This is the first of what I hope to be many posts from Steel City Midwives, and for our first post, I thought it would be important to explain our purpose, the rationale for our out-of-hospital practice, the reason for the crazy years of study and literally hundreds of births we were lucky enough to be a part of.

It all comes down to, allowed.

I cannot tell you how many times women have asked me, “During my labor, am I allowed to—” and then go on to list many perfectly reasonable actions—eat, drink, walk, squat, dance, yell, anything.

The answer is, yes. Yes, yes, yes, because it is your birth!

You, the birthing person aren’t here to serve us, the birth workers. We are here to serve you.

The word “allowed” should be barred from the conversation. It has no business in the business of birthing babies. By telling people what they are “allowed” and “not allowed” to do, the medical model has proposed it knows better than millions of generations of evolution and the Higher Power’s plan for birth. While we know a lot about birth in 2018, we certainly don’t know everything, and to think that we do is the height of arrogance. We, as midwives, try in every way possible to respect birth, learn from it, not control it.

We will be talking a lot about “physiologic birth” and “undisturbed birth” in this blog, but in a nutshell, the reason we got into birth is because we believe in a birthing person’s autonomy to give birth the way they feel is right, and don’t believe in the word, allowed.

Let me tell you story.

A young mother is 40 weeks pregnant and the doctors say it is “time” she has her baby. She is not allowed to go past her due date for no other reason except something might happen. It is a remote possibility; however life is pretty tenacious, and Creation is not haphazard. She is brought to the hospital, left to the care of mostly strangers who come in and out of her room throughout her labor to deal with the beeping machines. These interruptions and machines cause her fight-or-flight response to ramp up, completely taking her out of the birthing mode. The nurses would like to stay to comfort her, but they have many patients to care for. The mother-to-be is given medications to ripen her cervix, because her mind-body and baby are not ready for birth yet. She is then not allowed to eat, because of the very tiny possibility that she will need a cesarean section and will aspirate under general anesthesia. (0.667 per million women, or approximately 7 events in 10 million births [Hawkins, Koonin et al. 1997].) She is not allowed out of bed because of the very rare chance that her water will break and the cord will come down before the baby’s head. Of course, if we waited until the baby was well down in the pelvis before even thinking of breaking the bag of waters, there would be very little chance of that. Then the Pitocin (synthetic contraction hormone) is started. Soon enough it’s cranked up until mom is writhing in the bed she is stuck in and begging for an epidural. The baby may or may not like the length of the Pitocin contractions, or maybe he can’t cope with the drop in mom's blood pressure from the epidural. Perhaps he can’t navigate his way out because of the static positions that mom is allowed in because she no longer has sensory motor control in her legs.

Is it any wonder a cesarean is called for lack of progress or fetal distress?

This isn’t every hospital birth, but in many places around the U.S. this is a tale told too often.

Let me tell you another story.

A healthy low-risk woman is 41 and ½ weeks pregnant having her first baby in the company of her husband, and two midwives she’s been seeing her whole pregnancy. She is in early labor when the midwives come to see her. Instead of being told what she is or isn’t allowed, she is encouraged to keep moving, eat, rest, and do things that keep her mind busy until she can’t keep her mind off labor anymore. The midwives check on her and baby and then give her space to do what she feels is right. Labor isn’t pushed, because the midwives know that in most instances babies choose the best time to be born. They know if labor stops, it probably wasn’t the right time yet. The client is free in her own home to move into positions that help her cope with labor. The midwives check in with the couple periodically through the next hours. Later, the mom-to-be’s partner calls saying she’s feeling the contractions all over, and that she isn’t talking in between them; she can only moan. These are wonderful signs that labor is progressing, even without an exam. It sounds like she is in good, active labor. Her midwives, her lifeguards for the process, come to help her. They assess and offer ideas, but she is still the queen of her labor. She goes for a walk outside, bounces on a ball for a while, rocks in a rocking chair, then gets in the tub with the lights low while her husband pours water over her belly. She copes with her labor in every way she knows how, and then gives in and allows the process to take her over. Maybe this is the allow we should be talking about, when the birth workers and the birth environment are optimized to serve the process, the birthing person can allow labor to take over. This mother is in the most intense moment of her life, and she is sure she can’t go on, but everyone can hear how close she is to giving birth. Of course, if she wanted, the hospital is always an option, but she and the baby seem to be progressing very well through labor, so she is reassured. She is supported by her husband and the birth team gets ready for the pushing part of labor that is coming on at the peak of each contraction. She is encouraged to follow her instincts, the sensations intensify, and soon with each strong contraction those assembled can see a bit of the baby’s head. Because no one wants her to tear, she listens to her body and the skin around her vagina stretches slowly while the head of the baby is born. Then the baby, like the everyday miracle he is, turns and slips his shoulder from under his mother’s pubic bone, and with the next push he is born into a quiet, loving space. He and his mother are watched while he transitions into his new world and while she experiences the highest levels of the loving hormone, oxytocin, she will ever experience in her life. Her husband holds her while the new mother cradles the new life they have created.

This, of course, isn’t every out-of-hospital birth, but it is many of them.

This is why we do this.

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