At our retreat we discussed keeping your personal bias out of the equation when speaking with clients (I think we are all guilty of this at some time or another, aren't we?). Despite the uniform emphasis on repressing personal opinions, I noticed a clear bias on absolutely and always accompanying your mom to the hospital during a transport. I try not to believe in absolutes and always. What about the midwife who risks arrest if she transports a couple to the hospital? If arrested, she leaves her clients (perhaps someone in early labor) without a care provider. And what if the transporting midwife is a woman of color and thus more likely to receive harassment in a hostile climate? Let's be real, it is easier for us white women to work within the system, even when faced with a sticky situation.
The solution proposed was that perhaps the midwife shouldn't take on the client who is putting her at risk (for example, if you are in a state where it is illegal to attend a woman who would like to give birth vaginally after cesarean, then you shouldn't attend VBACs). Let's say for a moment that a VBAC client who is determined to have a VBAC feels pushed to birth at home unassisted but is not comfortable with that choice. She feels unsafe and torn between two equally unwanted options, birth in a hospital or unassisted birth. Is that the alternative? Putting women in a place where they feel pushed to make a choice (unassisted birth) that they are making only because they are denied care? Now there are plenty of women who choose unassisted birth but it should be a choice, not a situation a a woman is forced into because the alternative, another cesarean for example, is not acceptable to the mother. I hesitate to go there but what if the mom's fear of an unattended birth interferes with the process of normal labor and the baby is compromised?
I would argue that there is a difference between "dumping" your client at the hospital (something I think midwives should never do) and educating your clients on the legal status of midwifery in their state and choosing, for example, not to attend non-emergency transfers. I've heard that back in the day, couples would regularly tell their midwives, "please stay home, we don't want to get you in trouble." People were protecting a valuable asset in their community, the midwife. A compromise could be to accompany the couple to a hostile hospital as the client's doula rather then the midwife. Let's face it, there are some hostile hospitals out there and midwives have been arrested during transports.
If you choose to transport with your clients, despite the risk of arrest, good for you, but be careful of judging the midwife who does not. Readers, I would love to hear your thoughts on the matter.
I did learn some great tips on transports which I will share in another blog. Remember that many midwives who attend home birth have transport rates under 5% so this is NOT a common occurrence.