Saturday, January 18, 2014

The lineage of midwives; trees, frogs and the future of birth

The lineage of midwifery
Trees, frogs and the future of birth

A frog prepares to make the journey down hill to a pond where she will lay her eggs

The wisdom of catching babies, like other skills necessary for human life, was passed down from one generation to the next. It was deeply embedded in the tribes and bands that made up our early human families.  It continued, in this way, throughout the world for hundreds of thousands of years.

Women knew how to cook, gather food, create shelter and some amongst them became skilled at baby catching.  They knew of plants, of prayer, and of positioning mothers for birth.  With their hearts and their hands, they birthed millions of babies and although women died; we can see by the world’s population, that many, many more lived.   Our history books love to tell of the great generals who fought battles and forged empires but I stand in awe of the midwife who night after night walked out of her home and despite all the odds against her, helped preserve and build the life of her community.  

As I listen to the stories of women and midwives, I feel myself wanting to preserve this lineage.   I ask them if they have trained a new midwife to take their place.  They look down.  “It is not like that now.  Women feel pain when they have babies and go to the hospitals.   We are not suppose to use teas or baths. We are not allowed to deliver babies and besides we are old.” 

I am not trying to idealize beyond reason.  The midwives, of old, worked in isolation without the broad collective wisdom of books, research and modern science.   They worked, as my stories showed, in the midst of famine, migration, war and climate change.   They worked within societies where men considered women their property.  They worked as slaves and servants.  They were often called to do this work because someone, in their village needed to and often with little pay.  They were woven deeply into the fabric of their communities and the families they served.  They were village midwives.

Like the old growth forests and the spotted owl; I want to preserve this legacy, this lineage.   I see myself standing amongst the logged landscape of Ghana, Haiti and Oregon and trying to explain why these trees matter.  I want to say that if you cut down all these trees, the people will one day starve.   It will change our climate, our water supply, our animals, and our fish.   “These trees are holding our whole world together.”   Some people sit in trees, trying to protect them.  There are protests, lobbyists and lawyers all trying to save these last trees before they are all gone.   When you walk in the vast logged areas of SE Asia, you see that the people, who once supported their communities, are starving.   The entire system has been uprooted.  People who once took only the trees they needed for homes, boats and tools, stood and watched while powerful, outside forces took every last tree. 

I try to stand, on the logged landscape of childbirth and explain why it matters.  I can feel the trees falling around me.  I am trying to scream over the sound of the chainsaw but it is too loud.   I watch the lineage of midwifery struggle to survive.  Like the elephants of Cambodia, they look for safety and then slowly, slowly walk away.

Midwives today, in their many reincarnations, rarely serve a village or a community.  In my state, most midwives belong to a hospital, a large practice, a birth center or an insurance plan.  They are not community midwives.   They rarely, if ever, serve a community as primary caretakers of the women and babies of a neighborhood.   The mother’s health plan, the county plan, their insurance dictates where they go and where the women they serve will give birth.   In my community’s health center there are no midwives.    The mothers do not gather for a prayer and a song and wait together telling stories and laughing.  It is cold and quiet and empty. 

This place, where I live, is a place beside the forest where two rivers meet; a place once rich with wetlands and ponds.   The river is a superfund site and no matter the millions they spend, they cannot restore it to its original health.  The frogs from the forest try to make their way to the river to lay eggs and are squashed by cars and trucks and trains.   Trying to reproduce becomes the greatest hazard of their life.  It is not that laying eggs did not always have its hazards.  Frogs are the food of many animals.  They and their eggs could have been eaten but they knew when it was a certain temperature and when it was raining, you and all the other mother frogs headed downhill towards the ponds by the river.   They did not stop doing this because giving birth to tadpoles became harder but because their ponds were cut off, filled in and polluted. Birthing tadpoles did not become more difficult but the environment for giving birth in did.

In the lineage of midwifery, birth is normal.  Like the frogs trying to get to the river, women know how to do it.  In the ancient wisdom of birth, midwives allowed women to slip into the place of birth and wander out into their own real or metaphoric rice paddies and give birth.  They are given space to do what they have known, by instinct, how to do all along. 

 40% of women in the United States give birth with a surgeon who cuts their babies out of them.   They have been convinced that birth is dangerous, painful and something to endure.  On the other hand, women who want a natural birth feel desperate to orchestrate the perfect water birth with the exact right music, people and candles.    

But midwifery is not where you give more but how the well being of children are brought into our community.  In this way, each village or neighborhood has their own band of skilled midwives who care for their communities newest generation with love, education and support.    They protect this process, this new generation as a normal part of any healthy community.   In this model, normal prenatal care and birth happen within the community and is never tied to insurance providers.    Women can walk to their prenatal care with other women where they learn and feel supported by the their midwives and their community.   They will be able to choose, as they can in Canada, where they give birth; at home or in a birth center with a hospital available when needed. 

In the lineage of midwifery, birth is rooted in the food systems that nourish the mother and her unborn baby.  It is rooted in clean air and water free from contaminants.   Midwives help to create a nest for the next generation that is safe, clean and provides equal opportunity for children.  They work with farmers, schools and community leaders to protect the next generation.  The first thing a new midwifery student learns is how women and children are doing in the village she will serve.   She will discover the obstacles children face and how she can work within that community to empower women and families to make the village better for children.  The well being of mothers and babies and families is locally crafted and cared for.  This is the lineage of midwifery.   

Midwives can be educated, have standards, have access to life saving medicines and procedures and still be rooted in the history, culture and ecological systems of their communities.   

I am making all this up.   It is based on what I saw in rural Cambodian health centers and my experience as a midwife and a teacher.   I see midwives being trained to do hospital births and midwives being trained to do water births and no one being trained to do village midwifery care.   It is not that midwives and even doctors don’t want to do this.   The insurance companies and the laws that support them to do allow for it; at least not easily.

The midwife I met in Cambodia told me that her father planted thousands of coconut trees for the people of her village.   There were mangoes and many other things to eat but then the Khmer Rogue cut them all down to make rice fields and sold the rice to China for weapons.   She said in those times, there was enough food for everyone.   “When they cut down the trees and sprayed the land, the babies were not as healthy.”

In my village, when they let people build factories that pollute the land or transport explosive chemicals across the landscape the children will, in one way, or other suffer.   In the ancient practice of midwifery, the midwives sit down and have a voice to say this will not be good for the next generation of babies.  It will cause hunger, birth defects and harm to the parents.  All the technology, all the surgeries and monitors and induced births will not protect a child from environmentally induced illness and disabilities.  It is like the women told me.  It was not birth that killed our children; it was war and famine and being poor.

By taking birth out of the community and out of the home we have actually failed to protect children.   Our country works so hard to make sure that babies are born alive and the mother feels no pain and that the baby has every cute new item on the market that we fail to use birth to protect the long-term best interests of children.   We know babies need to be exclusively breast fed for six months but we allow a 12-week maternity leave.   We know vaginal births and early skin-to-skin contact protects babies from many health problems for many years.  We know that inductions have caused many babies to be born prematurely and suffer learning disabilities but we struggle to create birthing practices that are deeply rooted in community and long term well being. 

The traditional midwives of the world are endangered like the old growth forests and the spotted owl. They were scorned, looked down upon, burned as witches, outlawed, marginalized and called dirty.   No matter how much a small village may have loved them and trusted them, they were eventually rooted out as countries sought to improve maternal and newborn health.

I see this lineage.  The midwives are paddling the waterways of their ancient homeland.  They are in ships carrying immigrants from far away places.  They are riding in wagon trains and on horseback.    I also see, in my country, women struggling to conceive and afraid to give birth.   I see schools struggling to connect education to the greater purpose of building a healthy, equitable society.   I watch all the disconnected, competitive forces cutting down the real and metaphoric forests around the children and wondering why they cannot grow.  

The frogs of the forest face many obstacles.   The city has let non-invasive plants take over the forest destroying habitat and trees.  When they head down to the nesting ponds, not only do they face polluted ponds but also they must cross a highway and a railroad track.  Despite all this and the death of hundreds of frogs each night, they keep trying to get to the birthing pools.  Good- hearted people stand out there with buckets and pick them up and carry them to the ponds. 

The DNA of birth is strong. It is the way we protect and care for the next generation.   It is not simply a matter of getting the baby out alive; it is the journey that the mother, father and their extended community make together.  It is the way we use all the tools of breast milk, hormones, protective microbes, intelligence and bonding that help children thrive in a community.

Birth has been cut off.    There is a highway and a railroad and a polluted pond between most women and the reality of community cherished care of the newborn.  There are great political and economic barriers present in connecting the care of the family to the communities they live in with midwives. 

We know that certain plants and animals are indicator species.  This means that the loss of them is a sign that the whole ecosystem is in danger.   The widespread, elective loss of vaginal birth and breastfed babies is such a sign, I believe, for the human race. 

The village midwife walks tenderly in the world.  They are experts in their community and its unique challenges and obstacles.  The midwife works with others to help teens make healthy choices.  She gathers women in her community together for safe, healthy places to give birth and raise children.   She is based in her village. Her main work is the time it takes to grow a baby safely and the months of breastfeeding.  When these things are tended carefully, the place and nature of birth will change with it.  The question will become how we sue our precious healthcare dollars for the lifelong benefit of our children. 

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