We haven’t done a Midwife Highlight in a while, but after being moved to tears by this beautiful story, I can say I’m truly honored to have the opportunity to share the tiny but mighty Pam Crowl with you.
Pam was one of the first midwives I encountered after I moved to Colorado. We met at a workshop and she took me immediately beneath her wing—introducing me around, encouraging me through the process of getting registered, and making me feel at home.
She embarked upon her own journey, as our title indicates, fully thirty-seven years ago, well before direct-entry midwives were able to practice legally and, through her four decades of dedication to moms and babies, she’s seen just about everything there is to see.
And now, meet my friend, Pam!
When the snow plow passed in the pre-dawn of a January morning, the tall, leaded-glass windows of the Victorian house glowed. A variety of color highlighted the edges through stained-glass. Inside, a creamy wall was punctuated by a marble fireplace. Welcoming flickers of light filled a semi-circle of people. The panting woman in the center looked into the flames and the others focused on her. A small kerchiefed woman was kneeling in the center, back to the fire, her right hand gloved in latex and conducting the symphony in front of her. She accompanied the hand action with a low “whoo-whoo” tone, soon matched by the voice coming over a watermelon of flesh. The belly led up to a voluminous white cotton T-shirt holding back breasts bobbling to her sides. Two more kerchiefed ladies slowly moved, inches at a time, one to write something on a clipboard, the other to lean on the pregnant abdomen with a fetoscope (a DeLee-Hillis which attached to the head and made the wearer resemble a unicorn), as she contemplated the second hand of a large watch, her second finger and thumb mimicked the rhythm of the baby’s heartbeat. A man sat to the birthing woman’s right, whispering into her ear, one large hand slowly rubbing the curve of her belly, enjoying the last moments of anticipation, of not knowing the little person who pushed back. Several canvas bags littered the room, with an ordered space behind the youngest woman at the end of the horseshoe. Ensconced on blue plastic-backed pads, all in their predetermined position, lay the equipment belonging to the three women who were not in labor, the tools of their trade, things that made their occupation obvious. The three minds joined with one thought—how do they safely guide this woman and baby through birth?
The little woman directing the breathing song slathered oil on taut perineal skin. A wet hairy walnut shape emerged over its shiny surface and smoothed into a baby’s head facing mom’s right thigh. Spurting fluid and a quick shoulder dip signaled the moment of release, the moment a baby is considered born, the time on the clock when the whole child is outside of its mother’s body. Deftly slid into a U-turn that ended on his mother’s now deflated middle, he blinked into the eyes of those who made him, those whom he would trust for love and survival—the parents who’d just found out that he was a he. A warm blanket quickly enveloped the new family. A minute turned into a lifetime as the baby took a couple of sputtery breaths and let out a trial wail, provoking laughter and smiles around the room. Silently slipping around the blanket, the second midwife assessed the baby, relaying information to the furiously scribbling third midwife, who was also handing clean gloves to the baby-catcher calmly waiting between freshly bloodied thighs. Snaking out of the mother’s briefly numb vagina and still joining the baby to her insides, a rubbery cord pulsed between mother and child. The second midwife pulled clamps and scissors out of her pocket and prepared to cut it “long”, about eight inches from the baby, in order to keep the raw end out of water. A small warm tub was waiting in front of the fireplace and quickly placed next to the newly birthed mother. She slid her baby into it feet first, cradling his face in her hands. The promise of Leboyer, a radical French obstetrician, was that the child would “unfold” and be welcomed without violence, rather than the standard opinion that the babies’ experience was irrelevant. It was a calm, peaceful moment, but only a moment. It appeared he was reaching toward his mother and that ended the excursion into perinatal psychology when she scooped him back up into the arms and onto the breasts which would become the center of his world. All she wanted to do was bury her nose in the sweet smell of his head. With her movements, a cooperative placenta was deftly caught in a bowl, followed by a small plop of clot. All done, all OK—for the parents. Now the midwives would monitor mom and baby, help them all tidy up, get the baby breastfeeding, pack their equipment, clean the birth area, do a newborn exam, and a thousand chores that are done by at least twice as many people in the hospital. They would stay until everyone was definitively stable and comfortable with their life change. Later, as cars were packed, the midwives briefly shared a sigh of relief and joy about the last few hours, making quick arrangements to meet soon. In the sharp crack of a bitter winter wind, they set out to try and make it safely back to their own snow-covered homes.
It was 1981 in Colorado Springs and I had just experienced my first birth as an apprentice midwife. Nothing had prepared me, not films, books, classes, slideshows, coaching hospital births, nor two of my own births, for the perfection of the birth I had just witnessed. It was the kind midwives file in the memory category of “I was blessed to be at this birth.” It was a birth that keeps midwives going through the tough ones.
The couple who had a baby on that January day hired illegal “lay” midwives to do their prenatal, birth and postpartum care. Now I was a criminal, too. It was not illegal to have a baby at home, but illegal for anyone other than a certified-nurse midwife or doctor to help at the birth. It was an informed decision on my part to break the law. How did I get there?
My oldest son was born in 1974 after a supposed “natural childbirth.” I had taken childbirth classes. My first husband snickered with the other men and then pretended to be attentive, having been “forced” to go by their women. I figured we got into this together, we could darn straight go through it together. When the fateful day arrived, I breathed, I panted, I puffed my way through 8 centimeters before capitulating to the constantly appearing labor nurse who just wanted to give me something because I didn’t “have” to do the whole labor without medication. I think I said yes to get rid of her. My husband disappeared into the background of whirling lights, doorways, masked people, push, strap legs, push, strap arms, push, I can’t see, push, flashing scissors, push, baby feet in the air, yes, they have to do that, bloodcurdling scream that everyone is smiling about, I can’t move my arms or legs, why can’t I hold my baby? Go to sleep, lady, you just had a baby.
Strange feelings of inadequacy followed Sean’s birth. I went back to childbirth classes and became an instructor for the Association for Prepared Parenthood, Inc., bound and determined that I would learn those breathing patterns better than anyone. I wasn’t going to have another drugged birth. Copies of Immaculate Deception by Suzanne Arms and Spiritual Midwifery by Ina May Gaskin began percolating through the teachers. I discovered the Demerol, the episiotomy, and my son being taken away for six long, agonizing hours after birth probably contributed to my mental issues as a new mother. Gaskin had basically written a manual for direct-entry midwives with accompanying birth stories. Every so often at childbirth classes, one of “those couples” would be discovered–the ones who were going to have their baby at home. I was given a policy on how to react to anyone who brought up planned homebirth—tell them you don’t have any information on that subject, midwives are illegal, and please don’t consider having a baby at home without anyone. Being the inquiring mind that I was, I had to find out about the thing I didn’t officially have any information on. I decided to find and interview local midwives for a newsletter article. Who were these people and why were they illegal? What services did they provide? How could they consider attending births at home? I became friends with one of our students, who turned out to be a midwife who wouldn’t call herself a midwife. I felt a need to find midwives.
In the late seventies, a couple of certified-nurse midwives lived here, but didn’t even get to attend births at the hospitals. They were used for prenatal care in doctor’s offices. Two osteopaths shocked their contemporaries by being “old-fashioned” and went to a dozen or so homebirths, but the medical community made sure their hospital privileges were on the line if they continued to transgress. These doctors had even (horror of all horrors) “allowed” a couple of women who were attending homebirths to assist them. These midwives promptly shared the knowledge they had gained and quickly picked up apprentices. If they got caught doing births without the doctors—being midwives—then they were charged with the practice of medicine, their equipment and files confiscated, and they were given an injunction or cease and desist order. As long as no one died.
Death of a mother or infant could bring manslaughter or murder charges. When the doctors were coerced out of homebirth practice, a woman who decided to birth at home in Colorado Springs, or the entire southeastern part of Colorado, had no legal options for an attendant. Prenatal care was refused if a woman dared to be honest with her provider. A local pediatrician lobbied the legislature frequently to have planned homebirth declared child abuse. It was a hostile environment.
My journey to research that article led me to every “lay” midwife in southern Colorado and many of their clients. I discovered the weirdness of women being persecuted for helping women. That didn’t stop alternative-minded women from seeking anyone who could possibly offer insights and education in the nuances of homebirth, begging them to come to their own births. There were as many reasons to stay home during labor as there was diversity in faith and philosophy. I found people who treated pregnancy, labor, and birth as a normal function which only needed intervention on rare occasions. I became enamored with the joy exuding from a new mother’s descriptions of birth. I was enamored with midwives. I decided to become one. No one was taking an apprentice, so I went to nursing school, planning to become a nurse-midwife—I figured I’d get the education, skip getting licensed, then do homebirths.
In 1980, my second pregnancy brought the whole issue front and center. I was going to have this baby at home and no one could convince me otherwise. I needed a midwife. Some of the women I had interviewed before were no longer doing births. My doctor dismissed me from his practice for inquiring about homebirth. I found a prenatal clinic thirty-five miles away where the doctor came in once a week from even farther south. She was teaching and assisting midwives in a commune I had visited while doing my article research. Living too far away for her to commit to my birth, she supported me with the technical aspect of prenatal care and eventually connected me with an Informed Homebirth childbirth educator in Colorado Springs. My new husband and I enrolled immediately. It took a couple of weeks to convince our teacher that I was honest in seeking an interview with a homebirth midwife for care, not to send to jail. Midwives interviewed potential clients without letting you know who you they were, interrogation that started out with, “Are you associated with any type of law enforcement?” A pregnant police officer had been posing lately as a possible client and asked incriminating questions when she managed to find an unsuspecting midwife. Finally, we passed two interviews and I got to have firsthand midwifery care. Whew!
Prenatal visits that create a feeling of being listened to and understood—what a concept! The comparison to my first pregnancy with a doctor and delivery in a hospital revealed a massive gap, one filled by my midwife with answered questions and friendliness. I was immersed in a world I never knew existed, a world of caring about who I was, not just what happened in my uterus. Midwifery was about families and rites of passage. For me, it meshed completely with the philosophies of self-care and education about the female body that evolved with my generation during the late sixties and early seventies. The birth of my second son was a family experience without masked strangers. It was a satisfying, empowering event that left no doubt in my mind home was the ideal place for healthy mothers to have healthy babies. I felt low-risk women have the right to choose midwifery care. I wanted more than ever to become a midwife and pay forward what my midwife gave to me.
Three months after this birth, I dropped out of nursing school and joyfully accepted an offer to apprentice with my midwife and her partner. Three of us were selected, all previous clients, to take a six-month series of classes that these two midwives designed. Prerequisites were the first two years of nursing school. It was their experiment in designing some sort of consistency to a direct-entry midwives’ education. What I started then was harder than any college courses I have taken before or since.
The legal ramification to midwifery was addressed in my decision to become a midwife—the subject of intense discussion with my husband, children, bosses, and friends. Would they support me? Would they protect me? Would they turn me in? What would they do if the police showed up at the door with a search warrant? My midwife taught me what to do if an ambulance was called to a birth, what needed to be thrown under a blanket, slid in a closet, or held tightly in a deep pocket because some pieces of equipment could evoke heavier legal repercussions than others.
Anyone who ends up at a birth will probably experience a good one, especially if they don’t do a thing. The odds are always with the attendant that a birth will go well. The process works. When things went awry with homebirth in 1981, medical personnel immediately blamed the midwife. With my first apprentice birth, no one got arrested and no one went to jail, which was a distinct possibility had there been a problem and a transport. Transport was managed differently by each midwife—some just dropped their clients off at the ER door, some called an ambulance and left, some accompanied the woman as her “labor coach,” “sister,” or “friend of the family” who just “happened” to have the chart. The major issue with transport for a planned homebirth was that now it was called a “failed homebirth” and the woman was badgered by medical personnel about who her midwife was, rather than asked information about the reason that she was at the hospital. Angry doctors called the police. Every midwife dreaded a transport, but no one was willing to risk a woman or baby’s life by keeping an unsafe situation at home. My midwife and her partner were adamant that any transported client be accompanied by her midwife and her chart, regardless of what persona the midwife might assume at the hospital. They imparted their own ethics and morals regarding a profession entirely unregulated and underground—if it meant the death of your midwifery career, you protect the client.
Six years later, sticking to those ethics did end the homebirth careers of both of the midwives who initiated me—because of their refusal to desert a family in trouble, because they would not discontinue care on a newborn when physicians were more interested in who they were than the baby needing care in front of them. After a lot of money, court situations, and lawyers, one left the state to become a certified-nurse midwife and one would become a nutritionist and homeopath. But before that happened, these two ladies would attend several hundred women in Colorado Springs who hunted them down and begged them to come to their births. I am blessed to have experienced their loving care. They are the reason I am a midwife.
Pamela Crowl, RM, CPM, BSM, is a homebirth midwife practicing in the Colorado Springs, CO, area. She was active in the movement to legalize direct-entry midwifery and in 1994 was the 20th midwife to be registered in Colorado. You may contact her at firstname.lastname@example.org, or read more at http://coloradomidwife.com/, https://www.facebook.com/acoloradomidwifeLLC/
Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author
Books by Kim: