Born and raised in Knoxville, Tennessee, I moved to Bloomington in the mid-eighties to get a PhD in Russian literature at Indiana University. Although I was already in the grips of an enduring fascination with childbirth and the midwifery tradition, I thought of it more as an anthropological side project than a future career.
As a little kid, I had spent hours curled up on the couch with my mother’s pregnancy manual. Published in the fifties, it combined detailed, textbook-grade anatomical drawings of developing embryos and fetuses with pink and black illustrations of pregnancy advice about important things like flattering one’s growing bustline with the right style of maternity wear. A few years later came Spiritual Midwifery, which I had found, newly published, in a health food store at the University of Tennessee campus. This now-classic chronicle of hundreds of back-to-the-landers rediscovering natural childbirth on a commune in the west of Nashville helped launch countless midwifery careers, mine included. It made me look deeper into our history.
I learned about the Frontier Nursing Service in Hyden, Kentucky – cradle of American certified nurse-midwifery. I read about Black midwives of the deep South and granny midwives of the mountains. I won a prize at my state science fair for a data collection project called “Nurse-midwifery in Appalachia.” Some years later, midway through college, I almost changed my major to nursing and midwifery, but knew I was too immature for the responsibilities involved, so stayed with my other love, Slavics. And then a few years later I had a baby.
This girl was the best thing that ever happened to me. My experience with the protocol-driven, depersonalized nature of American hospital birthing, on the other hand, left me questioning why our medical system seemed to so undervalue the self-knowledge and preferences of individual women. Wasn’t that a dangerous thing to do? Since all of the standard medical interventions in childbirth bring risks of their own, why wasn’t more being done to keep birth safe by promoting basic, physiological childbearing whenever feasible? What was the relationship between simplicity and safety? These questions felt so urgent to me.
Midwifery drew me in over the next few years. I nursed my baby, became a breastfeeding advocate, and sold baby slings at La Leche League meetings. I took Sarah to grad school, taught classes, and finished my PhD coursework. For fun, I read every midwifery textbook and periodical I could get my hands on, joined a study group, and became active in the educational guild of the Indiana Midwives Association. I was invited to a couple of hospital births to provide labor support, and then attended a friend’s revelatory homebirth. Things changed forever one week in April when the midwife who would eventually become a mentor took me to three births, each more beautiful than the last. The third of these was for a Daviess County Amish family. Driving to their farm through corridors of blooming dogwood on a sunny Friday evening on the last day of IU’s spring semester, I knew I wasn’t going back to grad school. I was beginning the life I’ve had ever since.
The next three years were spent in the vivid intensity that is an apprenticeship in homebirth midwifery. I was simultaneously doing academic work while shadowing two busy midwives at prenatals, births, and postpartums, slowly gaining the skills necessary to do primary care myself. Fortunately, our state had an active midwifery organization that hosted educational conferences, and in the early nineties we had the Midwives Alliance of North America (MANA), and its sister organization, the North American Registry of Midwives (NARM), busily defining the practical and ethical standards of practice for homebirth midwifery, and developing our credential, the CPM (certified professional midwife). At that time there were very few brick-and-mortar schools for out-of-hospital midwifery. This was before the internet and the era of online education. However, it is hard to overvalue experiential learning in a field like mine.
I was schooled from day one in both the complex algorithms that drive good midwifery judgment, and in the simple ways we go about showing respect and kindness to all the families who trust us with their births. There is deep integrity to this form of training, but it requires an accountability system. That is why I so value the CPM. The renewal of my certification is dependent upon competent practice, ongoing participation in continuing education, and peer review. Recently NARM developed its Bridge Certificate, an advanced credential designed to verify that a CPM’s qualifications meet those defined by the International Confederation of Midwives and recognized by the American College of Obstetricians and Gynecologists. I earned my Bridge Certificate in 2016. Legal recognition is another form of accountability.
I am a proud founding member of the Indiana Midwifery Taskforce, which led a successful twenty-year campaign to give CPMs the ability to practice legally in Indiana. This grassroots victory was achieved through the work of hundreds of passionate homebirth clients, several extremely determined midwives, a few angelic medical friends, one tough lobbyist, and some strange political bedfellows. If we had known it would take so long, we may never have started. After four years of rules-writing and committee meetings, the law passed in 2013 will finally be implemented in the fall of 2017. It is too soon to say if the compromises required to get us to this point were worth it. But we go forth in good faith, dedicated to the consumer safety, professional accountability, and the needs of the families who employ us.
There is a joy in serving others that never grows old. Helping women discover and develop their innate abilities in childbirth and parenting makes me feel like I’m doing my bit to make a more humane world. Each woman’s experience of pregnancy and birth unfolds uniquely, and like the literary scholar I set out to be, I am endlessly curious about each of these stories. I am so fortunate to sit at the feet of birthing women, and so grateful for all my teachers, past and present: midwives, academics, doctors, but especially the women and babies themselves.