Recently I have seen a rise in people claiming to be a home-birth midwife that are not trained or equipped to provide the services they offer – all across the US. This has resulted in multiple fetal deaths, maternal deaths/harm, and unnecessary birth trauma. These ‘midwives’ are something to shy away from – here is how you can avoid them for your own birth.
Midwives are not interchangeable; no two are the same. Most serve with a heart of true passion and care; some serve solely with a wallet to fill or ego to boost. Some will walk with women throughout their entire journey, and some will bail on them for various reasons. Some midwives undergo years of training/attending/learning/practicing. Some claim to be a midwife but has nowhere near enough training to do so. It is crucial to interview properly to make sure your midwife is a good fit for you. Don’t hire a woman who will be ‘a deer in the head lights’ when you or your baby needs assistance.
Keep in mind, a licensed midwife does NOT mean a well-trained and educated one. More often than not, it only limits how they can serve you. In my experience, it is the licensed midwives who can be fear ridden, as taught in their medicalized schooling – not all though! Again, none are the same. It should never be a degree or license you are looking for. You want one who is there to serve YOU, not serving the state or medicalized model of birth.
Here are a few questions that would be great to ask a possible Midwife. Be sure she has answers, if you have questions that go unanswered – you should not take this lightly. She should not be hired. Never ‘settle’ on a Midwife.
What training have you had? Schools, degrees, certificates, preceptorships, internships, etc.?
(You can look up their schooling history, degree, and certificates online. Do not take anything for face value. Do your research before signing a contract. Again, some midwives do lie about qualifications. If they attended internships/preceptorships, ask to reach out to their preceptors. Some are fired or let go before completion and choose not to disclose this information. You may want to know why.)
Are you trained/certified in neonatal resuscitation? (You can ask to see their NRP certification card as proof. Yes, many birth workers do lie about their trainings!)
How many times have you had to resuscitate in your career?
How many births have you attended?
Where can I find reviews for your services? (You want to be sure you hire someone who is backed by past clients. If she does not have reviews, this could be a red flag)
How long have you been attending births as a primary midwife? (This asks how long they have been attending on their own, without a preceptor – someone guiding them)
How many births do you attend per month?
Do you have a backup midwife? Will I meet her? (Every midwife should have a backup. You should ask to meet this backup prior to labor if you do not want a stranger possibly walking into your home on birthing day)
Do you have an assistant or will you be attending alone? (Some bring an assistant and some charge more for the assistant)
How many times have you had to transfer during labor? (A midwife’s transfer rate says a great deal about her ability to serve women)
Do you stay with mom once she is transferred? (Many midwives will transfer mom to the hospital then leave once she is admitted. This likely isn’t something you want, be sure it will not occur)
How many times have you had to transfer mom/baby postpartum?
Will you attend twin, breech, and VBAC births? Why or why not?
What complications and emergencies have you seen and how were they handled? (i.e. prematurity, prolonged labor, fetal distress, breech, bleeding, dystocia)
What circumstances/conditions would rule out your attendance? (In many states, especially with licensed midwives, they are required to drop you from their care for many unnecessary reasons. Do not get to 37 weeks and find out she is dropping you because your baby chooses to present breech. If she is not competent, or holds her license above your births wellbeing – she might be a MEDwife and might leave you hanging with no care or reimbursement.)
Can you list each scenario that could possibly risk me out of your care?(Know ahead of time EVERY reason you could be released from her care. Depending on state, the midwife’s knowledge, her licensing, and her competence, there are many reasons they can drop you from care. Things that are not in your control Be aware of EVERY possibility before signing a contract)
What complications/emergencies are you prepared to handle?
Under what circumstances do you transfer to a hospital? (Some midwives are known to transfer women for silly reasons that are not science based. Be sure your midwife will not bail on you when you are vulnerable.)
What percentage/exactly how many clients have had cesareans in your practice?
Will you accompany us through a hospital birth if one was necessary?
Do you offer prenatal care? What is your schedule for visits?
What is included in prenatal care? (i.e. lab work, urine checks, blood pressure, fetal heart tones, fundal measurement, baby’s positioning, & vaginal exams & PAP)
What type of nutrition counseling do you provide?
Do you visit the home at any time before the birth?
Am I required to complete any kind of testing? (Some Midwives require specific testings or they will drop you from care. This is not autonomy and likely not something you want to sign up for. You should have complete control and say over your prenatal care)
Am I required to attend a certain amount of prenatal appointments?
What happens if I refuse appointments, procedures, or suggested medications? (If they have an issue with your having say over your pregnancy and refusing XYZ, run the other way)
When do you like to be called once labor has begun?
When do you come to the home once labor has begun?
What equipment do you bring and what must we provide? (You can tell a great deal about a midwife and the care she supplies by what she carries in her bag. Does she carry herbs and tinctures or does she simply carry Pitocin and oxygen. Know what she will be showing up with! Know what you are comfortable with being used.)
What emergency equipment do you provide?
How do you view the father’s role?
What is your role during labor? birth?
How do you feel about sibling participation in birth?
What non-drug measures do you suggest for pain relief?
How often do you listen to the baby’s heart rate during labor?
How often do you check the mother’s blood pressure?
Do you require vaginal checks at all, ever? (Vaginal checks can be harmful and mean nothing in regards to progression during labor. If she requires vaginal checks, she might not be a good fit. That would be a red flag that she does not support autonomy.)
What is considered fetal distress in your opinion?
What do you consider prolonged labor/birth pushing?
Do you have preferences for labor/ birth positions? (This answer should always be “It’s the mother’s choice”. If she requires you to lay in a certain position, this is a concern.)
How do you feel about water-birth? Have you attended any?
What measures do you take to prevent tearing?
Will you allow partner to “catch the baby” instead of you?
Do you check for tears after delivery?
Do you have local anesthetic & suturing equipment for this repair to be done without going to the hospital? Do you suture all tears or only major?
How do you prevent/treat excessive postpartum bleeding?
How do you handle the baby immediately after birth?
How long do you stay after the birth? What do you check at this time?
What is your schedule for follow-up care?
Do you do the newborn screening tests?
What are your thoughts regarding circumcision?
How is the filing of the birth certificate handled?
Do you routinely give me a copy of all my records after the birth?
How much do you charge for your services?
What services are not included in this fee?
Do insurance plans cover your fee? Do you accept direct payment?
When do you want the full fee paid?
Are there any refunds if I risk out of care? (I see it occur so often that a mom “risks out” of care and mom is left with no midwife and no refund. 7K+ down the drain at no fault of her own, and no home birth to show for it. Know about her refund policy and make sure you agree before signing!)
Determine the midwife’s willingness to be open to communicate, explain things that you don’t understand, and willingness to let you make your own decisions. If she is unable to answer all questions without hesitation, be wary.
Be sure to reach out to your local birth community and ask around. Some providers will present themselves to be something they are not. Their abilities will reflect in their past client’s experiences. Read all reviews, ask questions.
Hiring a midwife is not a simple choice, this plays a HUGE role on birth outcome. Knowing the difference between a CNM, CPM, and traditional midwife is also helpful in making a midwife selection. Again, Midwives are not interchangeable – none are the same. Do not settle, find one that is a perfect fit for you!!
When you picture a cesarean, what words come to mind first?
Cold. Quiet. Bright. Scary. Scrubs. Scalpel. Shaky. Drugged Up. Curtain. No Skin to Skin. Sore. Inactive.
But wait! Ending up with a C-Section, whether by emergency or by choice, does not mean that you have to miss out on being an active participant in your birth!
What is a Gentle C-Section?
While a gentle cesarean is not going to do much to change the postpartum recovery, it is still a major surgery, it can reduce the trauma or disappointment you may experience, if a c-section was not in your expected birth plan. And even if it was, how neat is it to have a more active and informed surgery, right?!
A gentle cesarean is something that should absolutely be discussed with your provider prior to you going into labor, whether you are planning to deliver at home or planning a scheduled c-section, everyone needs to be on board and knowledgable about your intentions in the event of a cesarean happening! OB/GYNs that do not routinely do cesareans need to be informed on their role during the cesarean and what things will be different, which will not be much on their part honestly – just a little extra time and flexibility. If you have a doula, she can aide you in advocating for your gentle cesarean, as you will be numb, but if not make sure your partner or support person is fully informed on what exactly it is that you are aiming for.
First things first, you will still be prepped like every cesarean mama would be; you will need to sanitize your body to prevent your opening from becoming infected, and everyone coming into the room will be scrubbed up from head to toe to keep germs to a minimum. You will be given a form of pain medication in your spine to numb you; your best bet is to ask for a spinal block instead of the epidural or general anesthesia. This will be a shorter lived pain medication (about two hours) that will get you well through the surgery, but not linger as long as the epidural and generally does not have as many side effects.
Insist on a small, low transverse scar that is to be double sutured. If this is a repeat c-section, make sure they remove built up scar tissue before suturing, so you are less likely to experience placenta accreta on your scar tissue in future pregnancies. This will increase your likelihood of a successful VBAC, if that is potentially a future desire of yours. Babies can squeeze out of a hole the size of a bagel, trust me, they do not need to cut you from hip to hip.
Leave the shawl down or ask for a transparent sheet to go in between you and the OB/GYN operating, so that you can see everything happening! Ask the OB/GYN or a nurse to talk you through the procedure and everything that is going on to help keep you fully engaged in your baby’s entrance.
Music may play during the birth to encourage a loving and soft environment. If possible, you can request that the temperature be warmed and the lights reduced just for a few minutes as baby emerges. Of course, when the OB/GYN is opening and stitching you back up, you will want them to have full visual. Have monitors turned silent and away from your face so you can be relaxed and at peace.
Allow baby’s head to be pulled to the top of the opening and turned towards you, to emerge slowly and gently. If possible, you or your partner can do this part, and still deliver your own baby! They can still do the breast crawl this way or just be pulled up to your chest for skin to skin. Delayed cord clamping should absolutely still be an option and you can almost always keep your placenta. They should allow the placenta a few moments to attempt to detach naturally, before pulling or manually removing, and it should be removed gently as to not cause any damage to your uterus.
Simply have them place the placenta in a bowl or container next to your bed for delayed cord clamping and keeping the placenta. It should not be allowed to go to pathology, except for a small sliver, if they absolutely must test.
Baby should remain skin to skin with you or your partner while you are stitched back up. After they stitch you, be sure to ask for them to swab your vagina for vaginal seeding, this provides baby with probiotics and healthy culture from your vagina that they would normally get passing through the birth canal. Baby should not be washed, especially with soap! Rub their vernix and any other fluids into their skin.
If baby must be separated from you for any reason, have someone else provide skin to skin, or at minimum stay with them, especially if you are declining vaccinations, or eye ointment.
Check out this video as an example of a gentle cesarean:
Recently, photos of Megan have filled the social media world, especially from free birth skeptics and doula groups that do not approve of a doula stepping out of scope to fully support all women. But did we really get the full story from a blog post that absolutely trashes any birth that occurs outside of the hospital? Did you know that the source from that article is a midwife that is well-known in the community for being completely medically minded and doesn’t actually follow the midwifery model of care, at all? The midwife is known for harassing local mom support groups that advocate for natural, home and VBAC births.
Well, we are here to shed a little light on Megan: a mother, a doula, a friend.
NOT a murderer.
By supporting anti-home birth, anti-midwife, anti-natural lifestyle bloggers, we do a massive disservice to our community, so seriously, stop sharing it. Take the story and do with it as you will, you may still feel she was in the wrong, but at least her perspective was placed out there and we are happy to be the platform to do so.
Here is the story, straight from the source.
“I was recommended to the couple by our chiropractor. They wanted a home birth and so we began our doula appointments with that in mind. I gave them every home birth resource I had and they interviewed a few midwives. It was soon after that the mother confided in me that her husband had been beating her throughout their marriage, even landing her in the hospital during the pregnancy. However, this had apparently stopped since we began meeting. I asked her several times to find a safe place to go, if not for her, for her baby’s sake. She said she felt preparing for the birth was changing him and she felt safe. So we proceeded.
As we began entering her due month, no midwife had yet been found. I asked what their plans were. They said they didn’t know, but there was no way they were going to the hospital. I reminded them that I was not a replacement for a midwife and I thought about recusing myself as their doula. I thought about it heavily. However, the abuse was deeply concerning and them being completely alone during the birth of their child seemed reckless. So I remained their doula.”
A doula, after all, is not a medical professional, but a support person, and the parents knew this, it was absolutely a decision they made on their part to not find a midwife, but to proceed with an unassisted birth with a doula.
“I confided in a doula group. At the time, I was a member, I needed their prayers and their support. I kept quiet that they did not have a midwife, since this area is very political about birth and there is one particular hospital midwife who is known for terrorizing mothers. But I digress…
The day came when the mother began having contractions. She seemed fine, but was throwing off signs of transition right away. I went over to see her to try and figure out what was going on. It was early labor. She was concerned about finishing laundry (this was at her aunts as she did not have a washer/dryer at her house) before she could have her baby. I wondered if this could be an emotional block to labor, so I helped her finish laundry. We arrived back at her home and contractions became steadier, confirming my theory.
The first two days went by. I went home a few times to rest. She still felt good and contractions had not become strenuous, seeming that she was having prodromal labor. I returned the second day and as soon as I arrived, her contractions began getting harder and more intense. She felt that baby was in a posterior position so we practiced some spinning babies techniques and even filled up the birth pool to relieve pain”
To be clear, posterior is not a dangerous position. It is simply a variation of normal.
“The next day was steady, but by the afternoon, she was tired and he was frustrated. We finally got her comfortable enough to nap. I left for a little snooze myself and was gone for only a few hours. I was on my way back when she called me, hysterical. Her husband had tried to rape her in the middle of this bout of labor and now refused to help at all since she wouldn’t have sex with him. Her contractions became much harder as a result and she began losing faith. I sent him to the store for groceries (we kept her eating through all of this to keep her nourished). I asked her very seriously if she needed to go to the hospital. Her husbands behavior was not okay and not justifiable in any way and that she would be safe from this happening again there. She gave me the same answer as she had before.. she felt safe because I was there and did not want to go to the hospital.”
This is so common in domestic violence victims, they do not want to get their partner’s in trouble, because they are scared for staff to find out, then to be alone or have a negative interaction with CPS, and more. And narcissists typically act well and presentable in front of others that they are not currently abusing, so it absolutely makes sense that he would act fine in front of Megan and the woman to actually be safe around Megan, otherwise, both the sweet newborn AND mama could be dead, so why should Megan have abandoned the family because they refused to transfer? And calling the police can actually be even more dangerous to everyone involved, because some abusers will go as extreme as holding those in the home hostage and abuse or even kill them before the police can get a warrant to break in and help.
“I had no idea what to do. I prayed with all my might that her baby would be born soon I stayed over that night because there was no way I was leaving her. The event had left her unwilling to do anything. She finally ate after I told her otherwise we HAD to go to the hospital because I was concerned with her paleness. Her contractions lightened and she felt she could maybe sleep. I rubbed her sacrum and had the inspiration to press and push upward right above her sacrum. As I did so, I actually felt the baby turn right under my palms. Suddenly, she felt better, contractions were manageable and she threw up. She felt she could definitely sleep now. I too, went for a nap, laid down for about half an hour when her water broke! She was happy, alert and could feel her babys head in the birth canal.
As she tried relaxing between contractions, her husbands stubble irritated her, so I took his position behind her in the pool, supporting her. He would watch for the baby. She began pushing, and in about half an hour, pushed her baby right out! Sure enough, baby was all wrapped in her cord, around her belly and shoulders. We quickly got the cord unwrapped and put her to mamas chest. She cried well, was the most beautiful shade of pink and eventually opened her eyes and looked around at everyone. She was perfect, they named her Junia.
I stayed, helped her to bed, shortly after she delivered her placenta. Junia nursed and seemed to be doing very well. I was helping clean up and about four hours after birth, I was ready to leave and just checking in on everyone and everything.”
I read many critical comments about WHY was she there so long. Honestly, it is not uncommon for doulas to stay hours after birth. In my business I stay at least two to three hours following a birth, whether in the hospital or unassisted. When I am a midwifes assistant and cleaning and sterilizing everything, I am easily there three to five hours following birth. If you do not, good for you, but you should not be judging why she was.
“As I peeked at Junia, I noticed that Junias nail beds were a little purple. She was still alert and pink, so I had them cover her up more and asked if they had a baby thermometer. They didn’t, so I asked the husband to get one from Walgreens. While he was gone, her color began to change. She began to get sleepy, which I knew was normal for newborns, but this did not seem right. She was ashy, her nails were still purple. I asked mom to lay her down. The first thing I could think to do was check her heart rate. I set my ear to her chest and her heart rate was slower than an adults and as I looked at her, she seemed to fall asleep. I tried rubbing her back to rouse her. Nothing worked. I asked the mom if she knew infant CPR, she did not, so I started CPR. Right then, the husband returned and I told him to call 911. Mucus started coming out during compressions and I did use a bulb syringe in attempt to get it out. All I could think was to keep her alive until emergency services got there.
The paramedics got there quickly and I told them what I had been doing. They looked for a heart rate and could not find one. When the cops arrived they asked if I was a midwife and I declined. When they inquired where the midwife was, I panicked because I did not want the parents to get in trouble and advised she had left. Later on, I did tell Detective Sowards when he interviewed me and he assured me I did the right thing by telling the truth, now.
The next part is a massive blur for me, except I remember calling my mom and praying to God to give the hospital staff the ability to bring her back to life. I got to the hospital where they attempted to revive her for 40 minutes. At 12:01am they called the time of death. Her parents and I just stood in shock for what seemed like the longest time. Eventually they asked to be alone and I told them I would check on them tomorrow. My mom had come to the hospital and I just crumpled into a ball of tears.
Over the next few months, I helped her recover, look for someone to donate her milk to, held her while she cried, attended the funeral, and be as much of a support as I could. Her MIL and husband tried to have her committed for not healing fast enough, aka cleaning and cooking already, at just two weeks postpartum. I have texts from the mother and I that discussed things like how angry she was with me for making them take her baby to the hospital when she could have passed peacefully on her mamas chest, instead of being injected, shocked and monitored in a cold ER, or the fact that she never got to touch her baby again after I started CPR, and in a way, I stole those last touches from her.
I couldn’t bear birth work anymore and went into a deep depression. Her family blamed me, the doula group blamed me. The local midwife I mentioned blamed me and began a smear campaign against me, saying I kill babies and am so anti-medicine that I ‘wouldn’t let them call 911.’ I even blamed me for a long time. I felt like I was cursed. I had committed to one other birth six months after and I didn’t know how I was going to get through it.
It was about this time that former clients got wind of the rumors and asked me what happened. I was open with them. It was amazing. They all rallied around me, telling me what a difference I had made in their lives and could not quit. Then it came.. I got a call from Junias mom. She told me I should not blame myself and hoped I would become a midwife so they could have a safer birth next time. I thanked her and said I would think about it. I never really wanted to be a midwife.
The birth of my last client came. It was quick. They were from my church and so we spent a good portion of her labor in prayer. I was grateful.. it gave me peace. She gave birth quickly to a baby girl. I cried. I felt like Junia all over again, but she was healthy, thank God. I came to check on them the next day and the mom gushed that, thanks to me, it was her best birth ever (this was #9 for her) and I should become a midwife. I cried again.
In March, I found out I was expecting again. The flashbacks, anxiety, stress, I did not take it well. My body has not done well and I truly feared bringing Junias birth with me into my own birth. Its a part of who I am now. Im trying very hard not to let it haunt my steps.
I came to this area four years ago, only seeking to give women the same blessings I have been gifted with and I still believe the heart of the birth world here is good. But this particular group have been in search of control and power for years before I ever arrived. Now this has happened and its become an excuse for them to make an example of me. For a long time, I proceeded according to what I know to be right, which does not always fall in line with what they feel is proper. But I feel that to violate my moral code would be the worst infraction of all and I could never bring myself to, even at the risk of my livelihood.”
In the autopsy, the Chief Medical Examiner, Mr. Gustafon, whom came to interview Megan after he had done an autopsy stressed that the cause of death he found was unofficial but that her lungs looked like she had had severe pneumonia for at least two weeks, which was impossible at merely 6 hours old. His theory was that, the stress mama endured from abuse in the pregnancy, caused a release of meconium during pregnancy, that was somehow consumed and/or aspirated most of it by the time of delivery, which resulted in mamas waters being mostly clear, which allowed for an infection to grow turning into full blown pneumonia once exposed to oxygen. The catalyst would have been her first breath, which is why she did not have immediate respiratory issues. He guessed that a hospital may not have even known until it was too late or been able to save her, had she been born there.
In question of her status as a doula, she went through DONA training, and chose not to certify through them due to not aligning with their values and was complete with her training with Bradley Method, but was still in provisional stage of completion, not fully affiliated, which she was chastised for, which is absurd. As you can see, the provisional affiliation expired in 2015, while the second educator card did not expire until just last month, January 2019.
The parents struggled with finding a midwife because they were very conservatively Christian and many of the local midwives are Pagan/Wiccan.
In questions about the charges and why she was found guilty, “the six charges pressed against me, were about practicing medicine and not placing me at fault with the death, as so many have inferred. I pled guilty to the count citing the use of the bulb syringe because of the uncertainty and cost of the trial, unwilling to cause the parents to be subpoenaed as witnesses and because honestly, I felt it was fair and if using a bulb syringe on a baby is practicing medicine, then technically, I was guilty. I am not sorry that I tried to save her life, but I do feel that if I broke the law, I will not do anything to hide from it. I have been very upfront about what I have done wrong and on those accounts, I am sorry.”
Since, Megan and the mother of Junia have both gone on to have healthy babies.
We wanted to make this article because there are ALWAYS several sides to the story. We wanted to show that the charges did not stem from the parents blaming her, but an angry local midwife that simply does not see eye to eye with most doulas in the community, and takes it out on them whenever she gets an opportunity to do so.
Things could have absolutely been different, had the mother not been abused by a toxic male, point blank!!! So why do we not chastise domestic violence in the articles that bash Megan so harshly?
Domestic violence is the NUMBER ONE killer of pregnant women! Not car accidents, not a specific pregnancy complication, but their very own partner. It impacts women from every country, all around the world. Several studies done by WHO show that several countries fall into an average of 1 in 4-6 women are being abused during pregnancy, and in general. Not only does domestic violence increase the risk of fetal and maternal death, but increases the rate of IUGR, preterm labor, hemorrhage, miscarriage and postpartum depression/anxiety. Pregnant women who experience domestic violence have a 37% higher chance of complications in pregnancy. These are women who have hospital births, home births, unassisted births, NOT JUST UNASSISTED BIRTHS.
Domestic violence is on no part the doulas fault, and the doula did what is in her scope to do as far as support, she supported the moms autonomy and choices and did not force her to do anything, nor give medical advice by diagnosing or attempting to prevent any specific complication, because that is NOT her role. Megan provided many resources to the mom to reach out, but unfortunately, many Christian families are falsely taught that you must obey your husband, which to some, means ANY and EVERY thing, which is so toxic. I have even witnessed in some churches that they chastise a mother for being a single mom due to leaving a toxic situation because divorce and disobedience is frowned upon in their church. I do not believe all Christians are this way, absolutely not, but it is something that needs to be more openly discussed.
It may even be that the husband demanded an unassisted birth, simply because he did not want to return to the hospital that he sent the mother to in her pregnancy and threatened the mother with HARM had she chosen to go to the hospital.
Bottom line, it is not classy to tear apart a fellow birth worker, especially applauding and referencing the same type of people for criticizing her, that we would otherwise never in a million years agree with.
If you are wondering as a birth worker, how to avoid finding yourself in this situation, you COULD avoid unassisted births, but then there are still women who are having unassisted births that need support, too. Simply, it is best to never use a syringe on baby, the parents can do that upon their own discretion. It is best for the parents to be just as, if not MORE, educated than yourself, as you are just the support. They should be thoroughly researched on unassisted birth and emergency situations and feel comfortable acting as the sole leader in those emergency situations, and not relying on you to do a single thing, because you are not a medical professional! If something seems off, call 911 right away, even before starting CPR, they will guide you through CPR if they feel the situation warrants it and under their guidance, you cannot do wrong because you are being instructed to follow their protocol.
We stand with Megan, because we know that she did her best under the unfortunate circumstances and her intentions were purely to help a family and help sweet Junia. It truly makes us wonder, where are the people investigating the hospital where people, including moms and new babies, die every day, despite being monitored heavily and in the care of medical professionals? Hmmm.. seems a little one sided doesn’t it?