Being a business owner in the social media age, especially in a field with such emotional investment, is an exceptionally vulnerable endeavor. I certainly couldn’t handle the personal attack our legislative leaders undergo, or the witch hunt our celebrities endure. What our young high schoolers go through today on Facebook, I simply can’t imagine. I am learning that what some require is a little more understanding of the personal trials of extending midwifery. I’ve resisted this in the past, because first of all, this is a service oriented field. Midwives and nurses are willing to sacrifice, which we’ve learned especially this week with nurses contracting ebola after committing to care for a sick patient with a deadly disease. This happened too when AIDS was new to our culture. People ran in fear, but nurses stayed and cared for those in need. The irony of being both a nurse and a business owner is that like most business owners, we get punched in the gut with complaints, and the fact that I just sacrificed my time, my family, and my own health escapes them.
The other reason I have skirted away from sharing some of the hardships of this role is because it is a bit disheartening to clients. It allows one to assume that we aren’t grateful, that we don’t appreciate the honor of being called to one’s birth or recognize the privilege of being asked to take the responsibility of extending primary care. Women develop deep and sincere relationships with their midwife, and us to you. It can cheapen the experience to later whine about what one had to invest in it. For those who are reading and walking away with that impression, please forgive me. I am taking a risk here, and pray the Lord allows my words to land in your heart with grace.
The Black Sheep
Most anyone within the natural birth community in Indiana is well aware that this practice, and more specifically, myself – Dr. Lane, is not well accepted among the homebirth midwifery circles. This has occurred for a few reasons. The primary reason, and the one so many fail to appreciate, is because ten years ago my husband and I choose to birth at home with a prominent midwife in the area and my son lost his life. This was a planned homebirth, after two cesarean sections and was a planned vaginal breech birth. I researched. I prayed. My husband prayed. We sought counsel from several providers. The night before I went into labor, I received an email that my midwives were not willing to take the risk and attend my birth. They argue now that they felt there was too much medical risk, but I know and their email was clear, what they feared was prosecution. I had attended a vaginal breech birth with these midwives previously, and my son had been persistently breech throughout my pregnancy with ultrasound confirmation. The plan to birth at home was consistent. I even have a sticky note, ten years later, of the script we were asked to tell the hospital in the event of a transfer, in effort to protect them.
After receiving their email, I contacted several nursing and midwifery friends for counsel. Being a weekend, I wasn’t able to connect with a new provider. My option was to simply walk into the hospital in labor and then lay down for a cesarean, or pray my sweet baby slides out like butter, transferring with any little indication of trouble. After several nurses (some also direct entry midwives) committed to attending me, and a significant amount of prayer along with my husband’s full support, we continued with our plans to birth at home. We had bags packed and the phone prepared for a transfer to the hospital just ten blocks away at the first whisper of need.
My son was born, after a steadily progressive labor, and he failed to breath. My attendants failed to assist him. Recognizing I likely had the most expertise and they were simply intimidated, I began mouth-to-mouth on my son and asked for the resuscitation equipment. They couldn’t find their supplies and their oxygen tank had been left on and was now empty. I then told my husband to call 911. He and I worked together to breathe for our son. The team of midwives at my birth, all except one, packed their bags and left. They left my son there to die. The image of my husband resuscitating our little boy will forever be burned into my brain.
My son arrived at the hospital within minutes of birth. The paramedics swooped him up and he was out the door. We literally lived that close. He never required heart compressions. This was a respiratory issue. During the ten days of his life, on the respirator, we learned who our supporters were and who just wanted to be part of the gossip or judge, and who our haters were. Yes, there were haters. My midwives disappeared, never to reappear and I didn’t perceive their absence at first, then assumed they were simply trying to avoid legal trouble. I wanted to protect them too. I told the medical staff I had friends at my birth, to avoid their being arrested for practicing midwifery.
The hospital informed my husband and I that we did not have parental rights. They explained that we could visit our son, but he could not receive my breastmilk and we could not make decisions in his care. He would be moved into a nursing home and could not come home with us. The details of all ten days now are etched in my mind as if they happened yesterday. At the time I rode through each moment as if my body was robotic and my mind was numb. I remember a moment at his bedside with my sweet husband, and our son having webbed toes, he mentioned how cute it would be to see him grow up and wear flip flops. My husband’s toes are also webbed and he is self-conscious of this fact, but on our sweet baby, it was endearing. We laughed. I later read in his medical record that the “mother sits at the bedside laughing, uncaring that her son is in critical care.”
We were interrogated. Lectured. Blamed. Hated. We were prayed for and told that we must discern who we had wronged, and fix it so the Lord could hear our prayers and save our son. We were told if we just believed enough, he would be raised. We were told that we cared more about having a homebirth, than our son’s life. In fact, to this day, and having learned all I know now, while I may not make the same decision today, I whole-heartily believe we made the best decision for our son with the information we had at the time. I also have every bit of confidence that I was obedient and felt the Lord was directing us in our decisions. Ten years later, I am beginning to see why we had to endure this trial.
I became the subject of a police investigation. The prosecutor pursued me with reckless homicide, child endangerment and medical neglect. Our supporters became sparse and our midwives sought legal counsel. They crafted their defense and in all accounts, I was the one to blame. There aren’t many willing to go to jail for another. These midwives had children, spouses, lives. If the police were willing to blame me, it was easy to make me the scapegoat. We retained counsel and I hid in my home, fearing every car that came around the corner was coming to handcuff me. We feared having our older children removed from our home. I questioned every decision we’d made. I questioned why I had to endure, where had I not discerned the Lord’s direction. I watched the midwifery internet circles I had just days prior sought refuge within, thought they were friends, speak horribly about me, even comment that I deserved what I got. I printed every comment but sat quietly.
Our attorney had advocated for us at the hospital, realizing our parental rights had been removed illegally. In fact, a judge had ordered that we were completely within our rights and all rights should be returned to us two days after his birth, but we were oblivious to this. My son was given artificial breastmilk through his feeding tube as I pumped my breasts at his bedside. They violated us both. They ignored our basic human rights. He underwent multiple brain scans and had very little brain activity. He was not brain dead, but he was a vegetable. In the ten days he laid in that bed, he deteriorated quickly. I was a nurse. I could care for him. I could dedicate all my time to caring for that sweet child. I knew though, if I were his nurse, I would want him set free. My husband made the decision for us, to remove life support. This was a brief moment, because we had a small window of time. The ethics committee might argue.
Our son was perfect. He was saved. He need not suffer. If he had been older and needed to accept the Lord for eternal life, we would have prayed indefinately and waited for a miracle. I asked the nurses if I could please pump my engorged breasts before we took him off life support and scurried away. When I returned, they had already done so without me present and we weren’t provided a room to hold him as he passed in private. I am so angered by the lack of compassion and the punishment the nursing staff made us endure, but I think often of the poor family beside us, and later directly outside the cubby we were squished within, who watched our son die in front of them and the trauma they too, certainly suffered.
After an hour of my baby gasping in my arms and within my husband’s arms, he took his last breath. We were not allowed additional time. I suppose the hospital staff felt we got what we deserved. After all, I was too educated to choose to birth at home. We had chosen to donate his heart valves and corneas, which are the only few options when one is not brain dead and therefore, must die of anoxia. We met with the organ transplant team and had a tiny glimmer of light that some good may come of his life. Someone would be helped from our tragedy. We soon learned that the coroner refused these families opportunity because he too, was angered. Our transplant team said he was simply “being a jerk and trying to punish us.” The law allowed for this injustice.
Our son’s burial was the hardest of all. What was suppose to be a closed casket turned into finding my son naked, wrapped in hospital blankets. The clothes we provided were thrown away. Still I have thoughts of digging my son out of the ground to wrap him in warm clothes and soft blankets. There were many days that I had to lean hard on the Lord to maintain the simplest of sanity.
Weeks after my son’s birth and death, and thick into the hatred we received from the community, from Indiana midwives, from my previous hospital associates and from my family, we received his autopsy report. My son had suffered multiple brain injuries during my pregnancy. He had no capacity to breath. I was devastated that my son, while cradled in my body was being harmed. I remember my husband’s relief at the news and I simply couldn’t relate. I was so unaware of the moment my son suffered within me. I felt as if I failed to protect him and then lived my life oblivious to his suffering.
I called the pathologist at the state’s lab for more information. That man, I literally pray for daily. I can’t remember his name but it wouldn’t surprise me to learn he was an angel, a true messenger of God. He spent a great deal of time talking with me, comforting me and protecting me. He was a great physician. He shared that the prosecutor had made the hour trip to his office to threaten him into making clear my son’s death resulted from murder. He said because they were so determined to charge me, he had my son’s brain flown to Florida, to be given a second opinion by another pathologist. He too found evidence of multiple brain injuries – one months prior to his birth and one weeks prior. The second was the most ominous and left his brain completely foam. He said, “When they charge you. Please call me. I will defend you, and so will the pathologist in Florida.”
We had no reason to share these findings publicly. People had already made up their mind about me. They never sought truth. They wanted to find me guilty of neglect, of recklessness. Midwives especially, because if this were my fault, then it meant that they could remove themselves from the possibility of ever having to face a similar situation. Death is a reality we can’t except for babies. No one wants to recognize that some breech babies are breech because they haven’t the neurological development to turn cephalic. They were already compromised. His five foot cord is thought to be the cause.
The National Advocates for Pregnant Woman came to my defense and ended the pursuit against me, but not after weeks of interrogation by my attorney who continued the abuse already initiated by the hospital. He did his job and I am grateful. However, he clearly thought I was an idiot. While defending me in what the prosecutor thought was an unassisted birth and gave him grounds for reckless homicide and medical neglect, I shared that I did in fact have a team of direct entry midwives. They were my friends and so in effort to protect them, I didn’t share they were medically trained. He wanted records from the midwives who had cared for me through my pregnancy, and the physician we were consulting with when planning a vaginal birth at home. Then he asked how much I paid them, and I shared, $1,200. He said, “Well, I think you got your money’s worth.” I was stunned into silence.
Sadly, I had to remain silent on all details of my birth because under the eye of the prosecutor, if I shared I had hired direct entry midwives, while it might protect me from reckless homicide and medical neglect, it would open me up for charges of conspiracy to commit a crime for hiring someone to commit a felony. My birth story was incriminating no matter what I said and in my silence, I witnessed the character of everyone around me unfold. If you don’t give people a story, they will make one up.
It seems much of my first year I was in a fog. I couldn’t care for myself, or the kids. My husband and oldest daughter carried the burden. I was so fearful. So very betrayed. I was terrified to live in a country that could violate someone so horrendously and have no recourse. So many others reached out to me with similar scenarios. Women abandoned by their midwives and they too lost their babies. Some had been violated and manipulated by the hospital, their children removed from their home simply for not following protocol. I lost hope. I scoured legal briefs about birth, breastfeeding and parenting. I further researched vaginal breech birth, vaginal birth after cesarean and poor birth outcomes.
Donating my milk was a comfort for me and after ten months of pumping and sharing, I now have a number of babies and adults who benefitted from the milk my son was never allowed. I found refuge at Witham Hospital as a staff nurse. The nurses and physicians there listened to me, and not simply out of curiosity, but with sincere compassion. They healed me and supported me through my next pregnancy and birth, a beautiful, all natural water birth. Frontier Nursing University held my hand through the remainder of my studies and supported me as I defended my innocence legally. As a private school, they easily could have rid themselves of the controversy and dismissed me. They recognized that I was making the best decision for my family with the options and resources I had at the time. They welcomed me back for my doctorate and I will forever be grateful.
Which brings me to the second reason I am an outcast in the homebirth community, I work darn hard to set high standards. This is a calling for me. I have been victim to poor midwifery care. I know the price one pays. When I worked to open my practice, there were no other legally practicing nurse-midwives in Central Indiana. Another opened at the same time as myself, but we laid new ground. She had refuge among the direct entry group and I worked against the persecution. New couples would interview each of us and most all shared they had met with the other midwives, and had been warned about me. I watched social media outlets speak about my being reckless and having lost my own son’s life. It was said that I had no experience, and while I was a new midwife, I had attended more than 2,000 births within the hospital, birth center and home. I was a very good nurse and established a very well respected midwifery practice in a short amount of time and with little to no support. After two years, I was awarded by the Indiana State Board of Nursing for my work.
I was isolated. I was set apart. I knew this was God’s will. I wanted to create something different. I wanted to offer excellent care that wasn’t found in the hospital, and based on the number of homebirth families being abandoned, it wasn’t happening at home either. It is easy to stand by women when births go well, but they don’t pay thousands of dollars to you to celebrate with them after they did all the work. They hire you for the hard births. That is where we must excel as midwives.
I think a combination of urban legend and self-protecting midwives surrounding my son’s birth and death, and then later sheer intimidation at my growing practice in spite of complete lack of support from the home birth committee continued to solidify my being the outsider. As the years past, the Lord validated my trial as necessary. If my son’s life was going to be short no matter his birth setting and if I had a heart for homebirth, I needed to learn the weaknesses so that I could improve them. I also needed to discover my allies.
There were times that I was asked to support the direct entry bill in Indiana. I was conflicted. I had many direct entry midwife friends outside the state who taught me a great deal and who I respect. I was concerned about their professional group, and was concerned about their grievance policy. At the time, if I wanted to file a complaint, I would have to share my concern within a group of local midwives (of which my midwife was the leader and would be present) and then I would be asked to leave while she defended herself. Her group of peers (and friends) would then determine her discipline. Even if she was found purposely negligent and this was the direct cause of his death, which I couldn’t argue, the most strict punishment was loss of certification for a single year. Why endure the pain of sharing? I was confident that the Lord would do His will, in His time, in His perfect way. I had a calling that now demanded all my time. I stayed focused on my path.
I also taught within a direct entry midwife program to help support our family as my practice grew, and although MEAC certified, this program did not meet high school standards in my opinion. References were not required for written work, even at the graduate level. Plagiarism to the point of coping and pasting directly from published literature was not disciplined anymore than requesting the student to talk with someone in the writing lab. Courses were taught based on midwifery tradition and the cycle of the moon, rather than evidence-based midwifery data. Again, I felt women deserved better. It was and continues to be my opinion that midwives can work to the best of both science and art while still honoring the midwifery-model-of-care. We can extrapolate all that is good and share this with families so they can determine their own course of action. The point is offering respectful and compassionate care.
It seems ironic to me that I have a reputation of despising direct entry midwives when I have always practiced legally and could easily have reported each of those who have practiced outside the law. I don’t report. I don’t speak ill. However, two years ago, I did testify against the direct entry bill. Why? Because when I testified in front of the House, the bill only required a high school diploma. Midwives do not simply catch babies, and they do not simply handle birth emergencies. They are primary care providers that must have the clinical expertise to determine a woman an appropriate candidate for homebirth. How can this be done without the skill set of providing a physical exam? My primary objective in testifying was to make our legislative leaders aware there already was a legal option, and it would be wonderful if they could get behind nurse-midwives!
There was argument that legalizing direct entry midwifery would allow for regulation. There were adversaries to midwifery in support because they felt it would give them the ability to prosecute and at the time there was no such avenue. I testified that this belief was false. In fact, practicing midwifery without a license was a felony. Practicing medicine without a license was a felony and we had case law for both of those. However, the attorney general’s office and most of our county prosecutors simply aren’t aware of this. In fact, the attorney general had been unaware of nurse-midwifery until a client of mine reported me for what she called abandonment. We provided our version of the events and the attorney general’s office not only ruled in our favor, but asked if I could be a liaison for nurse-midwifery in Indiana. We did not abandon. We referred the client to another provider when our continued care would have been inappropriate. This is our responsibility.
This I shared during my testimony, as well as the fact that two direct entry midwives were under investigation because it was evidence that if a direct entry midwife was reckless, she would be investigated and held accountable under the current law. One of those cases I had been consulted on, and that midwife was convicted after the deaths of two babies in this state. The other case fizzled out. I am not loyal to midwifery or homebirth to a fault. I am loyal to safe care. I have offered such expertise in a number of legal cases, and am currently working on three cases out of state – none of which I am even aware if I am working for the defense or the prosecution. My testimony remains the same either way, because it is driven by evidence.
My good midwifery friend, Kate Shantz, once told me that I had a boundary disorder, meaning I don’t draw them well. When I first opened my practice, I just wanted to serve families in whatever way they desired. This too often meant I was taken advantage of and when I started to draw boundaries, clients were upset. Why would I demand to be paid, when I had offered free care for so long? I also learned that those who don’t pay, don’t value my service but if I give it out free, they will continue to accept it and criticize me along the way. No matter how I try to please, I will always fall short. I have given more free care away at this point, than what I have been paid. This is a challenging boundary to draw but will ultimately allow us to better serve our clients.
Many feel that hiring a midwife means they are hiring a best friend. While we are available to you 24/7, this doesn’t mean you can demand attention continually and for all things that your best friend would not even tolerate. I learned to under promise and over deliver, but in doing so, I disappointed clients who had created inappropriate expectations. I’ve had many staff believe too, that when joining the practice, they now have a midwife at their finger tips to answer any and all questions and while I would sincerely like to meet these needs, it is hard to sleep when you are not allowed to silence your phone or ignore a single text because anyone could be a momma in labor. Staff have struggled to draw boundaries and become bitter when I have to do that for them.
Most always we realize we aren’t a good fit, whether staff or client, within the first few visits. It surprises me the level of anger that can boil up from just a few encounters. Women are emotional while pregnant, and sometimes we are the victim of the emotional roller coaster, especially postpartum. I will forever adore the women who are humble enough to admit they were victim to these negative emotions and were overly critical or hostile, and return to us with complete forgiveness. When negative commentary hits Facebook, I rarely comment. I observe. I don’t send out my troops to defend which is common within the midwifery community. In fact, my long-term clients aren’t the type to engage in such scenarios. They appreciate intelligence, professionalism, and high moral character. They would excuse themselves from negative commentary. Other times, it is a client who felt wronged, and I know exactly who they are and the facts of the story. I also know the Better Business Bureau has told them their complaint was invalid and so has the Attorney General, because you can bet if they are speaking openly on Facebook they are angry and have already taken measures to report me to everyone who will listen. These clients also know I can’t defend myself so they can add to their story and get compassion from the crowd in effort to validate their story. Thanks again to those who know my character well enough to know these attacks don’t hold merit.
If you’ve read this far, you’re likely concerned that we have a plethora of angry clients and staff. It feels that way sometimes. As most can relate, one upset client can feel like a legion of angry warriors and as a woman who is earnestly trying to meet and satisfy every single client in our practice, each less than absolutely thrilled client is one I take very personal. The reality of being a midwife and a business woman is that although we are only of very few practices in the country that offers three highly trained personnel at each birth, and can offer genuine primary healthcare with very low transfer rates, clients don’t often recognize the level of expertise and clinical skill they have in hiring our practice. We have excellent relationships with collaborating practitioners. We have made a very good name for ourselves within the community. We serve with a great deal of commitment, but we do draw boundaries.
We quite possibly make it all look so easy, that it is easier to complain. My heart spills for you here. This job is hard. Being a midwife is very hard. It is self-sacrificing. It requires the sacrificing of our family. It was commented this afternoon by a previous client that we turn over staff quickly, that working for me must be an exceptional challenge. Yes, it is. I demand a high standard of care. I take the responsibility of caring for your wife and baby very seriously. I expect my staff to train, to answer when I call, to show up and perform well, and to dedicate themselves to being a professional. If their skills aren’t competent, if they can’t make the commitment, if they don’t understand their role then I don’t keep them employed. This does cause for some bitter departures. It is what you expect from me when you hire me as your midwife. While I have upset many more than I would ever desire, we always, always, always draw the line at safe care. We are very, very good at what we do. That may intimidate. That may frustrate. You may vent on Facebook, but I am here to tell you, I draw these boundaries because I have seventeen years experience. I know my role well. I know the cost if we don’t do it well. I am on a mission and I am accountable. This is my son’s legacy.