Reclaiming women’s birth choices
Local author’s book Into These Hands: Wisdom from Midwives delivers powerful message
By F. Josephine Arrowood
Sun contributor
Geradine Simkins of Maple City — midwife, educator, mother, lifelong community activist, political leader, and wise woman — has created a labor of love with her new book Into These Hands: Wisdom from Midwives (Spirituality and Health Books, 2011). The collection of essays, penned by 25 seasoned midwives from across the country about their lives and their profession, delivers a powerful message about the effects of women’s birth choices on our society, both nationally and worldwide. It has been lauded by such luminaries as writer Alice Walker, internationally known midwife and educator Ina May Gaskin, actor and producer Ricki Lake, and many others prominent in birth-related fields of public health, nursing, academia, obstetrics and gynecology.
The writers chronicled in Into These Hands came from diverse cultural, ethnic, geographical, and economic backgrounds, to an initial exposure to birth that was (slowly at first, for many) being redefined from the experiences of their peers, mothers and grandmothers in American society. Yet all were shaped by the upheavals of the 1960s, coming of age during an era when “the country was whipped into a frenzy of cultural revolution” on many fronts. Geradine’s criteria for inclusion in the book included ”women 50 years or older; practicing midwifery for 25 years or more, to ensure that this is their life’s work; and leaders or wise women in the tradition” of their communities.
“Most got started in the 1960s or ‘70s, during a blend of social movements, including civil rights, antiwar, gender equity, the environment, and the second wave of feminism. Women were wanting to take control of their lives at many levels.” She points to intrusive, controlling birthing practices that had become commonplace in the post-World War II era, largely practiced in hospital settings, which included drug-induced “twilight sleep” for laboring women, forceps deliveries, prolonged separation from newborns, store-bought feeding formulas to discourage breastfeeding, and birthing alone, without emotional support and often physically restrained.
“Women got off their backs and took charge during this time of cultural revolution. But we weren’t always clear about that aspect of reproductive rights — the reality of birthing” — at first. Of the midwives whose essays appear in the book, “three-quarters of us did become pregnant and mothers. One of the women is a nun, exposed to births through nursing — her call to service was caring for the poorest of the poor. One is a migrant from Panama, whose cultural exposure was pretty down-home, relaxed, socially mediated. So we all came to it a little differently.”
Geradine sketches a bit of her own history in Detroit, “going to Wayne State University. The back-to-the-land movement was our desire to get back to some basic values and practices … choosing a lifestyle of ‘voluntary simplicity,’ more earth-friendly. The whole concept of having a baby at home was a little surprising to me! But a friend in California had had a baby at home — we were do-it-yourselfers, dragging cedar posts out of the swamps [to build a home] … we couldn’t imagine birth could be that hard!”
She says, “It was way harder than I’d expected, quicker and to the point, very hard but very doable. I did this all myself — powerful, very strong and capable. It allowed me to move forward in my life. We discovered for ourselves and our friends who we began to help having babies — to see clearly how amazingly potent women really are.”
What prompted her to write this book now?
“I’ve been in the midwifery business for about 35 years; most of that time has been catching babies. In the last couple of decades, I’ve been very involved with migrant farm workers and American Indian tribes. In my work, I’ve been developing a lot of qualitative research — stories about living one’s life as a Native American in America. I’m not American Indian, so I asked myself, ‘Where is my tribe?’ — and I realized my tribe was midwives.”
She explains, “Midwives are not recorded well in history, and we have not been good with [recording] our own history; others have told it, mainly men, mainly historians, sociologists. I’m near the end of my career and so are many of my colleagues. I started this anthology in 2007.
“In the book, I was sort of a midwife,” she says, by turns encouraging and demanding that her colleagues put their collective wisdom down as a written testament, vital to the survival and growth of the profession into the 21st century.
She laughs somewhat ruefully. “Most said, ‘I don’t have time! I’m too busy!’ I said, ‘If not now, when? If not you, who?’ The politics and the power struggles — most of us have opened our doors to police raiding our offices; a midwife in California has a court case named after her.”
The veteran midwife goes on, “The moment of birth is just one piece, one very small piece of the time we spend to honor what they [women] need. If you’re gong to be a midwife, be prepared to be an activist! They’re doing all they can to eradicate the profession, even into 2011.”
Many of the midwives wrote that they “never intended” to be outlaws or political activists, yet Geradine sees these roles as part of her professional duties. “It’s not for the weak-hearted,” she states, “you have to be willing to stand up to a paradigm focused on women’s procreative lives as corporate, medicalized,” and hugely profitable to that industry.
In general terms, she sees the three different birth settings as determinates of who gets to make the choices that affect birthing outcomes. “The hospital is the domain of the doctor. Birth centers are the domains of midwives, and home is the domain of the mother — where she’s in charge and feels most comfortable.” This is not to say that all three settings are exclusive; she stresses that positive outcomes may be had in each, and with the different kinds of providers: direct-entry midwives, “who tend to be experts in out-of-hospital births, while 95 percent of certified nurse-midwives tend to practice in hospitals,” along with doctors.
With their extensive clinical training that includes many hours spent with women during both prenatal and postnatal visits, experienced midwives gain strong experience in determining when a mother should be referred to a specialist’s care. Geradine shares an example of her decision — and what skills and experiences led her to it — to refer a woman into a doctor’s care in her essay. But for most women, birth is a healthy, normal experience, not a medical emergency or condition, and does not need over-intervention and fear-mongering. As one midwife, Debbie Pulley, shared about her own experiences giving birth, “ … the best place to have your baby is where you are most comfortable. There is not one right place for everyone.”
Many people may have a skewed perception of midwives, both direct-entry and CNMs, or historical “grannies” of another era, or with less training and skills than those in the medical establishment hierarchy. Not so, counters Simkins. Like many midwives, “I am trained as both: a nurse-midwife with a Master’s degree.” (Her several degrees include nursing, a Bachelor’s degree, CNM, and a Master’s degree, detailed in her essay.)
She points to international statistics gathered by the United Nations, the World Health Organization and many other studies, which clearly highlight the low Caesarian-surgery rates (about 3 percent), and safe, positive birth outcomes for both women and their infants in births assisted by midwives, whatever their avenue of training (not to be confused with level of training). This contrasts shockingly with the dismal statistics of “ultramodern” medical care in the United States, including an upward trend in Caesarian births over 30 percent, mostly related to scheduling convenience for the medical profession, and an unconscionable maternal death rate for American women — of all ethnicities and socioeconomic backgrounds — of 39th in the world, with infant mortality not far behind at 32nd.
Although she no longer catches babies, her Birthways Consulting in Maple City continues to focus on women and the childbearing year through midwifery. As a longtime regional and national activist and current president of the Midwives Alliance of North America (MANA), Geradine and others have shaped the profession through their advocacy work in accessibility of midwifery care for all, standards of training and care of childbearing women, a living wage for all midwives, and addressing disparities in such issues as equality for midwives of color.
“Midwives are the solution to several social justice issues, identified by the UN and others. We stand at the cusp of the greatest health care reform in ages.”
Although she and the other midwives in Into These Hands have plenty to say to the insurance-medical industry, they recognize that many in the profession are good people who want to help, but in that setting, “they’re busy folk, overworked — especially nurses. They want you to behave, stay on schedule, so they can get through their busy day.”
What should women and their families do in order to have a better birth experience in this country? “First thing: be informed. Recognize that you truly do have choices. Research shows that pregnant women are not given all the information they need, such as informed consent AND informed refusal. They then get caught in a system that just wants to move you through … that focuses on industry, not on health. [Birthing women] are a population of healthy people; the only way to [get their business] is to convince them that there’s something wrong with them.
“There are always going to be some of what I call ‘friendly doctors’.” says Geradine. “Whether the birth provider is a doctor, a direct-entry midwife or a CNM, what are their qualifications — do they listen to the woman and honor her requests, treat women as knowledgeable and capable? They don’t have to be radicals.”
She urges women to “read, go on the Internet, talk. Recognize that you will need to decide what’s more important, getting along and being a ‘good girl,’ or choosing an experience that you’re likely to only have once or twice in your life – sticking up for what you want.”
She envisions a time when women are going to demand what they want, even at the federal government level, “their right to choose how and with whom they give birth. Why people love midwives — within the context of the messiness of birth — is that they give individualized care, they honor the woman and listen to her,” thus stitching together stronger, healthier women, families, and communities.
Geradine Simkins’ Into These Hands: Wisdom From Midwives, published by Traverse City-based Spirituality and Health Books, is available through her website, WisdomFromMidwives.com and at local booksellers including Glen Arbor’s Cottage Book Shop.
