Dear Honest Midwife, 

I have been a midwife for over seven years, doing home births. I have built up a good practice and really love working with women and babies. I am making decent money, enough that we are now finally making a comfortable living and have everything we need as a family. I should be happy, but I’m not. 

As a midwife I have seen a lot of complications and even emergencies. I used to think this was because I was new to the profession and a few more years and I’d probably have the experience to be able to prevent these kinds of things from happening. But as I’ve continued to practice and attend midwife functions where other midwives share their stories, I have realized that birth is just often complicated, and can get dangerous regularly, not rarely. 

Lately I feel certain that my luck is going to run out. I have never had a baby die, but I feel like if I keep doing this, I will. I have repeated all my neonatal resuscitation skills over and over again, and I feel like I’m very good at it, but I know that sometimes it is not enough compared to a hospital team.

What should I do? I don’t want to leave my clients to just go find another midwife who might take big risks with them; I want to be there to monitor them and convince them if they need to go to the hospital. I don’t want to quit and be without the income my family needs to survive. But I also don’t want to put women and babies at risk anymore pretending like I believe that what I’m doing is safe!

Sincerely,
Amanda (not my real name)  

Dear Amanda,midwife touching pregnant belly
 
You’re in a tough situation that is incredibly familiar to me. I went through a very similar awakening over the course of almost ten years in the profession. Since I came out to share my story last spring, I have received numerous messages like yours from midwives who have realized that they are no longer comfortable with toeing the party line about the safety of home birth. 
 
There are no easy answers. I wish there was some easy way to give up your entire identity and career, survive socially and financially, and ensure that none of your previous or potential clients were in a worse position for your absence. But there is no easy way. 
 
I can tell you what some others in positions similar to yours have managed to do:
 
  1. I completely left the profession to go back to school and study psychology
  2. Another midwife has closed her practice to attend nursing school with the eventual goal of becoming a Certified Nurse Midwife
  3. A CNM who had been doing home births has moved into a hospital-only practice
  4. At least one midwife has become a successful hospital-only doula
  5. Another midwife remains in the home birth profession, ensuring that women who don’t meet very strict risk criteria are risked out and is now maintaining malpractice insurance  
Regardless of the path that you take, to me the most important thing is that you make sure you are honest with any clients that you do take on. Before I stopped practicing, I developed an Informed Consent document containing the following language:  
 
Birth is an intrinsically risky event for both mother and baby. [Midwife] has made no claims or assurances to the contrary.  
[Midwife] has informed me that a hospital is the safest place for my baby and me during labor, birth, and immediate postpartum.  
[Midwife] has informed me of the statistical risks of giving birth at home based on her understanding and research. I have been informed that the chances of death or significant injury to myself and/or to my baby are at least four times higher than the chances of death or significant injury within a hospital setting.
[Midwife] has in no way attempted to persuade me to give birth at home, nor has she made any assurances as to the safety or advisability of giving birth at home.
 
Not surprisingly, couples who received this document from me tended to decide to give birth in the hospital, where I happily supported them. But even if they hadn’t, I could at least know that I had been honest with them. 
 
Best wishes as you navigate this tricky and difficult situation. You are not alone. 

Love, 
Honest Midwife
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