We’d like to thank everyone who participated in April 2’s day-long summit. It was a pivotal meeting of attendees and speakers from all walks of life and backgrounds, where game-changing ideas were presented, and relationships were forged and strengthened.
Jan Tritten began the day with a call for unity, and unity was the experience that attendees most carried away. As midwife after midwife shared a story of how legal sanction had affected her life and her family, we saw the common threads that run through these stories. Home birth midwives had similar experiences with the law, despite the different legal systems where they worked, whether the midwife was a CPM or a CNM, “legal” or “illegal.” A powerful panel of mothers and birth activists described the effect that the legal climate around midwifery has on birthing women. The day began by laying bare the problems, and it ended with solutions: a panel of committed lawyers described their work advocating for midwives and justice in maternity care.
The diversity of perspectives voiced over the day enabled all present to elevate their own perspectives. By understanding the common threads, we could identify political problems and their solutions. We could see the forest, instead of the trees, and walked away with the knowledge that we are not alone and the hope that, together, we can generate solutions.
A few things that came out of the summit that we think deserve clarification, especially for attendees who requested a summary that they could share with their own organizations.
First, we want to highlight the diversity of attendees and speakers. Not everyone agreed on everything, but discussion was respectful and productive. We’ll continue to foster those discussions.
Second, understand that the summit was a place to share stories and ideas in a neutral environment. No one was on trial here. Our interest in the cases before us at the conference lay in the ways that legal systems treat home birth providers, and how that treatment affects the safety and accessibility of home birth as a legitimate healthcare option. This issue transcends the facts of any particular case, including the question of whether the midwife might have made a mistake in this case.
Why support midwives, even before the facts of a case come out?
Many voiced concerns about “supporting” midwives who may have made negligent decisions in care. This is a critical topic and something that must be clarified. Doctors make mistakes. Midwives make mistakes. Decision-making in childbirth is not a clear science. But when doctors are negligent, they are treated one way, and when homebirth midwives are negligent, they are treated another. Our question is not, “Was she negligent?” but “How did the legal system approach the allegation of negligence?”
Midwives should not be sanctioned for professional negligence through the criminal justice system, when doctors are immune from criminal prosecution for professional negligence.
Our analysis starts from the assumption that women have the right to choose whether to give birth inside a hospital or outside of one, and that women have the right to choose a birth provider whose approach to childbirth, for example as a physiological or a medical event, most likely mirrors their own. A healthcare system concerned with the safety of mothers and babies does not try to force every woman into a one-size-fits-all birth care model. But when the providers of out-of-hospital birth support are treated as outlaws, the choice for home birth goes underground and becomes less safe, less transparent, and less accountable to birthing women and the public at large.
For this reason, we are concerned with equitable legal treatment of birth care providers, and interested in the effect that the inequitable treatment of those providers has on birthing women. Legitimate healthcare providers are held accountable for negligent acts every day—but they are held accountable for negligence through medical malpractice lawsuits and disciplinary sanctions. That same system of accountability should apply to midwives. So, when we hear of home raids, arrests, and homicide charges against home birth midwives, on allegations that amount to every-day medical malpractice claims (failure to diagnose, failure to intervene), we say, “No, that particular sanction is not appropriate, period.”
Disincentivizing midwifery is not good for maternity care.
We are interested in ensuring the survival of midwifery as a profession, not for midwives, but for women. We support midwives because we support the rights of birthing women to make personalized decisions in birth care. That includes their right to give birth where and with whom they choose. The choice to give birth inside the hospital is not meaningful unless you also have the option to give birth outside of it. The inequitable legal treatment of homebirth midwives makes home birth midwifery an extremely risky profession, and thus dissuades providers from offering these services.
Should midwives be held accountable for negligence?
Absolutely. Quality of care is paramount in order to ensure safety for mothers and babies. Midwives must be held accountable like any healthcare provider, through equitable and transparent systems. These are systems that treat maternal health care providers—doctors, nurses, and midwives—the same. They allow mothers to protect themselves and their babies and to make personal healthcare decisions with full and transparent information.
But the necessary first steps toward effective systems of accountability for out-of-hospital midwives are
1) the legal recognition that midwives ARE legitimate healthcare providers,
2) the recognition that there is no legal obligation to give birth inside a hospital, and home birth is a legitimate healthcare choice, and
3) regulatory systems that legitimize the midwifery model’s treatment of the birthing woman as the bottom-line decision-maker in childbirth.
The theme that emerged throughout the day was the need for unity among those who serve and advocate for women and babies in childbirth. Regardless of our individual beliefs, we must find our common ground if we are to see real and lasting change in the way birthing women are cared for and treated. It’s time to lay down our weapons and recognize our mutual concerns.
Thanks to all who participated in this enlightening, inspiring, whirlwind event. We look forward to seeing all of the fruits of our labor throughout the coming year.