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The He/art of Birthwork

Posted by Sarah Stogryn on

12 years ago my plan was to leave the non-profit job I was in and go back to school to become a registered Ontario midwife. Then I read Gentle Birth Gentle Mothering by Sarah J Buckley. I realized I couldn't be the kind of midwife I'd want to be AND practice within Ontario's medical system. The Universe had other plans for me anyway and later that year I got married. I continued to work as a doula, being careful to never colour outside the legal lines. Because of my own commitment to being informed about birth practices beyond what is expected of a doula, and how I held space, shared information, offered alternative perspectives to consider, encouraged my clients to listen to their intuition, and supported their right to make the choices that were best for them, (or maybe for some other reason!) more than one client over the years referred to me as their traditional midwife. Doctors have asked me from time to time if I was a midwife from England.. I was always very clear that while I appreciated the sentiment, I was "just a doula who reads a lot". I didn't want anyone thinking I was too big for my britches or didn't know my place. I didn't want legal trouble. Keeping my family safe and well was and is my #1 priority.

I had to stop attending births a couple years ago as it doesn't work for our family right now. My life is very full with unschooling my highly sensitive 4.5yo, and my PDA  Autistic 9yo, as well as my business Hedgecraft Herbals. I don't have the energetic reserves to be fully present for people through pregnancy, birth, and postpartum while still being the person my family needs. I don’t know what it would even look like to be honest. “Doula” doesn’t describe me anymore, my old contract has been outgrown, and I wouldn't know where to start with a new one. Because while I'm not "just a doula who reads a lot",  I'm also not an Ontario registered midwife. I'm something in between, in a province with little room and no common vocabulary for in-between-ness. I may not be attending births but I am still a birthworker, birthkeeper, birth witch, birth--- something.  

I'm working on a course for people who want birth support like what I offered, but don't have access to it. And I still read a lot of books related to the childbearing year. Reading is and always has been how I learn best.

Birth is a sacred mystery worthy of our respect.
I believe: that each person’s journey is their own; that we each perceive life (& birth) through the lens of our own experiences and level of consciousness; that trying to change someone’s level of consciousness for them will cause them harm; that we each do the best we can.
I view the birthing person as the expert, the one who holds the power, and the one who is MOST knowledgeable about their own self, pregnancy, and needs.
I value intuition on the part of both birthing person and birth worker.
I see birthwork as both art and science; modern and ancient.
I believe the birthworker is a servant to the birthing person and that this role is a most holy privilege not unlike the acolytes serving in the temples of ancient goddesses.

'Midwife' and all associated terms are essentially owned by the Ontario government and using them to describe yourself here is a chargeable offence. There are also “protected acts” which can only be performed by midwives or otherwise licensed medical professionals. The protection of those terms and acts is taken very seriously and I've been on the receiving end of threats to try and keep me (a perceived but not actual violator) compliant because while I stayed inside the lines, they didn't like how I coloured. The beliefs driving this sort of gatekeeping or protectionism are that birth is an inherently dangerous medical event which requires active supervision and intervention by medical professionals (at the very least "just in case"), and that birthing persons are incapable of making good decisions on their own so must be protected by law from their own naivety or even stupidity (infantilizing much?)

In the 1990's Ontario midwives fought for a place within the medical system. Today midwives may only legally practice if they are educated and registered by the province. They function with a blend of traditional midwifery skills and modern medical skills as a fully integrated part of the medical system. Ontario registered midwives work hard to get their credentials, and are consistently underpaid and undervalued. I understand why they want to protect what little ground they've staked out within the medical system. It's a system though which is still rooted in patriarchal, colonial, capitalist values. As a group of largely women serving largely other women their place at the medical system table remains tenuous. Sometimes it seems to me that the more threatened the system is by their presence, the more tenuous their place at the table becomes, the more deeply they have to lean into the accepted medical ways of doing things and away from the he/art of midwifery, away from being WITH women, in order to keep their place at the table at all. I can't help but think the schism this causes to some midwives is akin to splitting off a piece of their soul. That's a high price to pay.

Informed choice, choice of birthplace, continuity of care, and being partners in care with your midwife are central tenets (privileges if you will) of Ontario midwifery but they obviously only apply to those who tick the right boxes (aka low risk according to the system) to qualify for and get access to midwifery care in the first place. The fact that these tenets even have to be articulated as distinctive from obstetrical care is a whole other kettle of fish! Sticking with this kettle for today though ;) if any of the boxes get unticked along the way, privileges can get revoked in the name of safety and risk mitigation. Being partners in care with your midwife sounds lovely at first but the inherent power imbalance between midwife and client negates a truly equal partnership. When it comes down to the wire, the little spoken of rule is that the client will comply with the midwife because the midwife has knowledge and authority which supersede the clients innate knowing and being. If you don't comply, you face the possibility of being "risked out of care" altogether (hence the power imbalance, which also compromises the ability to make free and informed choices).

For what it's worth, Ontario midwives aren't free either as their ability to practice is dependent on the permission of their local hospital(s) and if they are perceived as drifting too far away from what medical convention says is best they can face financial penalties or the loss of their midwifery license which would effectively end their career. Ontario midwives are just as caged as the birthing persons they serve and they too are infantilized, patronized, and dismissed by the system they’re part of.

Despite all this, most birthing people and many midwives are comfortable with the system as it is and that’s okay. I really do mean that. We are, by and large, so disconnected from our own bodies, our intuition, our soul, our womb, our power, our place in the world, that the idea of taking full responsibility for our childbearing year is not just absurd it’s terrifying. The Ontario midwifery model contained within the “safety” net of the Ontario medical system is a good choice for many many birthing people. Most people don’t actually WANT full responsibility for their wellbeing and gladly hand it over to professionals. I wholeheartedly support a person’s right to birth where, how, and with whom they choose, including the whole spectrum from a planned cesarean to an unassisted birth. I chose Ontario midwifery care for both of my own births. It was the right choice for me at the time. My midwives were wonderful women who worked very hard to support my choices within the constraints of the system they practice in. In truth however, choosing Ontario midwifery was a compromise for me. I didn’t want a doctor led hospital birth. I didn’t want a completely unassisted birth (because I value the tradition of women supporting women). I didn’t want to have to travel out of province or country. I wanted to birth in my own home. So I chose Ontario midwifery and worked hard to make it work for me. Ideally though, there’d have been another path available to me - the path of legal non-governmental midwifery. A path where I wasn't constantly juggling how to honour my own intuition with keeping the boxes ticked so I could have the birth that was right for me. 

The government agrees that consenting adults can decide what happens sexually in the bedroom, but birthing persons (largely women) are not given this same freedom when it comes to where, how, and with whom they give birth. Birthing persons may choose to give birth within the medical system, or they can give birth "unassisted" (though if investigated they may be required to prove they weren't 'neglectful' of the baby at birth in doing so). There are some in power who believe that anything other than following "doctors orders" is by default neglect and act accordingly. In theory a doula can attend an unassisted birth solely as a doula but it's dicey ground and many doula organizations prohibit their members from doing so. Frankly most doulas don't actually want to be at births without a medical professional anyway. It's not how they trained and it shifts the dynamics of the relationship in ways that aren't always right for them. 
Traditional birth attendants, direct entry/ 'lay'/ traditional/ non-registered midwives are not legally permitted to assist a birthing person if it involves any of the government protected acts or if they use any of those words to describe themselves, even when consenting adults are making informed choices. Put your fingers in a willing vagina for fun and everybody is happy but put fingers in a vagina carefully, thoughtfully, safely, with full consent, and to obtain potentially useful information in labour - well that is grounds for federal charges. Of course most of the time vaginal exams aren't needed at all, sometimes a birthing person can do it themselves, and they should never be routine, but in the times when a birthing person WANTS one, a skilled safe attendant is willing, and the birthing person decides the benefits outweigh the risks and limitations, well frankly as far as I'm concerned, the government should have no more say over that then who the person has sex with.  As it stands however, the government still controls who touches vaginas and that means no matter how much we sing the sweet songs of midwifery, the government is still setting the tune, controlling our bodies, and prosecuting those who choose a tune of their own. 

I don't know what the future holds but I do know this - - the system as it exists now is not serving women. Not the midwives. Not the birthing persons. Not the babies. Not the families. Patriarchal, colonial, capitalist systems exist to bolster themselves at all costs. The medical system is rooted in beliefs which keep people small, dependent, and afraid. But there is MORE out there. There are deeper and wider levels of consciousness. There is genuine kindness, respect, equality, and LOVE. For now, I write. I read. I speak. I share. I listen. I explore. I contemplate. For later? Only time will tell.


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