I spent a bit of time talking with a friend recently about the tragic loss of a baby in her family. The baby was birthed in the hospital as planned, and there she died, drawing along a cascade of tragedies in her wake.

I want to share the thoughts I shared with her as I feel they’re pertinent to the practices of birthworkers.

And I want to share the thoughts I shared with her as I feel they’re pertinent far beyond the practices of birthworkers.

If we scrape away the details, I believe we’ll find they’re perfectly pertinent to the living of these, our lives.

My friend had a lot of questions. Naturally, as I wasn’t there, I could only guess at the answers but, as far as I could ascertain, the woman and child were handled appropriately.

My friend wanted to know if a very subtle change in the baby’s heart rate through the last weeks of pregnancy might have been a signal of the looming disaster.

I said, “Well, I’ve seen a lot of babies shift to lower heart rates through the last few weeks/couple months of pregnancy and, as long as those numbers remain consistently in the 120-160 range, it very rarely proves of concern. In fact, I can’t actually think of a time in my own practice such an occurrence has proven of concern.

That said, however, it may very well have been a harbinger in your case…”

Then I wrote—and this is the heart of what I really want to share today—

“Here’s the thing, though: if we step back from a single case (as absolutely priceless as the people comprising any single case are) and view pregnancy and birth across the board, MOST of the time (even fully 85%) both proceed without issue. That means we must measure the families we serve from the assumption all is well, then work backward to unwell from there when irregularities or departures from normal arise. Yes! We must listen. Yes! We must watch. Yes! We must take careful note of what we hear and see but, because most families surely will carry and birth their babies without experiencing problems, we also must resist the temptation to, per fear of the myriad potential complications possible, treat the families we serve as though they’re very likely to actually present with any of those complications.

Our nation’s thirty percent cesarean rate is a perfect example of how mainstream American medicine, per just such fear, has failed to acknowledge and honor the fact most women and babies are able to move through birth without incident when properly supported. This fear-based point of reference drives those within that system to treat the bulk of those they serve as potential problems and the result, ironically, is a dramatic increase in problems—even the very thing originally feared.

As a homebirth midwife, I strive to listen and watch and take careful note. Thankfully, most of the problems that arise among the families I tend are noticeable from a distance, and I’m able to secure the additional care required to see everyone safely through. It’s always nerve-wracking when a family I serve surprises me with an unlooked-for challenge, though again thankfully, even then I’m generally able to facilitate safe passage. But it’s purely devastating—and I do truly know this—when I’m surprised with a challenge that arises too suddenly and moves too quickly for me to salvage.

When I first began the pursuit of my calling, I read a book with something along these lines printed on its pages: “There’s an irreducible risk to childbearing.” I can’t remember now if it was Robert Bradley or David Stewart or even someone else who wrote them, but I do remember the very sobering chord they struck in my young soul, and I had to decide then and there whether I could serve as a midwife with the reality of them forever rippling through recesses of my psyche.”

I finished then with this. “The day those ripples overtake me, and I begin treating my clients as potential problems versus probable victories will be the day I’ll need to bring my calling to close.”

In the days following our talk, I found I was myself in need of this reminder—this admonition to watch the tints and hues coloring my approach to my practice, as well as my approach to my life.

Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author

Books by Kim:

Homebirth: Safe & Sacred

A Midwife in Amish Country: Celebrating God’s Gift of Life

Nourish + Thrive: Happy, Healthy Childbearing

One Little Life at a Time: Recommendations + Record Keeping for Aspiring Homebirth Midwives

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