The Roots of Dogma: Ina May's Religion & the Midwives Who Follow

dog·ma  n. 

1. A doctrine or a corpus of doctrines relating to matters such as morality and faith, set forth in an authoritative manner by a church.

2. An authoritative principle, belief, or statement of ideas or opinion, especially one considered to be absolutely true.

dog·mat·ic  adj.

1. Relating to, characteristic of, or resulting from dogma.

2. Characterized by an authoritative, arrogant assertion of unproved or unprovable principles

After reading the recent article in the New York Times about Ina May Gaskin and her battle for home birth, it all makes sense.  Now I know exactly where the dogma started.  

As I read the article, I learned more about who Ina May Gaskin is on a human level.  It seems to me that her perception of birth is much like a religion.  Her followers even reference her as a "saint" and feverishly distribute copies of "Spiritual Midwifery" to expectant mothers.  Apparently, being a saint these days means that you were involved in a four-person marriage, are proud of doing LSD and attending workshops to process your acid trip, and that you preach to the masses about just how safe birth really is without having any real education, medical training, or reported data to back it up.  The roots of Gaskin's movement are most clearly articulated with this sentence: "The participants in the caravan settled in Summertown, Tenn., in 1971. They took a vow of poverty and veganism and lived communally. Birth was a revered 'sacrament.'"  

Do women have a right to choose any religion they please?  Sure they do.  Do they also have a right to know whom they are following?  Absolutely. But (and this is a big "but") when a mom hires a CPM or a lay midwife to attend her birth, does she fully understand the dogma at the root of that woman's practice?  I don't think so. And this is the big problem that I see.

When a woman seeks the care of a midwife, someone who is posing as a professional caregiver, the expectation is that they operate under certain professional parameters, religion aside.  I have to believe that most women do not understand the dynamics of who it is they are hiring or how the the extremist nature of the "root" philosophy will impact the care she receives.  I know I didn't.  I was looking for a more personal model of care and thought birth to be an intimate experience.  I liked knowing exactly who would attend our birth and that our midwife would be present for the duration.  I thought midwives to be a safe, reliable, professional option...part of our health care system (as some are).  Surely it must be safe if they are running freestanding birth centers in the middle of reputable suburbs.

So what went wrong?  How did we end up in the hands of midwives who were so far from the professionals, the people we thought them to be?  What I didn't understand is the vast spectrum in philosophy that resides within the practice called "midwifery."  I wasn't looking for religion and I didn't knowingly volunteer my baby for sacrifice at the altar to advance anyone's cause, yet somehow that's exactly what happened.  Blind religious faith masked as natural childbirth and sold on a communal platter.  Some might call it a cult as in this post from 10 cm, The Cult of Natural Childbirth.  I must admit, in retrospect, much of this parallel seems eerily familiar.  Especially after reading about where the dogma started and after personally experiencing the backlash from the NCB community after speaking out about our experiences.           

What bothers me most is that the "Big Push" for midwives is aimed at the general population. Women are brought into the care of extremist midwives with specific selling points and marketing tactics that make birth sound alluring and empowering. There is no honest discussion of the real risks involved.  Ina May is a good saleswoman - she has already successfully marketed her cause across the country, with 27 states now licensing CPMs (who are directly trained and credentialed from Ina May's organizations, MANA and NARM).

How is this happening when most don't fully realize just how extreme the founder's roots really are?  How can someone earn a license to attend life and potentially deadly events without an education?   How are these women earning the privilege of attending our births with no oversight or accountability whatsoever?  Dogma cannot be allowed to influence maternity care.  Best practices must be defined, standards of care established, reporting outcomes required.  I hope we can reach women in MI and help them understand the complexity of this issue before Michigan makes the same detrimental mistake. Please visit:  Top 10 Reasons Why HB5070 Would do More Harm Than Good.

Every woman has the right to know exactly where this movement is coming from and what it's all about. They also have the right to know how many families it has adversely affected through infant loss and injury, BUT unfortunately, without regulation to require reporting outcomes, we don't have that data. We just have small voices fighting to be heard.  To read more about some of those small voices, visit: Hurt by Homebirth

Click here for Another reader's review of the NYT article .

To read more about dogma in midwifery visit: 

N.A.R.M ~ No Accountability, Renegade Midwifery

The "Whistleblower Midwife" & More

Midwife Masquerade: What Does Your Midwife Believe? 

Midwife Masquerade: Denial

Should my midwife be my friend?

When Our Baby Died

Freestanding Birth Centers ~ Common Myths Revealed 
The Hypocrisy of Midwifery

Free standing Birth Centers: Common Myths Revealed

The quotations below are taken from the website of Greenhouse Birth Center, a free standing birth center in Okemos, MI. Many of these statements - or versions of them - inform the philosophies and practices of birth attendants nationwide. They are reassuring and empowering. They are also woefully incomplete and oversimplified.  As with many things, birth cannot (and should not) be summed up in one sentence, one phrase or one mantra. For mothers considering out-of-hospital birth, it is essential to be able to think critically about statements like these. After all, birth is complex and our understanding of it should be equally complex. To that end, we've taken these statements of belief and fleshed them out a bit to paint a more realistic picture of birth and maternal care.

• "Birth works."  Birth often works, but not always.  Sometimes women and babies need help. 

• "Just as our bodies know how to grow and nurture our babies, they know how to give birth and how to feed them."  Our bodies are beautifully designed, but they don't magically know how to give birth or how to breastfeed successfully all of the time.  They are not perfect in function.  We have intuition, but we also have experts to help guide us when our bodies need help.  Birth and breastfeeding come with great challenges for most of us.  Many women and many babies have died during childbirth. 

• "The very things that help you go throughout pregnancy safely and well are the things that will help you give birth safely and well - health, confidence, support, privacy, and tender loving care."  What's missing from this list of what will "help you get thorough birth safely" is careful monitoring by educated, skilled professionals who can and will recognize signs of danger, acting appropriately to keep you and your baby safe.  Another  key factor in determining "safety" is the availability of emergency technology, equipment, medications, and medical personnel.  It's irresponsible and crazy to think if you're confident enough, trust birth enough, and are supported with love that things will turn out fine.  I used to think that, and it cost my baby his life. Safety means you and your baby go home alive, anything less is unsafe. 

• "The best way to care for a pregnant woman is to educate her, support her, nurture her, and help her watch for problems so that she can avoid them or correct them when possible."  All true statements.  You have to first accept that problems exist in order to appropriately address them.  Then you have to have the skills and knowledge to recognize them when they do appear.  I would add that appropriate transfer of care when the "problems" detected are outside one's scope of practice is critical. "Education" does not mean indoctrination and manipulation of research, data, and truth. 

• "That if a problem should arise with mother or baby, consultation and collaboration with appropriate health care professionals provides safety and smooth transition of care when needed." Also true statements, but without guidelines this determination of when the transition of care is needed, is very subjective.  There are no rules to follow, and nothing that defines what is high versus low risk.  To many home birth midwives, high risk is "just a variation of normal".

• "That the presence and assistance of experienced women -the midwives- are useful guides to mothers in their journey of pregnancy, birth, and parenting."  The ideal is there, and likely the intention, but for many of us we felt like we were "unassisted", left to follow our intuition, with no real guidance at all during labor.  "The presence and assistance of experienced women" is great as long as the relationship stays professional in making clinical decisions as oppose to influencing clients with personal agendas.  

• "That a safe, comfortable space, designed for gentle birth and individualized care is the ideal way to provide our services to the women in our community who want alternatives to the medical model of care but are not comfortable with a home birth."  I think this statement bothers me most.  The insinuated "safety" of a freestanding birth center is such an illusion!  There is nothing safer about giving birth in a different building than your own home when that building (aka freestanding birth center) adheres to no regulation, has no medical equipment for emergencies, has no insurance, has no guidelines for scope of practice, and doesn't report its outcomes.  To insinuate otherwise is fraudulent.  And, I would further add that sometimes birth is rather violent, even in a comfortable space.   

Please visit the Reformed CPM's post entitled, "Just Believing Does Not Make it So" for more on this subject. 

Should my midwife be my friend?

There is an interesting dynamic between an expectant mother and her midwife.  Those of us who have experienced this relationship know how binding and powerful it can be. Of all the aspects of this relationship, there are two that stand out to me as being problematic. One is the false sense of empowerment and control that is cultivated in the mother as she prepares for birth. And the second is, quite simply, the the highly intimate nature of the midwife/client relationship. These things can complicate the relationship to the point of compromising care, leaving women vulnerable and targeted for unbalanced influence that could put them and their babies in harm's way.

First, let's consider the issue of empowerment and control. If I had to paint a portrait of the kind of women who seek the care of midwives, one of the defining characteristics would be their tendency to carefully analyze every decision they make.  Mothers interested in midwifery care are reflective, educated, well read, and thoughtful. They don't make any choice without asking questions and they don't do things just because it is considered the norm.  They search long and hard until they feel completely reassured that they're making the best choices for their baby. Ironically, this is the type of woman who seems particularly vulnerable to being swept up in the arms of midwifery.  

In fact, these women who think they are "educating" themselves about birth (doing all their homework, so to speak), are the same mothers being seduced by imagery and manipulated data from the NCB community. They are assured that home birth is safe - safer than hospital birth.  They are told that hospitals use too many unnecessary interventions.  They are told that what would normally be considered a high risk factor is "just a variation of normal".  They are told that our culture has lost the ability to birth naturally, robbing us of the opportunity to "experience" birth and keeping us from being the women we were born to be. But the midwife's sales pitch for natural birth is often one-sided, with a stark and deliberate absence of information offered about the inherent risks of out-of-hospital birth. As the midwife builds up the appealing (and false) image of the gentle and safe nature of birth, the mother develops a sense of pseudo-empowerment and a false sense of understanding. The image of a perfect natural birth starts to take shape and the mother's determination to achieve it settles in.   

Essentially, through very carefully crafted and presented propaganda, women are offered an important motivator in deciding to birth outside a hospital - the illusion of control.  In out-of-hospital birth, the woman is taught to control her thoughts, to "trust birth" and to listen to her intuition to guide her through labor.  Her cervix isn’t checked unless requested. She isn’t told when to push. She relies only on her own instincts.  These mothers feel as though they are making a conscious decision about everything from environment to having the freedom to birth the way they choose . . . as if it's as simple as picking out what to wear for the day.  Midwives cultivate this notion by assuring moms that, simply by being women, they are experts on labor and birth and will therefore be able to make the best choices for their babies. As the big day approaches, women develop a false sense of control and unrealistic expectations for their birth experience, including the charming idea that they will somehow be "empowered" if they are able to accomplish this feat "naturally". 

In reality, we must all admit that birth is not something that can be controlled - not by mothers, not by babies, not by doctors, and certainly not by midwives. At best, a doctor or midwife can attempt to guide us through the experience, watching to keep us safe and taking action when things aren't going right.  We cannot control birth and being led to believe that we should is deceiving. 

Another element of the dynamic between the expectant mother and the midwife that proves problematic is the idea that your midwife should not only be your caregiver, but also one of your closest friends.  Midwives sell themselves on the fact that they spend hours of personal time getting to know you and your family intimately. But consider for a moment how creating that kind of close, personal relationship with your care provider can backfire. Establishing an intimate relationship with your care provider can establish a false sense of security and build unfounded trust. Personal relationships involve emotion and those emotions directly affect your ability to make clear and balanced decisions.  This is where the “midwife spell” comes into play.  When a midwife has taken the time to get to know you and bond with you, their influence upon your decisions becomes quite powerful.  “But with great power (and friendship!) comes great responsibility” and, sadly, in some cases the nature of this power becomes unbalanced and potentially manipulative.  This is why we hear stories of women trusting their midwives far beyond what a rationally thinking woman would do.  (Examples: extremely prolonged labor, using garlic to treat Strep B, attempting high risk births outside a hospital such as breech babies, multiples, and VBACs, etc).  In these cases, trust and personal relationships become a liability and can prove detrimental to overall care.

These dynamics between mother and midwife are key components to "advancing the cause" and many women don't realize they are buying right into it.  As she seeks control over her experience and a competent friend/midwife to guide her through it, a woman leaves herself vulnerable to manipulation and influence. She is lulled into a false sense of control and subject to making poor decisions based upon emotional ties.  Then, when things go wrong, the responsibility immediately falls upon the woman and family for having made the choice of out-of-hospital birth.  Never mind that a true “choice” cannot be made if all facets of risks and benefits aren’t presented for evaluation. For many women who believe in making educated choices, and even those who defend their right to have a choice in where/how they give birth, they don't realize that choices are being made for them all along the way. 

When it's all said and done, who would you rather employ? A competent doctor who lacks bedside manner but who keeps your baby safe, even if it means having to make tough decisions that you might not like? Or a midwife who is your friend and encourages you no matter what, but puts you baby's life at risk? I think the answer is obvious.