Nearly eighteen years ago, much to my surprise, I found myself pregnant. Within the span of two years, I was surprised twice by this condition. (Turned out to be the two best surprises of my life, and they continue to surprise me every day.)
Equally surprising is the fact that all these years later, North Carolina still appears to be in the dark ages when it comes to a woman’s right to do one of the most natural things on earth in a natural way, and a midwife’s right to attend a child’s birth as a competent and independent professional.
In 1994, upon discovering that I was about to become a parent, the first thing I worried about (before the million other things I began to worry about) was who would help me deliver my child. I had second hand knowledge of how the traditional birthing experience was for most women in this country – forceps and epidurals and episiotomies and countless medical interventions that held absolutely no interest for me. Trusting my instincts, I intuitively knew that birth was not a medical procedure, unless an emergency warranted that it become one. I was determined that my children’s births would be as natural as possible. So I did what lots of similarly minded women do: I sought out a Certified Nurse Midwife (CNM).
Thankfully, I was able to find one, even though I had to travel a bit to see her. The fact that it was a bit challenging to find that midwife was another surprise to me. For most of human history (and in many societies still today), official and unofficial midwives have been the go-to people who assist women in giving birth. (Obstetricians are a relatively new development in history.) Thanks to my amazing midwife, I was able to lucidly labor through two completely natural deliveries, including the second one with my ten and a half pound baby boy whose shoulder was caught in the pelvic canal for a minute and whose birth ALMOST became a medical emergency.
It didn’t become a medical emergency because my midwife knew exactly what to do to get him out.
Her supervising obstetrician, however, did not.
“I would have broken the baby’s shoulder to deliver him,” he told my midwife as I was holding my newborn son. In fact, he asked her why she didn’t go ahead and do just that.
She paused and said, with authority, “Because I didn’t have to.”
The emphasis was on the word “I.”
Instinctively, I caressed my son’s shoulder.
(He would separate that shoulder thirteen years later in a pickup football game at school, but I’ll save that story for a future rant about the insurance industry.)
From that moment on, I wondered why the obstetrician was supervising her at all. Certainly he was a competent professional, and thank God he was around in case something had truly gone wrong and required surgical intervention. But clearly, she knew how to do important and life saving things he didn’t know how to do. Both of them were important to an overall successful birth experience. But why was he supervising instead of collaborating?
Fast forward fifteen years, and I see on the news that here in North Carolina, seven certified nurse midwives are surprisingly unable to practice and help their clients bring new life into the world, because their supervising obstetrician has abruptly and without explanation withdrawn his support as their supervising physician. This also leaves countless women about to give birth in a panic about their sudden lack of care and options for imminent childbirth.
There is such outrage from all corners of the state that the howls reach the governor’s ears rather quickly. Wisely, the North Carolina Midwifery Joint Committee averts the immediate crisis by providing a 75 day grace period to the nurse midwives to find a new supervising physician – and practice in the interim without one. Everyone has a little breathing room now, and the women who’ve been planning for nine months to give birth in the manner of their choosing with their chosen care provider will now be able to do so.
But my mind goes right back to my question of fifteen years ago. Why do CNMs need to have a physician supervising them at all? If they truly do need one, doesn’t that put the women and babies who are being attended by midwives without a supervising physician during this 75 day grace period at unreasonable risk?
Of course not. If the supervision were truly necessary, it would be irresponsible to allow a grace period. But no one is complaining. That’s because just about everyone involved knows that CNMs provide the best possible care. They aren’t doctors, but they don’t need to be. If you ask anyone in the medical field, you’ll learn that nurses and doctors receive very different kinds of training and provide care through different, but complementary, models. Nurses who go on to become nurse practitioners provide exceptional primary care in their own right. Patient outcomes are just as good, and patient satisfaction is often higher. They are competent professionals who know when to refer patients to the right doctors when matters get beyond their area of expertise – just as a primary care physician knows to refer a patient with cancer to an oncologist.
The notion of supervision is condescending and superfluous, and even the American College of Obstetricians and Gynecologists agrees it’s not the best model of professional relationship. In a joint statement issued by the ACOG and the American College of Nurse-Midwives, both national organizations affirmed their shared belief that a collaborative, not hierarchical, relationship is ideal for women’s health care:
The American College of Obstetricians and Gynecologists (the College) and the American College of Nurse-Midwives (ACNM) affirm our shared goal of safe women’s health care in the United States through the promotion of evidence-based models provided by obstetrician–gynecologists (ob-gyns), certified nurse-midwives (CNMs), and certified midwives (CMs). The College and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among providers. Ob-gyns and CNMs/CMs are experts in their respective fields of practice and are educated, trained, and licensed, independent providers who may collaborate with each other based on the needs of their patients. Quality of care is enhanced by collegial relationships characterized by mutual respect and trust, as well as professional responsibility and accountability.
So why isn’t North Carolina on board with this thinking? State law requires that all CNMs here be under the supervision of an ob-gyn. And while the grace period issued by the state for the midwives to find supervising physicians is helpful for women about to give birth now, midwives have a tough time trying to find physicians willing to supervise them. (This has to do primarily with fear of malpractice lawsuits, but I’ll save that story for a future rant about the insurance industry.)
The only lasting solution is to change the law to allow the CNMs to practice as the truly independent and competent professionals they are.
So, in a blog where I typically post about nutrition and the government’s role in it, why have I taken a bit of a detour? Because it’s really not much of a detour. As a health coach, I’ve noticed how often those aspects of our lives that should be primarily regulated by our instincts wind up being regulated by outside agencies. Eating and birthing are two of the most natural things human beings do, and they are two of the most regulated activities in our society. The accepted norms are not the natural ones. It’s rare, even considered radical, for women to be attended by nurse-midwives when obstetricians are the accepted “traditional” providers. When it comes to nutrition, it’s the “radicals” who promote the whole foods lifestyle.
It’s even more problematic in the nutrition world. Food is the foundation of health, but the so-called “authorities” on how to eat well regularly dispense information that is simply wrong. Just take a look AGAIN at the USDA food pyramid. It’s wrong on every level. It’s also the fight Steve Cooksey has taken on – suing the North Carolina Board of Dietetics and Nutrition for allegedly curtailing his freedom of speech. Without a license of any kind, but with a generous dose of natural instincts, personal experience, and common sense, he promotes a diet that works for a lot of diabetics, while the NCBDN has at least one member who promotes a diet that harms them.
Childbirth and nutrition are just two areas in which we are encouraged to distrust our instincts – instincts that would tell us that eating processed foods is bad, and that giving birth naturally is normal.
Isn’t it the most surprising thing of all that we even need to look to authorities outside ourselves to do the same things animals in the wild manage better than we do?
It is surprising, but because we’ve complicated things, we do need experts.
The trick is to find the experts who will gently guide us out of the maze of complicated and artificial regulations, and back to the reality of our instincts.
This weekend, we may well hit our first 20 authors who’ve chosen the expanded and improved Instant Wellness Author Package. If you want the guided support that comes along with being among the first 20, don’t delay. Join us now!
What’s new and controversial in the world of nutrition? Apart from the congressional farm bill, things seem a little quiet. Maybe I should get started on that rant about the insurance industry? If you have a suggestion for something you’d like to see me address in next week’s article, let me know. Hope to see you there!