Here are some choice quotes that families may want to see before choosing these lay people to attend their birth:
I am certainly guilty of allowing my memory to lead me down a primrose path. My memory lingers over moments when I was heroic, times when I saved the day, and events that make me seem, in my own mind, like a smart and responsible caregiver. I have to force myself to see things differently, and it is uncomfortable. That time when I expertly resuscitated that breathless baby? I didn’t know he was in distress until he was born; I had missed any warning signs of that. The time I successfully helped a mom avoid the hospital when her blood pressure was a bit high? Her blood pressure was actually dangerously high, and that stunt could have ended in a double tragedy. The time I had to hoist that mom out of the pool and get her on the bed to free her baby’s shoulders? (What a hero I was!) Except, she shouldn’t have been in that pool at all; she trusted me that it was a good idea to get in there in the first place. And it was only luck that her baby’s shoulders freed in time. My memory wants to remember me a certain way, and it is up to me to strive for a more honest perspective.
The author of The Honest Midwife found the exact same insulting facsimile of “peer review” in her career that I have in Utah:
The peer review process after a midwife presides over a complicated birth is a disturbing procedure. Midwives rarely ask hard questions, such as whether this mother truly was a low-risk candidate, whether or not the midwife was monitoring the baby carefully, and why she decided not to call for help sooner. Most peer review processes are characterized instead by soothing platitudes, an atmosphere of comfort and understanding toward the midwife, and reassuring all participants that they are indeed wonderful, special people.(…)
It was a couple weeks before I had an opportunity to discuss the case at my very first official peer review. A new midwife at the time, I was very eager to hear my fellow midwives’ opinions on what I could do differently next time to avoid ever seeing a hemorrhage like that again. I got an answer I was not really looking for: “We know you didn’t do anything wrong. We know you. We know you’re a good midwife. Sometimes things just happen.” At the time, it felt flattering, but insincere: they didn’t actually know me. They had never attended a birth with me and had spent precious little time with me. They claimed to know me, but what they really knew was what they would want to hear if they were in the hot seat. Peer review was more like an enabling therapeutic back-patting than any form of accountability. I learned how to play this game, even though it never felt right. You failed to risk someone out? Well, the birth went well anyway, so your intuition must have been right-on! You didn’t call the second midwife in time for the birth, ten times in a row? Your mamas sure go fast! Your client ended up in the hospital needing a blood transfusion? These things happen in hospitals all the time! Sometimes I would forget my place and offer a piece of harsh criticism; I was never the most diplomatic person, after all. But this was met with resounding censure: we are here to be supportive. I would apologize and get back in line. I felt I had too much to lose to stop playing their game.
Frandsen also found a culture of illegal activity and silence in her time at a midwive’s college:
When, as a student midwife, I first participated in nonhospital births, I witnessed some things that made me uncomfortable. At my school, the head midwife would sometimes do illegal vacuum-assisted deliveries. The first time I saw one done I didn’t realize it was illegal, but when I started talking about it freely, I was quickly quieted by the more senior students. “We call it ‘the fruit,’” they said, a reference to the vacuum’s brand name, Kiwi. I rationalized that these other students and midwives would not be using “the fruit” if it was really harmful, so the law must be an unnecessary one. Soon, I was recruited to help usher family members out of the room “so the mother can rest,” as a cover for the vacuum use; I would then lock the door and stand guard. If I was instructed to cover the mother’s face with a cold washcloth “to help her relax,” I made sure her eyes were covered so not even she could see the vacuum being applied. I rationalized that surely she would have given us permission to do this to help her get her baby out without transporting, but that it wasn’t smart to ask permission to perform an illegal procedure. Toward the end of my apprenticeship, I was the one holding the vacuum, applying it to the baby’s head, exerting the carefully angled pressure to help pull the baby down. I rationalized that now I would know how to get a baby out, if I were ever in a situation where there were no available hospitals. I did not originally plan to attend a school where I would learn to perform dangerous, illegal procedures; I became complicit through a chain reaction of participation and justification. “The fruit” was only one of many “exceptions” I learned to make; many of these exceptions I carried with me to my later practice. Illicit use of medications, cavalier usage of toxic herbs, induction techniques, pretending not to see a cesarean scar, fudging dates, doctoring charts, “accidental” breech deliveries, cheating blood pressure readings, lying to doctors, ignoring borderline test results, pretending to know answers while furtively Googling, waiting just a little bit longer for baby’s heart tones to improve, purposely underestimating the staining of amniotic fluid, misrepresenting our personal statistics and the statistical realities of our “profession”… all of these practices are endemic to direct-entry midwifery in the United States. I know because I did most of them. I was present (and silent) as others did them. I heard the stories in “peer review.” Not every midwife does all of them; very, very few, if any, do none. It all starts with one small step, and we justify along the way, until we are lost in the woods with no moral compass left to guide us.