The Paradoxical Perception of Midwifery in American Culture By Stacia Guzzo


This past Sunday night, midwife Robin Lim was named CNN Hero of the Year at a formal award ceremony in Los Angeles, California. The award, which was given after eleven weeks of public voting on CNN.com, came with $250,000 to support Lim’s quest to provide quality prenatal, labor, birth, and postpartum care for the poor and underserved in Indonesia.  She accepted the award amidst a standing ovation, and closed her words of acceptance by simply saying: “Every mother counts. And health care is a human right.”

The recognition of Lim—or Ibu (“Mother”) Robin, as she is called by those whom she serves— is well-deserved.  An American woman, Lim provides midwifery care at the Bumi Sehat clinics which she helped to establish. Each year, she helps thousands of Indonesian women get care and attention during their pregnancies and the births of their children.  She began her work in 1994, seeing pregnant women and children under five for free out of her home. As her reputation spread, supporters of Lim, along with local business and community leaders, helped to advance her cause. Today, the village-based Bumi Sehat clinics are located in both Bali and Aceh. They provide free prenatal and birthing care as well as breastfeeding support to any woman who needs it, regardless of her ability to afford it.  Ibu Robin’s words to CNN reflect that her commitment to her cause is an altruistic one: “”Every baby’s first breath on Earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving.”

This sentiment seems to be the golden thread of purpose that connects most midwives whom I have met, connected with, or read about. Gentle birth, empowered mother, a safe and loving environment for a little one’s first earthside moments—such is the creed of most women in the vocation of catching babies. Certainly, if you looked at a midwife’s tax return, you would see that she isn’t in it for the money. And considering her schedule (inability to leave town easily, needing to arrange childcare while at a birth, working for up to 70-hour stretches at a time), it certainly isn’t for the convenience. No—as one midwife once told me, midwifery called her. She couldn’t deny her vocation, even if she wanted to. It was as integrated into her state being as her involuntary breathing.

Less than four miles from the Shrine Auditorium where Lim received her award, a different midwife’s journey has taken place over the last few months. Instead of joyous recognition and award money, this story has been one of pain, fines, and conviction. In October and November, midwife Katie McCall spent her days fulfilling 240 of her 280 hours of community service, part of a punishment deemed appropriate by a Los Angeles judge for then-student midwife McCall’s choice to stay with the laboring mother when no other midwife could be found available to oversee her at the time of birth and the couple refused to go to the hospital. In addition to performing a potentially life-saving technique to help the baby birth safely despite a shoulder dystocia, Katie also stopped the mother’s hemorrhaging due to a retained placenta. A bystander—not the birthing family— lodged a complaint to the California Medical Board about Katie’s decision to catch the baby and tend the mother without a supervising midwife. This eventually turned into a criminal investigation and Katie was arrested and charged with practicing medicine without a license. A jury convicted her despite hundreds of letters of support.  Katie, a single mother of two children, was ordered to pay $10,000 in restitution to the medical board, perform 280 hours of community service (including 40 hours of hard labor), had her license (issued in 2010) revoked, was put on probation, and was forbidden from working in her trained profession. The raw, humbling, and inspiring journey is partially documented in her blog.

So what is the difference between how these two women were perceived? Both have committed their lives to helping pregnant women and babies. Both have endured emotional heartache, personal and financial strain, and extreme inconvenience for the sake of their calling. Both are educated and experienced in their field. And yet one of them is upheld as a national hero, and one is sweeping floors at a homeless shelter on Skid Row as part of her community service, wondering how she will support her children without the ability to work in her trained field.

I have to wonder if the perception of the public is due, in part, to the populations and locations in which these midwives serve. The one deemed heroic serves poor women in Indonesia; the one deemed felon serves American women that span all races, creeds, and socioeconomic spheres. The first serves a deserving, but removed, “Other,” and the latter serves women that could easily be our neighbors, relatives, daughters, sisters…or even us. Why is midwifery (and along with it the idea that birth doesn’t have to be a medically managed event) more easily swallowed when it doesn’t hit so close to home?

I’ve written before on this blog about my belief that every woman deserves the opportunity to be empowered by birth. These two midwives, while standing in stark contrast in the public eye, have both been champions in upholding the dignity of pregnant women. They have stood as holy witnesses when the sacred threshold into motherhood, life, and breath has been crossed. Yet I wonder if midwifery is considered just outside the boundaries enough—perhaps it is considered the care of poor people, or of hippy radicals, or only appropriate for underdeveloped nations—and because of that, it scares us when it gets too close. Birth isn’t considered “normal” in America unless it is in the hospital under the supervision of an obstetrician. And perhaps, in part, that is why Katie McCall was convicted of a felony for her heroic act by a jury of her peers, and why Robin Lim was chosen by America above nine other equally deserving men and women as the most admirable.  We’ve forgotten the inherent dignity of the birth process in America, and because of that, we don’t adequately value the birth servants that sacrifice so much to reclaim that dignity.

When considering these two stories, I once again feel the anger of knowing that institutionalized birth (or the perception thereof) continues to reign in America. We don’t have a culture that trusts birth as a normal process or trusts birthworkers that aren’t doctors. We praise the work of midwives who serve in other countries because our bias perceives: “Well, of course they can’t afford quality health care in that part of the world, so at least those poor people are getting something.” Yet the Bumi Sehat clinics provide an opportunity for which every pregnant woman could hope:

Our gentle birthing practices put mothers and families at the center of the birthing process by supporting their labor in safe and empowering ways. This gives women the capacity to give birth naturallly without the use of medical intervention, which can cause more risk for the mother and baby. Safe, gentle, birthing practices such as water birthing, early skin-to-skin contact between mother and baby, delayed cord cutting and the use of herbs and homeopathic alternatives instead of pharmaceuticals, all contribute to healthier births, healthier mothers and babies. To ensure babies are well-nourished and less likely to suffer from illness or malnutrition, we support breastfeeding at Bumi Sehat. Moments after birth new mothers are encouraged to put baby to breast to enable them to receive the full benefits that mother’s milk can deliver. We also send mothers home with breastfeeding support pamphlets to answer any questions they may have once they return home.

-taken from the Bumi Sehat website

Here in America, Katie McCall sought to provide a space of dignity and reverence as well. Her website expresses her philosophy, stating that “she believes her job is one of empowering women to develop their own trust and connection with their bodies and their babies during their own unique journey into motherhood.” Unfortunately, our system of “justice”–reflecting the bias of our culture–did not receive her with the same appreciation as the Indonesian peoples received Ibu Robin. Instead, they condemned her.

Different cultures, different perceptions of birth, different reactions to those who seek to make it a better experience for the women they serve. Contrasting these stories, it seems clear that a midwife’s heroism can certainly be recognized by the public–but only as long as she doesn’t make us stretch past the zone of our cultural comfort.

Stacia Guzzo is a homesteading theologian/stay-at-home mother who received her Master of Arts in Theological Studies from Loyola Marymount University and is currently working toward a Master of Divinity at Fuller Theological Seminary. Stacia has been a teacher and speaker in the Los Angeles Roman Catholic Archdiocese and has served as managing editor for Spiritus: A Journal of Christian Spirituality. Her areas of interest include embodiment theology, ecological justice, food ethics, and the spirituality of birth. Stacia’s perspective offers unique insight into the raw, fresh theological undertones of every day life; coming from a Jesuit background, she embraces the Ignatian attitude of “finding God in all things.” In addition to her theological studies, Stacia currently works part-time as a doula, childbirth educator, and apiarist.

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Categories: Childbirth, General, Motherhood, Social Justice, Spirituality, Women and Community

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73 replies

  1. I’ve been feeling uncomfortable about this all week. Thank you for putting my thoughts into words.

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  2. YES YES YES YES YES!!!!! This has been burning in my gut for days. THANK YOU for saying it.

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  3. Stacia,
    I watched the CNN interview with Robin Lim with her own reaction to receiving this award. While it is expected that most award winners will echo the sentiment they were surprised, robin spoke (with sincerity) of with love and gratitude of the other candidates. This women lives in the “Zone” of love, really, she is remarkable.

    Everything you stated is so true about birthing in the U.S., but I wondering which came first, the inability of women to trust their bodies or the medical profession’s drastic shift from vaginal to C-section births? Having suffered greatly in labor, resulting in a very necessary C-Section, I am grateful for the procedure, but equally grateful for the 48 hours of constant presence of two midwives. How much of the C-Section graze is due in part to medical malpractice on the part of families (just to play devils advocate)?

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    • Cynthie,

      I think that women lost the ability to trust their bodies slowly. In the early-mid 1900s, “twilight sleep” (a drug concoction of morphine and scopolamine) induced amnesia in laboring women. The drug did not reduce pain–in fact, it made women so crazed that they were tied to their gurneys during childbirth–but the women did not remember their experience. Women began speaking out about this toward the end of the 1950s (around the time when the natural childbirth movement was forming). But unconscious/semi-conscious labor still existed. I know of one woman in particular who slept through her entire labor because of the drugs–she woke up and the baby had been born–most likely with forceps since she was unconscious and therefore unable to push.

      Imagine this entire cycle of generations who grow up without mentors in birth. By the time the natural birth movement began, those women were considered counter-cultural. Coinciding with this movement was the refinement of the epidural. Many women didn’t have mothers or grandmothers who could tell them that the pain would be hard but not insurmountable, or even that they would be okay. Childbirth became a parody of itself in television and movies–often their only exposure to childbirth before giving birth themselves.

      Still, it is interesting to consider this: in 1975, about 20% of women chose to have an epidural. Today that number is between 80-90%, depending on the hospital. In 1972, the National Natality Survey noted that 7.3% of live births were via c-section. Today, our national rate is at an all-time high–34%. Over 1 in 3 births.

      In my opinion, the trend of women failing to trust their bodies is a culmination of many generations where birth became a detached or frightening event. Without mothers, sisters, aunts, or grandmothers to guide new mothers, how can most women hear that they are strong enough, that they are capable, that their bodies were made to do this?

      I also want to address your situation, however. We’ve talked about your birth experiences, and it’s important for all to recognize that there are legitimate reasons for c-sections, for drugs, and for numerous other interventions. Doctors–obstetricians, specifically, as surgeons–can be and are life savers. That being said, however, I think that if we approached birth with less fear and more intuition, our culture would not immediately jump to prophylactic interventions for every birth. I don’t think it is necessary, and I don’t think it does any justice to a woman’s sense of empowerment. Nor does it do anything for the medical profession. Most doctors can no longer deliver a breech baby vaginally, nor can they deliver twins vaginally (particularly the second one). Many do not have much practice manually palpating a woman’s belly, relying instead on multiple ultrasound readings. Many doctors do not practice manual stretching of the perineum during crowning rather than jumping to an episiotomy. These are important skills that are being lost, and just as women are losing trust in their bodies’ ability to birth, so are doctors losing their trust in their ability to rely on their gut, their hands, their logic, their eyes and ears, and their experience.

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      • The unconscious labor and birth you described happened to my mother in 1969. She has no recollection of the labor OR birth and I was delivered by forceps. She remembers waking up alone in a room and wondering what had happened to her baby. She greatly regretted the way she brought me into the world.

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      • While I agree with pretty much everything in this response, I must comment that a woman’s body can birth a baby whether or not she is conscious. There are stories, one of which is in Childbirth without Fear, of twilighted women birthing babies without even the knowledge of the medical staff — they’d come in and hear a baby crying under the sheets.

        And many many stories of natural births where women consciously chose not to push at all, letting their bodies do the work of birthing the baby. (For myself, it felt AMAZING to push, so I do not share this experience, but my body was doing most of the work already. I only pushed because I was impatient!)

        I’ve no doubt that many instrumental deliveries were performed while the woman was unconscious. I just wanted to point out that the body can do the work without the pushing. Do not push the river; it flows by itself.

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      • Angela, you are certainly right; I never had to be told to push with my son. My body just did it! An incredible experience. I just wanted to point out that twilight sleep isn’t unconscious sleep; the women are conscious (although in an altered state) during twilight sleep. I was referring to a woman who was chloroformed for the majority of her late labor; in this particular case, I believe the baby was extracted with forceps. Thanks for providing the opportunity to clarify.

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      • Regarding the question of what came first, “the inability of women to trust their bodies or the medical profession’s drastic shift from vaginal to C-section births”, the history of childbirth in this country is a complex one. At the turn of the 20th century, in the wake of industrialization, both urban and rural centers suffered from very high rates of infant and maternal mortality. At that time, women were also heavily involved in the suffragist movement and beginning to demand self-determination. Twilight births were very much a part of this movement- in which women demanded relief from the suffering of childbirth. At this time, there was also the trend of ‘educated motherhood’ in which women believed there was a need to seek guidance for child rearing (rather than relying upon instinct). Sadly, many of the practices espoused have been since determined as developmentally harmful to infants (like minimal holding and ‘crying it out’).

        During the 1920’s there was a major shift to professionalize midwifery under the Sheppard-Towner act of 1921, which was a women led, massive grassroots campaign to support breastfeeding and to train both midwives and doctors in order to reduce infant/maternal mortality. On some levels, this shift was extremely successful, as teaching folks not to feed babies spoiled cows milk, to sterilize birth tools, to wash hands and to minimize vaginal exams, did in fact reduce deaths. However, when the American Medical Association realized there was money to be made in the private sector of maternal health, they lobbied to overturn the act. Meanwhile, the groundwork had been laid for the medicalization of childbirth and the scientification of motherhood in general. One of the very tragic outcomes of the professionalization of midwifery was the destruction of African American Midwifery in the South, which is a legacy of structural racism that continues to be embedded in our medical system (African American infant mortality rates are currently more than twice that of Caucasian).

        That is a tiny slice of the history… Understanding how this unfolded is helpful to gain an understanding of why public health in the U.S. has emerged the way it has, and to understand that one reason women lost faith in their bodies at the turn of the century, was because they and their babies were dying in large numbers. Society responded with the ‘en vogue’ tools of the era: Science. And business followed soon after to reap the economic benefits of the new field of prenatal medicine. Since then, women have gained most of their understanding of birth from this scientific sphere and have, more and more, lost the wisdom that generations of mothers and grandmothers have held. Sadly, despite some technological shifts, we have not evolved our medical model much since 1929, despite all of the research to support gentle birth practices. The entrance of litigation into medicine is a huge part of this shift.

        Incidentally, the global community now faces a similar kind of predicament as women in the US did at the turn of the century. As developing countries urbanize, a maternal and infant health crisis is exploding. Guided by the auspices of western healthcare, global NGO’s enter to ‘help’ and in the process, destroy traditional midwifery traditions- deeming them the cause of the problem (in exactly the same ethnocentric way African Midwifery in the South was destroyed). This is why acknowledging Robin Lim at this moment is so important- it validates the Bumi Sehat model, which acts as a bridge between the two worlds and if replicated could temper the colonial impacts of Americanized medicine around the world.

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  4. Beautiful piece! Thank you for expressing the paradox so concisely.

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  5. I believe that Robin feels like she is now a tool for awareness and change. I know of another woman who served 12 years of her life in Prison because a mother she was serving died in childbirth. I’m not saying I have any answers but I feel this is a crack in the wall towards opening up awareness across the world. There is no way to heal the pain of what this woman is experienced. But I believe stories like hers will now be listened to a little differently and pray Americans will stand up and change the future!

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  6. As a midwife in the US I am totally in support of my profession. That being said, I take issue with your statement that “Both are educated and experienced in their field.” I think this is where the problem was for the jury. Unfortunately, Katie was a STUDENT midwife at the time of this incident according to your article. The government, for better or worse, has the responsibility to protect the public from unsafe practitioners. As a student, one must presume she did not have the appropriate amount of education yet to work independently. Do I think her punishment is ridiculous and totally unwarranted? Absolutely. But to compare a student to Robin Lim is fair to neither. I wholeheartedly support natural birth and the demedicalization of birth in the US. Midwifery is well proven to have better outcomes, less cesareans, and less intervention. The US needs to incorporate midwifery as a norm, as it is in Europe, where the maternal/neonatal morbidity and mortality rates are far superior to the US. I celebrate Robin Lim’s accomplishments and hope that it spreads the flame of midwifery a little bit more in our country.

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    • Katie received her CPM in 2008 and her LM in 2010, has assisted over 500 couples through their childbirth education and has attended over 550 births. I stand by my statement that she IS educated AND experienced. I did not state that her experience was comparable to Robin’s, as I do not think it is necessary for that to be the case. The experiences and situations that each face in their respective circumstances are very different and cannot be compared to one another.

      You are right in saying that at the time of the incident she was a student and as such was not yet able to work independently according to the medical board. However, she urged the couple to go to the hospital. They declined. She called every midwife she knew. No one came. So her choices were this: call 911 against the couple’s wishes, leave the situation and let them birth unattended (a situation that would have certainly been more disastrous considering the dystocia and retained placenta) or catch the baby. And I deem her choice heroic because while it may not have been a legal one, it was a moral one.

      I do agree that the US needs to look to Europe for a better example of the normalization of birth, and am also hoping that Robin Lim helps to shine a spotlight on a much under-appreciated vocation in this country.

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      • I agree, Stacia-Katie was between a rock and a hard place. I don’t disagree with her decision-it was the ethical thing to do. I am not familiar with this particular case, or her background, so I was only responding to what I read in the article. I would have done the same thing as Katie. This is a real injustice.

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      • I think part of my anger over this case is that midwives–I know several personally–devote their entire lives to their call, but because of public perception aren’t given the respect they deserve (from the media, the medical community, and here the legal system). For so many, it continues to be a frustrating and sometimes career-ending situation.

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      • I just went to Katie’s blog to see if it listed the dates for her certifications, experience, and the incident for which she was convicted of practicing without a license. I’m not going to argue that the sentence was harsh. However, your reply (the one to which I’m replying) makes it sound as though she had all that experience and a certification at the time of the student delivery. According to her blog, the delivery occurred in 2007 (she started studying midwifery full-time in 2006), and her CPM was obtained in 2008, her license in 2010, and the number of deliveries/experience you reference was as of 2011.

        She was undoubtedly between a rock and a hard place, as she couldn’t get a supervising midwife to come but couldn’t in good conscience abandon the couple with no medical care. I would have to question why a student midwife was ever sent to a laboring woman’s home without supervision in the first place – that was really what set her up for the impossible choice. The sad thing is that her own ethics would not allow her to leave the couple, who have the right to refuse medical care; but had she left and something tragic happened to the woman or baby, she would have been villified by the public, as well as her profession.

        I am personally a fan of midwives, and my first child was born in the hospital with CNMs (certified nurse-midwives) on hand. He was ultimately delivered by an OB, as there were problems and the CNM called in the OB on call. But it was definitely a positive experience overall to have my prenatal,delivery, and postnatal care overseen by CNMs, and I wish that more were available in this country. It is sad and unfortunate that most of the news stories regarding midwife-attended births seem to involve those who break the law and practice without a license or even training (and I say “seem” because I do not have any statistics to back that up – that is merely my observation of the stories I have personally read/heard).

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      • To clarify: I began attending births through non-MEAC accredited midwifery schooling part-time in 2004, switched to full-time attendance at a MEAC school in 2006. By 2007 I had attended about 350 births. The birth the trial was about occurred at the end of November 2007. I got my CPM in 2008. In 2009 I was told I was being investigated for “practicing medicine without a license” for this one birth out of about 400 I had attended by that point. In 2010 I was given the go-ahead by the state to submit for licensure. I received my license from the medical board in 2010. By the time I was arrested in November 2010 I had attended approximately 500 births. I was arrested by the same body that gave me the ok to apply for licensure and awarded me my license. I was allowed to continue practicing midwifery all the way up until my sentencing this September, 2011.

        While I do not claim to have anywhere near the same experience as Robin Lim, I attended two different midwifery schools for a total of six years prior to working as an independent midwife. During that time I was left alone at a total of 3 of the 400 births I attended while a student (one was a car birth, one was a birth where I arrived as the baby was crowing and the third was the birth I was convicted for). I know very few midwives who attended school as long as I did before being granted a “license.” I do not know any midwives who managed to only be left alone at less than 1% of their student births. Keep in mind that if Robin Lim happened to attend a birth in California while she was here or even took a blood pressure or palpated fetal position she would be committing a felony. THIS to me is the atrocity. It is not about comparing one midwife’s skills or type of practice or style of being with woman with another. It is about the public not respecting or understanding the CALLING of midwifery.

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      • Katie, this is EXACTLY the point of my post. The final line of your comment, in my opinion, sums it up perfectly. I feel a deep frustration that it would even come up to compare the skill of one with another; what purpose does that serve? That misses the point.

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      • Well stated

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    • I know I’m late, but I just had to comment. I am only sixteen and I understand how unjust this is. If a woman gives birth unassisted at home, she is thought of as crazy, but would never be arrested. If a woman can’t make it to the hospital and her husband (or anybody for that matter) delivers it, he is a hero. So why is this woman, who is educated and experience, being punished.

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  7. I did not see this as a comparison of Robin’s skill versus Katie’s skill. The American bleeding heart sees Robin standing with women and says, “wow what a great thing Robin is doing”, and the American god-complex model sees Katie standing with women and says, “wow what a horrible thing Katie was doing.” The bleeding heart says, “Robin saves lives” but god-complex says, “Katie takes them.” It isn’t about comparing skill, or education, it is about comparing Robin’s empowering women of the world to make their own choices versus Katie’s empowering women of the U.S. to make their own choices. The American perception is that Robin is right, Katie is wrong. I stand with the author of this post: they are both doing the same thing: standing with women. One is rewarded, the other convicted.

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  8. I, personally, had my daughter in a hospital, and I did ask for an epidural, after having terrible back labor for a day and a half. I ended up breaking my tailbone, slowly, as a result my my daughter’s head position. I planned it this way- with the epidural to remain as an option, after experiencing labor. I love my OB- but I also respect midwives, and their profession. I hadn’t heard of this case with Katie, but I DO think that this was unfair. If I were having a heart attack, and a doctor, or a med student were nearby, I’d hope that one of them would stick around to help me if they could. If I were giving labor, and hemmoraging, I would certainly be grateful for the help, and any bystander that was offended by a stranger- qualified or not (and it sounds like she was qualified) can shove it. This is as ridiculous as someone suing someone for giving them CPR and saving their life.

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  9. I am a CPM in Iowa. I was a part of the Iowa Midwives Association (www.iowamidwivesassociation.org) with Robin Lim. I was arrested for practicing midwifery. Beverly Francis was arrested for practicing midwifery. I think the point is to draw attention to the fact that we honor midwives in the 3rd world there, and put them in jail here.

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  10. Thank you for writing this.

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  11. Over the past 4.5 years, I have been prececpted by Robin Lim, CPM. When I am not in Bali, I live in a state where CPMs are not legal and I do lots of fundraising for Bumi Sehat here and across the East Coast. Robin and I have had extensive conversations about this topic over and over, again. We sat down soon after she won Top Ten Hero to go over the states in the USA where CPMs were being barred from practicing. Her speech time was very brief but please share the rest of the message that she brought which was intentional but keeps getting cut out of the media so far. “The very best way that I know is to support your midwifery to mother care so that the midwives can help lower the risks of motherhood. We can save lives together, mothers and babies.” CNN Hero of the Year, Robin Lim, a Certified Professional Midwife She does care about the plight her sisters have here in the USA and she is with us in fighting it. More people in our organization that just Robin are working toward change for states like mine. It’s really an universal concern that the birth center there cares about. My fellow student midwives and the midwives, nurses, docs, herbalist, acupuncturists, office staff, etc there at Bumi cannot believe the laws of where I live!!!

    Very well-written and thoughtful words, Stacia. Thank you for them. It’s a conversation that runs through my brain and out my mouth almost daily.

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    • Stacy,
      Thank you for bringing up the rest of Robin’s message! I watched her acceptance three times and had tears in my eyes each time. I urge everyone to go to CNN.com to see it for themselves–her words contain a powerful and important message.
      Thank you for your comment!

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  12. The difference is that Katie chose to apply for for a license and attended an approved midwifery school – all midwife students understand the rules/laws – they are not allowed to act as a midwife without a supervising midwife present. Katie broke the law.

    I don’t agree with the punishment, but as a student midwife, she knew the rules. She jeopardized her ability to care for other families and her license. She should have called EMS and reminded the family that they have the right to refuse transport.

    When you choose to train and work as a licensed health care professional, you don’t get to pick which rules you follow, even for a good reason.

    For example, if a client showed up at my birth center with a breech baby about to birth, I would call for transport, because there are hundreds of families relying on me and the birth center. Big picture.

    I do not agree that there is an anti-midwifery agenda behind Katie’s prosecution. The hundreds of freely practicing Licensed Midwives in California and other states demonstrate that there is no anti-midwifery cabal.

    Unfortunately, if you choose to enter a licensed profession, you have to follow the rules or lose your license.

    As to the Samaritan defense (if i were having a heart attack, I would hope a medical student would step in) – not relevant. If Katie had happened upon the family giving birth by the side of the road, her intervention might have qualified as Samaritan care.

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    • Samantha… unfortunately the student midwifery law for CA LMs is not all that clear. There were several areas where I was incorrectly informed by both my MEAC accredited school, my instructors and even the medical board itself. As it currently stands in CA, NOT EVEN THE LICENSED MIDWIVES themselves are practicing legally. This is not widely known either. I have yet to meet a single homebirth midwife who is practicing under the specifics of our law, despite all the hooplah about CA being so pro-homebirth and progressive. The California Association of Midwives is in the process of trying to implement both education in this regard and support of changing legislation. But in the meantime, every with woman is at risk in our state.

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    • Oh! I almost forgot to add… the jury appears to have found me guilty of a felony for either palpation or a blood pressure taken (which I can’t even remember if it was taken by me or an EMT who was present) not for the actual birth itself, which had sufficient evidence to defend itself by way of the good samaritan law.

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    • Samantha,
      I find it unfortunate that you seemed to miss the point of the article. Katie has already suffered judgment; it is not my intent nor desire to see it perpetuated here. My purpose in writing this article was to bring to light the discomfort that American culture has with midwifery through the comparison of two midwives in very different situations. In many ways, you have confirmed my argument by seeing Katie through the lens of the medical model of care.
      I continue to be amazed at the ability for midwives to tear each other down. I continue to see it again and again. Luckily, it has also been (almost) balanced by collaborative birthworkers (midwives, OBs, educators, doulas) who choose to support each other. That’s not to say that you needed to agree with her decision, but it’s interesting that of all the points made in this article, you chose to zero in on whether or not Katie deserved conviction.
      I appreciate that Katie came to help clarify the situation. Obviously I do not know all of the details of the case, but it was my hope in writing this to convey that our cultural perception of birth (and how birth should be managed) makes us quick to judge someone in her situation, and how it is easier to praise someone who is removed from our cultural hangups.

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      • With all due respect, I am uncomfortable with the asserted notion that midwives or doulas should be offered unwavering support even when there is a logical basis for concern, as if to imply we should refrain from critical dialogue about important issues and the resultant negative externalities they pose for mothers, infants and midwives. I think it would be unfortunate if, in our defensive stance, we mirror the distorted attitude promulgated by the medical birth world in its fear of litigation (wherein doctors can do no wrong) by attempting to perpetuate a myth of the infallible midwife. On another note, I have a really hard time following the parallel drawn between Katie McCall and Robin Lim. Katie practiced in a paradigm that affords primarily white, middle class and affluent women access to choices, however, does little to address disparities in birth outcomes amongst low-income or non-white women and rarely seeks to ameliorate the underlying inequalities that create such disparities. In contrast, Bumi-Sehat is one of the only organizations– world-wide– working to address maternal health in this way; serving poor women whose basic human needs are rarely met. While I appreciate the sentiment of the author to address the lack of support for midwifery in the United States, I think the choice to use the above comparison to make that point is overly simplistic and generally misguided. What is distinct about Robin Lim and Bumi Sehat is a model of care that serves the poorest of the poor; one that is simply not replicated by home birth midwives in the United States. We must begin to compel a richer examination of the issues if we wish to affect change in maternal-child health in the United States– otherwise, these conversations mostly serve to complain “to the choir” . Meanwhile, ‘normal birth’ in this country is addressed through the lens of privilege– a lens that, in its naiveté, fails to acknowledge issues of underlying poverty and inequality that pose insurmountable barriers between these services and most American women. Why not use our fervor to engage in some critical self-reflection about what we are empowered to do –yet fail to– for poor women in this country, rather than continuing to fight a short-sighted battle to give the privileged more birth choices. For this to shift, privileged mothers, doulas and midwives must become more committed to understanding the intricate link between this work and the social justice issues vulnerable women and babies in this country face. That is what Ibu Robin is doing in Bali and I would suggest that we have much to learn from her efforts.

        Like

      • Nora, while I do disagree with some of your assumptions, I think the latter half of your comment brings up an important topic and is worth further dialogue. Thank you for your contribution to the discussion.

        Like

  13. Yes, what a paradox! I’m so excited for Robin Lim and the awareness of midwifery that her award will bring to Americans and Canadians. But we certainly have a long way to go!

    Like

  14. This is what I come up against all the time: “Birth isn’t considered “normal” in America unless it is in the hospital under the supervision of an obstetrician. ” I agree, oh, how I agree with that line. Thank you…..most of the women I come in contact with are shocked when they find out I had 3 births outside of the hospital. I don’t think it’s shocking at all, it seems pretty natural and normal to me. But the questions, critiques, and odd looks ARE the norm- as if somehow I am endangering myself and my babies by not seeing an obstetrician.
    My question is, why are we trying to change this world from the outside looking in? Why can’t we get midwives certified as OBs? And take over the medical world from the inside? Seems more logical. And no, I don’t consider CNMs as real midwives. They usually don’t have any power, and not as much professional knowledge.

    Like

    • jerusalemmom – I am not sure why you would take a low shot at CNMs! We have a long history in America of standing with women for their births, including out of hospital births!

      Frontier Graduate School of Midwifery opened in 1939 and has been on the front line of midwifery education ever since it was founded by Mary Breckinridge to train additional midwives to attend births in the mountains of rural Kentucky as part of the Frontier Nursing Service ( a home birth service that first opened in 1925 using British trained midwives). To this day it includes home birth and birth center care as part of its curriculum for CNMs. I know, because I am a home birth midwife and that is where I went to become a CNM.

      The Maternity Center Association in New York City opened the first American school for nurse-midwives in 1931 to train CNMs to provide care for inner-city families (home birth!) see more at
      http://betterbirth.blogspot.com/2008/01/new-york-city-midwifery-care-1931-1961.html

      MCA went on to open the first free standing birth centers in 1975, first in downtown NYC and then in the South Bronx as well. I know, because I have a niece and a nephew who were born at the Childbearing Center when I was the doula for their moms.

      Kitty Ernst (a CNM) has been the force behind the creation of the American Birth Center Association which opened the door for licensing birth centers across the country, owned by and staffed by CNMs, CPMs and even OBs. I know, because I took Kitty’s class in how to open a birth center back in 1993 and two of my grandchildren were born at the Austin Area Birthing Center (owned by a CPM and staffed by both CNMs and CPMs)

      CNMs have been attending home births here in the States since the 1930s and still do.

      I know, because I am a home birth midwife who is a CNM.

      Like

  15. BRAVO. What an incredibly well-written argument. Thank you for saying it so eloquently.

    Like

  16. Just a comment in clarification to one detail..Robin Lim was not “chosen by America to win”, she was voted to win by her supporters all over the world, mainly in Bali, Indonesia, also Italy, in America, and many other places as well. Such a sad a terrible outcome for the midwife here! It’s sad for all the moms and babies in USA.

    Like

    • Thank you for clarifying; I should have included the international campaign in the article and appreciate that you brought it to the table here. I appreciate your comments.

      Like

  17. I’ve read your post and then all the comments. All I can say is to thank you for blogging about this topic and for generating so much discussion on it. I have relatives in the med profession (ob/gyns included), I have two friends who are midwives, and all I can say is that I am for any and all practices that empower women!

    Like

    • Thank you Grace. I think the most important thing is for the discussions to start. People can’t start working together, nor can situations change, if people are talking past each other, looking down on one another, or are ignorant of the problem in the first place. Here’s to the conversation!

      Like

  18. AGain, thank you for the awareness you bring in writing this ariticle and the dialog. Again a comment, There was a hard campaign among Robins many international friends and supporters…to bring money to support her clinic because we directly know her heart is pure and her service powerful. We voted daily and 10 times. I don’t know how many random American voters chose her from the other 10 completly worthy choices.
    What a wonderful opportunity for some education and justice around Katie’s situation! And that it will go international.. I pray that your situation will be exonerated…or will be the case that can turn this unjust situation around here in America. Thank you for your dedication and service, and so sorry for the pain and shame brought to you of shared heart in purity and service. with aloha,

    Like

  19. robin was my midwife and I know her quite weII. She was eIected by the BaIi community and not by America. There was a big campain for her here, which I supported. We aII voted 10 -100 times a day for her. offices and hoteIs got staff recruited to vote… So it was not America voting for her. It was our community that voted for her…. the community she Iives in….

    Like

    • Thank you for your comment–no doubt there was a big campaign in Indonesia for her, as there was here in America among birthworkers and their supporters. Please see my further comment below.

      Like

  20. Maybe one short term strategy for providing protection to women who wish to have out of hospital births and birth-workers that support them is to start a new religion. What kind of legal protection might that provide?

    Like

  21. I appreciate all of the comments from women who have worked with Robin in Indonesia; however, I am unsure about your aim in discrediting the fact that American voters were (at least in part) responsible for her win. I personally knew of many facebook campaigns from midwives, birthworkers sites, natural parenting sites, etc to vote for her. Furthermore, what is the purpose in saying that she won solely because people who worked closely with her voted for her hundreds of times? I simply can’t believe that is the only reason she won–if for no other reason then that it makes it seem more contrived and less of a public recognition. Make no mistake, I believe the award was well deserved (I stated as much) and respect Robin Lim immensely for the work that she (and all of you who work alongside her) do in Indonesia. I just don’t quite understand the aim for your argument. What does it hope to accomplish?

    Like

    • For me, I live in Hawaii, but know Robin when she lived here, as well as visited her in Bali, I don’t think its about discrediting America. Its more in response to a post by Anita, on the,”American Bleeding Heart” vs “Katie must be punished.” comparison. That is not how I view this….I view this as huge support for the Grassroots Clinic that serves Bali. This is how she won, and I am grateful to know All of Bali Voted her in. Of Course! 100 times a day! Her own Community! None of these people ever knew of Katie’s dilemma, so to frame this win in these terms doesn’t feel right for them or those of us who didn’t know of the situation in America.
      So now, and because it is an American award, the world and America gets to see this complete unfair double standard. It just wasn’t an American jury of bleeding hearts that brought on the award or made the choice. This is the point. It was an international mix and her powerful Bali community that chose her and brought on the award. How wonderful! I hope to visit again and volunteer! This light on the subject will hopefully bring on the change needed in America. Hope this clarifies some.

      Like

  22. I have visited the Bumi Sayat clinic and was in awe at the way children were brought into the world there. It seemed so peaceful, gentle, and safe. In contrast, when I gave birth, it was in a hospital where I was terrorized into thinking I might not see my child after I woke up from a cesarian birth. I was whisked away, put to sleep, thinking the baby was in danger, and only awoke several hours later, terribly sick from an infection I had acquired in the hospital,a huge scar, and with a baby I was not allowed to nurse. This was in one of the best hospitals in California. that is not to say that everything goes well at birthing clinics, they have the same birth dramas as hospitals, but their approach is just so different. When my daughter was born, I couldn’t get a midwife to do home birth because of a similar case which had just occurred where a midwife was charged with a crime for a birth that didn’t go as planned. We need to change the laws in the U.S. to allow choice. I wish I had had it.

    Like

  23. The AMA convicted her. They don’t want us to have choices other than them. It is about $$$ and keeping fear in the air around something natural. I hope that she can continue in the profession that she loves.
    Rebecca

    Like

  24. Thank you for writing this and I enjoyed reading your perspetive. I see your point and it very well may be valid.

    Interestingly, I had a different reaction to Robin Lim’s big win. With tears in my eyes, I thought “There is hope! People in America are starting to embrace midwifery again.”

    I also thought her win may have been because the voters were people like you and me who are passionate about midwifery care and natural birth, and we went on the CNN website and voted like crazy. I think her winning is a huge victory and will shed light on the importance of midwifery care not just in poor countries but in our country as well (where we have many poor people who cannot afford an expensive hospital birth.)

    I hope I am right :)

    Like

  25. This story has hit me at a very deep level. As I listened to her speech, all I could think of ‘even women in America deserve this sort of birth’. I am a nurse at a large hospital, and I see devastating effects of non-compassionate birth attendants. What is there to do?

    Like

  26. Maybe the “Winner” can become a voice for the “Loser” one can dream…..

    Like

  27. I have been thinking a lot about the thoughtful article and comments. I am a midwife, not currently in practice, and had my child at home with midwives, an experience for which I am deeply grateful. The comparison of Katie and Robin is thought-provoking and complex, as is the history and politics of midwifery in the US generally. As Rebecca noted, the fact that midwives pose a symbolic threat to the very lucrative capitalist enterprise of healthcare in the US today is a fact. The organizations and lobbying groups which represent ob gyns, hospitals, etc hold much power over federal and state legislative bodies. It is also true that, paradoxically, US governmental bodies, foundations, missionary groups, international NGOS have long supported midwifery training abroad while blocking the development of professional midwifery in the US (for one example, see the Rockefeller Foundation’s position on nurse-midwifery in the States in the early twentieth century discussed in Laura Ettinger’s history of nurse-midwifery. In response to midwife2moms comment, while there are many excellent and dedicated nurse-midwives, the profession has a more troubled past which is somewhat revealed in Ettinger’s book. The Frontier School of which you wrote was started by Mary Breckinridge who disparaged the traditional midwives of Appalachia Kentucky, calling them ignorant and dirty and blaming them without evidence for mortality rates, in order to justify her project. To get funding for the Frontier School, she argued that the babies they would “save” were white babies of pure “stock,” pandering to anxieties of “race suicide” at the time. She started a national organization of midwives from which she banned African-midwives. White feminist women, as reformers, missionaries, and public health nurses played a central role in general in eliminating traditional midwives in immigrant, poor and African-American communities in this country. As for Bali or the US voting in Robin, Stacy–it’s important to reflect on how ethnocentric we in the US are–that assumption reflects this bias. So when you write that America voted Lim in, and are called out on that, Ni Iah is giving you the gift of constructive criticism which can help you and others of us in the US to grow intellectually and spiritually. Midwifery and feminism are important sites for struggle but if they are to grow and be effective spaces for change they can’t be home in the sense that we all have to get along and agree with one another. Let’s keep the discussion going.

    Like

    • Thank you for addressing everything you have here. I think it is essential that normal birth advocates in this country take more time to examine our assumptions so we can understand the way ethnocentrism, racism and classism play into both the history of medicalized birth AND the contemporary midwife/doula world. What we are discussing is a multifaceted topic. It is unfortunate that Stacia feels the need to de-legitimize the sense of triumph the Balinese community feels in Ibu Lim’s award in order to express her sense of indignation about Katie McCall’s inditement. What I feel is lacking in this overall dialogue is a sense of humility about the kinds of realities women face in the “third-world” (which is often considered a rather patronizing term) as opposed to those they face here. For example, the article expressed a sense of frustration that Ms. McCall has to sweep a homeless shelter rather than make a living as a midwife. This comment speaks to the massive disparities in wealth and poverty both within the U.S. and between the U.S. and Bali. To me, that is the larger paradox this overall conversation reveals. My hope is that the “calling” to be a midwife goes beyond catching babies and can be translated into supporting the needs of mothers of all classes whether they are in birth or not. I wonder if it is not about our “calling” at all, but about being of service– however that path unfolds? Just a thought.

      Like

      • Nora, I have read all of your comments and appreciate your perspective. I want to express that this article is not trying to capture the extent of the reality that Ibu Robin (and many who serve in underdeveloped countries) faces on a daily basis. That is a perspective that can be beautifully and articulately presented by those much more close to those daily struggles than I am. But I want to again stress that this is not the point of the article; many, many more pages could be written on that topic and it would be an important and informative post for many (especially Americans) to read.

        I would, however, urge you to read about Katie’s experience on Skid Row, and would also encourage you to consider your own assumptions about the population she has served. She might have a different story to tell.

        That begin said, this blog has run across a similar discussion in different contexts (regarding race and class privilege). Those of us who have worked with the poor in other countries (yes, I have done so myself, although not to the extent that some of the previous commenters have done) can see the disparity between what America deems poor and what other countries deem poor. However, does that lessen the plight of the poor here? Does that invalidate their struggle? The reference to sweeping the floors was a way to convey a point through prose, but there is much more going on there. Mental illness, post traumatic stress disorder, drug abuse, histories of physical and sexual abuse, and much more.

        I think it does an injustice to the individuals who struggle with that kind of poverty here in America to present it as less worthy of our compassion and empathy. Every human suffering is worthy. And there are some unspeakable struggles throughout the world, I do not deny that. But I cannot and will not compare the levels of need as more or less worthy.

        Finally, to address the comment that I am trying to “de-legitimize the sense of triumph that the Balinese community feels,” I apologize if you felt that this was my aim or if my article or comments were read as such. I have tried to express several times my respect for Ibu Robin and for the community she serves. My hope in previous comments was to say that this is a worldwide celebration and that there were certainly people in America supporting Ibu Robin. I was unaware when I first heard of the award that it was a worldwide competition and so my writing reflected as such. Because I do not have full administrative privileges on this blog, I could not change my references in the article.

        Again, I if my comments were misconstrued, I hope that those who serve with Ibu Robin know that we in America do celebrate with them.

        Like

      • Stacia– Thanks for your response. I apologize if message was unclear. I did not intend to lessen the plight of the poor in this country; quite the contrary. What I was attempting to speak were the following comparisons in your article that I found paradoxical:

        “…one of them is upheld as a national hero, and one is sweeping floors at a homeless shelter on Skid Row as part of her community service, wondering how she will support her children without the ability to work in her trained field”, and, “The first serves a deserving, but removed, ‘Other,’ and the latter serves women that could easily be our neighbors, relatives, daughters, sisters…or even us.”.

        To me there were two distinct paradoxes in these comparisons. The first was to compare destitute women in Bali to middle class women in the US and flip the notion of entitlement, as though this represents some kind of injustice to the privileged class of women who enjoy midwifery care in the U.S. I found that comparison to be simplistic because it did not speak to the global power disparity between those two groups.

        The paradox I saw in the second line is that, despite the reasons why, Katie is currently offering service to poor people. However, you portray those services as inferior to those she provided middle class women as a midwife. Furthermore, by discussing her need to make a living, you reveal the inherent class-divide between Katie and the skid row population. Katie’s own comments in this thread speak to her desire to fulfill what she describes as a “calling”. Yet, this notion seems conditional to the act of catching babies, not to being of service to those in need—as her unfortunate circumstances have in fact guided her to be of service to those in dire need.
        My comments intended to shed light on the fact that Robin was awarded the status of hero not for her glorified role as a midwife, but for her level of service to those in need. While I recognize the deep spiritual commitment all birth workers (myself included) are guided by, I believe your own comparison of these two cases reveals its own paradox about the role of professionalization, service and even the very American notion that we are entitled to follow a “calling” if we want to.

        I suppose if Katie had been indicted for offering prenatal care to pregnant women on skid row, I could see the paradox you attempt to describe in your article. However, that is not the case, it sounds like she was training to be legitimized as a professional – the benefits of which are a career in a “trained field”, i.e. financial stability and a solid consumer base. This social position– which is inherently a position of power and authority — is very different than that of, say, Jesusita Aragon – the traditional folk midwife in Northern New Mexico who delivered me and any other babies who needed catching in that extremely poor region of the Rockies.

        I appreciate this article for establishing a forum for some really important conversations about birth justice in its complexities here and globally. I sincerely hope the best for Katie McCall and imagine that this challenging leg of her journey to be of service will, n the long run, reap many gifts for women in her community.

        Like

      • oops- I switched my 1st and 2nd examples around… sorry about that. Hope my meaning is clear.

        Like

    • Heather, thank you for your comment. I appreciate everything you have said and also appreciate the chance to look at something a bit differently. You are right that America is largely ethnocentric, and as stated above, I wish I had the administrative privilege to change the wording in the article now that I know that the competition was a worldwide one. Thank you for adding to the discussion; I also was unaware of the history that you mentioned regarding Frontier and am going to look further into that topic.

      Like

  28. I’m sorry. I didn’t mean to hurt feelings at all, honestly. I’ve just been with many women in hospital situations where the CNM did more harm than good, under the guise of “natural birth”. I was shocked. But without exception, the lay midwives I’ve been at births with are amazing and very professional. The problem is that here in the US the term midwife is a bit vague compared to the birth attendants in other parts of the world.

    Like

  29. I wrote this in a sub-reply above, but feel like it is more general response:

    I have a really hard time following the parallel drawn between Katie McCall and Robin Lim. Katie practiced in a paradigm that affords primarily white, middle class and affluent women access to choices, however, does little to address disparities in birth outcomes amongst low-income or non-white women and rarely seeks to ameliorate the underlying inequalities that create such disparities. In contrast, Bumi-Sehat is one of the only organizations– world-wide– working to address maternal health in this way; serving poor women whose basic human needs are rarely met. While I appreciate the sentiment of the author to address the lack of support for midwifery in the United States, I think the choice to use the above comparison to make that point is overly simplistic and generally misguided. What is distinct about Robin Lim and Bumi Sehat is a model of care that serves the poorest of the poor; one that is simply not replicated by home birth midwives in the United States. We must begin to compel a richer examination of the issues if we wish to affect change in maternal-child health in the United States– otherwise, these conversations mostly serve to complain “to the choir” . Meanwhile, ‘normal birth’ in this country is addressed through the lens of privilege– a lens that, in its naiveté, fails to acknowledge issues of underlying poverty and inequality that pose insurmountable barriers between these services and most American women. Why not use our fervor to engage in some critical self-reflection about what we are empowered to do –yet fail to– for poor women in this country, rather than continuing to fight a short-sighted battle to give the privileged more birth choices. For this to shift, privileged mothers, doulas and midwives must become more committed to understanding the intricate link between this work and the social justice issues vulnerable women and babies in this country face. That is what Ibu Robin is doing in Bali and I would suggest that we have much to learn from her efforts.

    Like

    • Nora, you bring an important perspective to the table. It merits a longer reply like the one I did above, but unfortunately I don’t have the time to do so with a sick infant on my hands. Please know that your comments are acknowledged and have definitely provoked some thought on my part.

      Like

  30. The problem with the story is that Katie decided to NOT call her supervising midwife and chose instead to act in an illegal capacity. It has been a long haul for direct-entry midwives to become licensed in California and the irresponsible practices like what Katie decided to do continues the perception that homebirth midwives are not accountable to the licensure process. Her punishment was appropriate.

    Like

    • Louana, I’d have to defer to Katie on this one, but my understanding of the situation is that your statement just isn’t true. From what I understood, she called several experienced midwives to try to get assistance and nobody would/could come.

      Like

  31. Complete travesty. I often wonder where the Good Samaritan Law is in these cases. She’s prosecuted for doing what she was able to do, and may have been prosecuted for standing by and doing nothing. Things need to change and litigation is not the answer.

    Like

  32. Great article. Although as an EMT and student nurse, I have no idea why Katie didn’t call EMS personnel, esp for a retained placenta! That’s like healthcare ethics 101. I don’t think her punishment was fair at all, but the first thing you learn in training is usually (and should be!) the medical world is run in a CYA fashion. If she had called EMS, I’m sure the baby would have been born at home and Katie probably could have helped with the retained placenta as well since she was trained. EMTs are licensed to catch babies for normal births, and medics are trained to manage more serious situations like a retained placenta. Plus, EMS can’t force a pt to go to the hospital without an order from police or an MD. Just call EMS… most of them are men and hate OB/GYN emergencies. They’d be glad to defer to a trained professional! I feel like poor Katie could have saved herself a lot of grief if she had done so.

    Like

  33. hello i am a Lebanese midwife student .. i want to know what is the situation of a midwife in america ? what is allowed to do ? she can deliver in hospitals ? and i wanna know if it is a direct entry (in univerity) to be a midwife ? any help please …. thank you

    Like

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