The Price of Apathy

No one came. No one came to express how important women’s childbirth choices are to them.  The Department of Health and Environmental Control (DHEC) invited us to a meeting- a “workshop”- to help shape the new birth center regulations.

“Stakeholders,” the invitation letter said.  Who is the most important stakeholder in the childbirth choice game? The midwife who makes her living catching babies? Well, if she is like me , she has plenty of other potential income sources. So, no, not her. The doctor, who is absolutely certain that these women are crazy to be choosing something as dangerous as out-of-hospital birth, and feels the need to regulate it to death, and, oh, by the way, it doesn’t hurt his bottom-line either? He still has plenty of consumers who have blind faith in what he is selling. So, no, not him.

The most important “stakeholder” in the childbirth choice game is the consumer. Because there are really only two ways to become a parent- which the majority of us do, sooner or later. And if you choose to grow that little person that makes you a parent in your body, it has to come out- one way or another. And even if you adopt that little person- his/her birth matters to him/her, and therefore to you. Really.

OK- in all honesty, six people did come to the meeting- besides the seven DHEC employees (yes, they had us outnumbered)- the four state birth center owners, the lawyer of one of the birth centers, and me, a homebirth midwife and childbirth activist. I had spent a good bit of energy trying to rally consumers to show up, and based on some of the feedback on social media, at least a few people would be there. Nope. Not a soul. The most important stakeholder-the consumer- was absent.

On some level, I don’t care. At 48, the chances of me having to personally navigate another pregnancy and birth are slim. And even if I were pregnant, and “The Man” had limited the options of the general public, I am very well connected (and possess a proven pelvis!). I could easily find someone to catch my baby at my birthplace of choice- which is not a birth center.  Can you say the same? If you or your daughter or your best friend wanted an out-of-hospital birth, and the laws hindered her/you, is there anyone who would risk breaking the law for her/you?

You might say, “Wait a minute. I’m confused. I thought you said it was a meeting about birth centers. But now you’re talking about homebirths.”

Read on.

You might say, “It doesn’t matter to me, I was happy with my natural hospital births.” Good for you. I’m glad. Did you realize that one of the reasons that unmedicated hospital births are even a thing is because of decades of women fighting for women’s rights in childbirth, for women to have a choice to birth where and with whom they choose?

Or you might say, “I have homebirths. No sweat off my back if the birth centers close. If I am not having my baby at home, then I am on my way to the hospital, because my midwife told me we needed to go in.” As a midwife, I could say that, too. I mean, I don’t own a birth center. I could even think to myself, because it would be un-PC to say it out loud, “Sure! Let the birth centers close. All the more business for me!”

But that would be ignoring the fact that the medical establishment has an agenda. Not just in this state. It is a national agenda. It is an agenda to close birth centers that they do not control. It is an agenda to end homebirths with CPMs. And if “they” succeed in closing the independent birth centers in this state, it is encouragement for them to keep pushing until the LMs- the homebirth practitioners- are phased out too.

But, again, why should we care?

As Robbie Davis-Floyd discusses in Birth as an American Rite of Passage, the extremes on the continuum help to define the “norm” in a society. Homebirths and birth center births help to encourage hospitals to practice more evidence-based medicine. They encourage them to listen more closely to consumers. Because they have competition- they have serious financial incentive to step up. When they don’t have competition, they don’t have to step up.

Did you know that there are actually hospitals around the world that have a 90% C-section rate, and places (even in the United States) where a vaginal birth is “not allowed” for huge groups of women? As I write that, I say to myself, “How is that even possible?” But it is. And it didn’t happen overnight. It happened a step at a time. Women’s rights and choices being slowly eroded until, voila!, they don’t have any.

You might say, “Well, you have to go to a meeting like that, you are protecting your livelihood”. And my reply is, you may think I am so passionate about women’s rights and the quickly eroding rights of out-of-hospital birthers in this state because I am a midwife. But you would be wrong. I am a midwife because I care so much about the rights and health of women and babies, and I know that what I do makes a difference. Not just in that pregnancy, or that birth, but in the REST OF THEIR LIVES.  I go to these meetings not to save my job, but to better mankind. (Hokey, huh?)

I get it. The issues are complicated. The language of the various bills and regulations is hard for me to understand sometimes- and I am pretty well-versed in it. But that is all the more reason to come to meetings, ask questions, get educated. But most importantly, come to the meetings to show the powers-that-be that you care. That you are watching them. That you expect them to make choices in the wording of your states laws and regulations that expand rather than limit women’s choices.

Did you know that the members of the DHEC Board who get to give the thumbs up or down to the regulations are not elected? They are appointed. By our governor, Nikki Haley. So if the AMA, which is a generous campaign contributor, says, “Nikki, tell that Board of yours how dangerous it is for us not to control all the births in this state,” what do you think is going to happen? Unless she thinks it will cost her votes- now or in the future.

I was at a DHEC Board meeting a few months ago where they were discussing the birth center regulations. One of the members was insisting that the language needed to be more restrictive. One of the board members spoke up. “Do we really want to get those women riled up again?” He was referring to the uproar that ensued when DHEC tried to shut down the birth centers in November of 2013, right around Thanksgiving. I mean, what normal person wants to be getting called away from the Thanksgiving dinner table to discuss birth? Not the Board- so they definitely remembered that week and all those unhappy birth consumers.

This. This is what grassroots effort is all about. The people making noise. Disturbing the comfort zone, the business-as-usual attitude of the powers-that-be. But it only works as long as they know we will keep coming back again and again.

National expert in grassroots birth battles, Katie Prown, has taught me a lot about what has worked in other states to gain or maintain birthing choices, and what hasn’t. And the main thing that works is massive public outcry against unfair or restrictive birth practices. And to remember that while money talks, votes, or rather potential votes, of lack thereof, speak louder.

“But I don’t really have time for that”, you say. “I don’t have time to write letters, or go to meetings or rallies. I have ____________________ (a job/three little kids/a sick grandmother/a life).” And I say, “We all have the same amount of time.” You may be choosing to do other things. They may even be really important things. Just don’t be surprised when you wake up some day, and don’t have the choices you think you deserve.

As one of the leaders of that grassroots movement, I’m here to tell you, we (myself and the other leaders) are constantly saying to ourselves, “Should we ask them (the consumers) to write a letter now? Or wait? Well, if we ask them to come to this meeting or write this letter, then we can’t count on them to be ‘available’ next month when we ‘really’ need them. We don’t want to burn them out.” Newsflash- in this day and age, telling “The Man” that we won’t put up with His foolishness is a never ending process! Let me tell you in a way every mom will understand. This is like changing dirty diapers. There is always going to be another one. And the consequences for not changing it and changing it promptly can be overwhelming. And painful.

Question- if there was a mom who was hoping or maybe even struggling to avoid an unnecessary c-section, how far would you go to help her? Would you give her physical and emotional support? The same type of support that many of you reading this article had- or wished you had had- in labor? How many hours would you be willing to spend? Now say that woman is your daughter? Your friend? Would you spend more time? Effort? Money?

If the system is allowed to further restrict the practices of the natural birth practitioners in this state, there will be many more women struggling to avoid unnecessary interventions- many of which lead to unnecessary surgery, unsuccessful breastfeeding, feelings of inadequacy, increase in postpartum depression. Some that lead to death. No one is in a position to help all those women individually, but we can help them to avoid ending up in that situation by improving birth choices and the safety of birth across the board.

Over the years I have gotten many calls from women, some of whom I have to tell something such as, “I’m sorry, you have no choices. DHEC put out a memo saying that we can’t attend out-of-hospital VBACS.” Some of these women have lashed out at me, saying, “Why aren’t the midwives doing something to change that?” And I get off the phone and think- you have no idea how much effort I have put into “saving” VBACs. You also have no idea how many women I have hung in there with in labor- far beyond what most practitioners would consider reasonable- so they wouldn’t have to face the VBAC fight with their next pregnancy.

I cannot tell “The Man” what you want. You have to tell him what you want. And keep telling Him. Again and again and again.

Nicole Lavallee is a Certified Professional Midwife and Licensed Massage Therapist who is trying hard to fight the good fight and encourage others to do the same.

All photos on this page are courtesy of Whitney Hempsey, at Studio 412 Imagery.