Over the weekend I heard a horrible rumor. Three times. I heard that I am out to “get” midwives (specifically CPMs) and that I have a “hit list” on specific ones to put out of business.
While the idea that I have the time (or power) to put anyone out of business is hilarious – the suggestion that I want to intentionally harm an industry I have worked to promote for nearly 7 years is devastating.
Over the years a lot of things have changed in my beliefs about birth work and birth advocacy. Seven years ago it was something fun to do with my time once a month, when I helped plan the Fort Worth Homebirth Association meetings. Things got more serious once Tarrant County Birth Network (TCBN) was formed, and really got rolling as the resource guide and annual events became a reality.
My philosophy then was still one of wonder and possibility; you can have whatever birth you want, if you just have the right provider, in the right place.
After a few years, and talking with countless “real” birth workers, I started to wonder why some people didn’t love their out of hospital (OOH) birth. I began to understand than the type of provider you have plays a part, the birth location plays a part, but your biology, your emotional environment, your choices on who is part of the landscape of your birth all have varying levels of impact on your perception of your birth outcome.
In 2013, the national Birth Network (of which TCBN was affiliated at the time), asked us to get involved in legislation at the state level, and I became interested in finding out how our system works.
Up until last month, the state of Texas had a board of midwives, OB and consumers who oversaw the Midwifery program through the Texas Department of State Health Services (DSHS). They held quarterly board meetings and also had a complaint review committee that was (somewhat surprisingly) open to the public.
In 2014, I attended my first board meeting & complaint review.
Complaint review was exactly what it sounds like. When someone filed a complaint against a certified professional midwife, DSHS would investigate that complaint, getting information from all sides, and then the complainant and midwife would both have the opportunity to speak at the review.
A complaint might be something as frivolous as a nurse at a hospital complaining that a midwife transported a non-emergency client (and not understanding that midwifery is legal here).
The board meeting, while less dramatic, was interesting because I got a bit of a look at how ATM (Association of Texas Midwives) factors in, and began to understand the process of making change at a state level a little more directly.
Most of what I heard at that first complaint review was a reality check for me in how I ran our organization. Driving home, I told my husband I was quitting the birth network (I obviously got over that). I was part of the problem. I was part of the consumer culture that sets women up with false expectations that their birth choices are limitless. I was part of the consumer culture that was setting midwives up because we were (inadvertently) telling consumers that if one midwife wouldn’t deal with their risk factors, they could find another one who would. I was part of the culture that believed that a high transport rate was just a “med-wife”.
I was screwing up the messaging and my efforts to help the midwifery industry probably were instead reinforcing the idea that homebirth midwives are renegades who will push boundaries to get you your OOH birth. Big freaking FAIL.
This was the education I got from attending the board meeting and complaint review. This was information I couldn’t get from just reading blog posts on the internet.
So then what IS the right message?
We began a process of redefining who the birth network should be. We want to help women have access to positive birth experiences in every birth environment and no matter what their risk factors. Respect and safety are the foundation where every birth should begin. Whether you have drugs, or hydrotherapy, or an OB, or a midwife are all decisions for you to make – and there aren’t wrong answers.
While both professionals and consumers are members of Birth Texas, we are first and foremost a consumer advocacy non-profit. No business or individual profits from the work we do. Instead, the entire community profits from consumers being informed and making educated decisions in their care. That is how better maternal health happens and makes change. Access, evidence-based care and informed consent.
Does that mean we are now anti-homebirth/birth center? Absolutely not. Most of our team had OOH births (including me, 2x) and would choose them again.
Am I out to “get” a group of certified professional midwives? No. Not one, not many, not all.
Have I encouraged women to begin filing complaints? Twice. Twice in 7 years, I have told someone that their experience seemed legally questionable to me, based on my understanding of the law, and that I personally would consider a formal complaint if I was in their shoes.
Have I encouraged women to post a review on Google or Yelp? Yep. I try to tell everyone that they should talk with their midwife first to try to resolve things. But we live in a consumer driven world – and I cannot tell women to go review OBs if I don’t also tell them to review their midwives.
I have attended a few more complaint reviews and board meetings. My favorite one was the last one, on my birthday. There wasn’t a single loss to be discussed and we were done by 11am.
Happy birthday to me!
Beginning in October, Texas Department of Licensing and Regulation (TDLR) takes over the complaint and licensing process for midwives and complaint review will not include public access. I get it. I support it. I’m interested to see where it takes us.
I hope that the move to TDLR also includes mandatory reporting so we can find out exactly what the OOH mortality rates are, and a better way of searching for provider complaints. I am incredibly grateful they now stream their meetings on the internet (as is my day job).
Last week I ordered a friend her home birth kit as a gift. This weekend I talked a friend through her choices of home, birth center or hospital. I don’t have a preference where she has her baby, she has fabulous options – she lives in Dallas/Fort Worth – the best place in the country to give birth.
Today, I am reflecting on the words of another birth advocate, Dawn Thompson of Improving Birth, from a video in 2015. “I will continue to to be passionate, no matter what. Because there is nothing you could say that takes away what I have seen. Nothing… We are going to improve maternity care.”
If you made it all the way to the end of this manifesto, kudos to you, thank a midwife you love and spread the word that informed consumers are the best kind.
~ Shannon Blackwell