Mary Lou Singleton: ‘We need to go back to rallying for abortion on demand without apology’

“We can’t do this as individuals — we have to do this as sisters.”

Mary Lou Singleton

Women’s bodies have always been the focal point of patriarchy. Indeed, females are oppressed due to their reproductive capacity and men’s desire to control our “means of (re)production” (and “their” offspring). Liberal and conservative men alike have worked to ensure women don’t have bodily autonomy. As a result of patriarchy, women’s knowledge of and control over our own bodies has been wrested from us. We are forced to depend on male legislators, a male-dominated medical establishment, and Big Pharma. Women’s traditional knowledge and practices — like self-abortion, menstrual extraction, other alternative forms of birth control, and woman-centered birth practices — are no longer common knowledge. While feminism has fought for women’s reproductive rights — for access to things like abortion and the pill — Mary Lou Singleton says we need to look beyond rights, and towards sovereignty.

Mary Lou is a midwife, nurse practitioner, reproductive sovereignty activist, and founder of Personhood for Women. I had the pleasure of watching her present at this year’s WoLF Fest, and spoke with her over the phone last week, from her home in New Mexico.

This interview originally aired on the Feminist Current podcast.

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MEGHAN MURPHY: I was so impressed and inspired by your presentation at WoLF Fest and have lots of questions. But first, can you tell me a bit about the work that you do and how you came to that work?

MARY LOU SINGLETON: I am currently a family nurse practitioner and I do primary healthcare for whole families: pregnant women, infants, young adults, and elders. I recently transitioned into that after 20 years practicing as a home birth midwife. I wanted to provide full-spectrum family healthcare, and that’s what I do now. I have an integrated health clinic. I’m also an herbalist and have an herb pharmacy here. I help people with all aspects of their health in a primary care setting.

MM: And how did you get involved in midwifery?

MLS: My whole life, from the time I can remember, I wanted to help women have babies. I clearly remember being told, “That’s a man’s job.” People who were more supportive told me that meant I wanted to be an obstetrician. I was really good at school and was tracked for med school literally from first grade. All my high school and college decisions were made based on this idea that I was going to med school.

Then, in college, I took an anthropology class called “Sex and Culture.” For the first time, I learned about midwifery in a contemporary context. It was a classic light bulb experience: This is what I’ve always wanted to do; I just didn’t know it existed. So I immediately shifted gears and started putting all my energy into becoming a midwife. I trained with several midwives around the country and then eventually ended up in New Mexico. I studied here, became a licensed midwife, and practiced for 20 years doing home births.

MM: The conversation around reproductive rights today is almost completely dominated by 1) Access to abortion, and 2) Access to the pill or other forms of hormonal birth control. What is your perspective on that conversation? Is there anything that’s missing?

MLS: Yes, there’s a lot missing! I think it’s true for most Western countries, but certainly in the United States, it’s framed as a left/right, liberal/conservative dichotomy. The liberal people are fighting for, like you said, access to birth control and abortion. Conservative people are fighting to end abortion rights — many of them are fighting to criminalize birth control. As I have grown and matured in the fight for women’s reproductive sovereignty, I stepped back and realized that this is liberal patriarchy and conservative patriarchy jostling about how they want to control women.

I do think that the liberal perspective of birth control and abortion is informed by male ruling class forces that want women to be sexually accessible without consequences to men, and also want to control the population. They tend to push for more birth control for all women, especially poor women and women of colour in the non-Western world, and limited abortion freedom. They never push for abortion on demand and without apology.

Meanwhile, the conservative ruling class wants a huge desperate population that will work for them for slave wages. They don’t want anyone to have birth control or abortion because they want more people — desperate people are easier to control. They also have this religious perspective of the traditional patriarchal family where women are owned by one man in the marriage contract and produce heirs for them.

MM: You used the term “reproductive sovereignty,” not reproductive rights or reproductive justice. What does reproductive sovereignty mean?

MLS: To me, reproductive sovereignty is women understanding that we’re completely sovereign over our bodies. It means women’s health in women’s hands. And it means all decisions about reproduction are made by the woman herself, in a full context, where she is free of patriarchal forces who are coercing decisions and choices.

So, to get full reproductive sovereignty, we have to dismantle patriarchy. I believe that in order to dismantle patriarchy we have to dismantle capitalism, where women are the means of production of new people. And if we’ve done that, then we can come to this goal of women having true freedom over their own reproduction.

It also means moving past this authoritarian model where women believe our bodies are scary and dangerous, and that we need authority figures to save us from our bodies. In true reproductive sovereignty, women trust their bodies. Certain things might happen where we need access to experts who can help us, but for the vast majority of our reproductive functions, we and our friends can take care of it.

MM: A huge problem with the reproductive rights movement is that we’re allowing our rights as women and our reproductive health — our bodies — to be controlled by the medical establishment and the pharmaceutical industry. How did this happen? What did women do before these industries took over in terms of our reproductive capacities, our pregnancies, and our reproductive health?

MLS: There’s this great book that people should read — especially if they’re interested in how this happened in the United States — called, When Abortion was a Crime by Leslie Reagan. The book details the rise of the consolidated medical industry and the destruction of women’s reproductive sovereignty. When physicians who are now medical doctors took over all of medicine, they criminalized all other kinds of providers of healthcare — they criminalized herbalists, chiropractors (for a while), and even eclectic physicians who didn’t believe in the current model and practiced differently.

The medical industry was moving away from plant-based medicine, towards industrially produced chemicals as medicine. One of their biggest threats to doing this was midwifery. Midwives were in every community. They didn’t just help women have babies — they were the ones women went to when fevers were too high for the mom’s comfort level, when bones were broken, when someone had skin problems or abscesses. These midwives also helped women with their dying processes and their death rituals. So midwives were really integrated into their communities. Women — and even men — trusted midwives.

This was a time before antibiotics and blood transfusions. This was a time when people were just learning to wash their hands before doing surgery. People knew you were much more likely to die in that industrial hospital system than if you stayed out of it, especially for childbirth. So the problem was: how to get rid of the midwives? Well, at this time, there was no industrial birth control. Birth control was abortion. In her book, Reagan documents women’s diaries and newspapers from cities that advertised menstrual regulation services. There were many women who had multiple abortions. Pregnancy wasn’t considered real until you could feel the fetus move. It was considered regulation of the menses to end an early pregnancy, and midwives were the primary providers of that.

So the way the medical industry got rid of midwives was by criminalizing abortion. That was very effective, because abortion has always been a shameful private thing. Women would go on the streets and defend midwives: “I’ve had eight births with her. She’s great! Everything was safe.” But people kept quiet about abortions and let the midwives be taken away and criminalized for providing abortion services. The criminalization of abortions was about the destruction of autonomous midwifery and women’s reproductive sovereignty.

MM: Obviously, I want all women to have easy and free access to abortions at all medical clinics whenever they’d like. But what we’re not talking about is the fact that self-abortion is not as difficult or dangerous as it’s made out to be. What are the ways that women self-abort? How can women learn how to conduct abortions on themselves or other women?

MLS: Luckily, our foremothers had been through this fight before. They saw the changes as we went from having some abortion freedom to losing it. There are a lot of great resources and literature out there for women to find these skills. One of my favourites is called A Woman’s Book of Choices by Carol Downer and Rebecca Chalker. They are women who have had illegal self-induced abortions and they interview women in this book. They detail cervical massage (which is an interesting form of abortion I didn’t know about until I read about it in the book), which is a form of self-abortion that works best for women who have already had a child. The cervix is more open and the woman can put her hands inside her vagina to reach up, feel her cervix and find the opening of her cervix. Then she keeps dilating it — messing with it until it’s more and more open. That will almost always induce a miscarriage. There is a large body of stories from women who used this as their self-induced abortion method before Roe v. Wade. It was a pretty common method.

They also detail menstrual extraction, which is a method I find really exciting and interesting. That came out of a group Carol Downer was part of in LA, whose whole mission was, “Women’s health in women’s hands.” Menstrual extraction is a method where a group of women together extract the contents of the uterus with gentle suction. A Woman’s Book of Choices has instructions on how to do that, including equipment, safety, and how to make sure you’re doing it right.

Another method women have been using but is less in our hands, because of the pharmaceutical industry, is a drug called Misoprostol or Cytotec, which was originally designed to prevent stomach ulcers. It’s a strong prostaglandin and causes uterine contractions and expulsion of what is in the uterus. Many women are buying this drug online and using it to self-abort. There’s an organization called Women on Waves that has information for women in countries where abortion is not accessible. They detail how to do a safe Misoprostol abortion, including how to access that medication. That’s a little less exciting for me because we are still dependent on the pharmaceutical industry, which is something women certainly do not control.

That leads us to the issue of RU-486 or Mifeprex, which is an incredibly safe progesterone blocker that reliably induces abortion, especially if it’s used with Misoprostol. But there’s a total lockdown on that medication — it’s very odious. It’s the only medication I know of in the United States that has just one distributor. Providers like myself who have prescriptive privileges have to apply to get it from this distributor, and prove that we can legally do abortions in our state. Then we get one dose at a time, or, if you’re a bigger clinic, they can determine if you are allowed to have more. But it’s not like penicillin — it’s not like I can order as much as I need. Also, every dose has to be accounted for with demographic information on the woman you gave it to and what the outcome was. So they’re collecting information on women through it too. That is incredibly infuriating to me. It’s such a safe medication that I think it should be sold over the counter. I’m disgusted that there’s such a lockdown on this medication.

MM: As I mentioned earlier, there’s a big focus on women’s right to the birth control pill and how important it is to women’s liberation. What do you think about the pill and what’s your perspective on popular birth control methods in general?

MLS: I want to premise by saying I don’t want any birth control methods to be illegal and I don’t want to do anything that feeds into right-wing and conservative efforts to remove those options from women. But I personally don’t think the birth control pill is very good for women, nor do I think that long-term reversible contraceptives like the IUD and the implants are good for women. These medications have serious side effects and risks. Hormonal birth control affects every cell in a woman’s body. Any woman who’s taken the pill can attest to how it affects our moods. While using these methods, more women experience these side effects than don’t. There is a complete suppression of libido, and that should be really scary to women. There is a Stepford aspect to chemically neutering us — taking away our libido and making us sexually accessible to penis-in-vagina ejaculatory intercourse. I’d love to see a more widespread critique of hormonal birth control on the part of the radical feminist movement.

There are studies from the 70s and 80s that say the safest method of birth control for women is using barrier methods, natural family planning and withdrawal, with early abortion as backup. But we’re brainwashed into thinking that abortion is terrible and has to be avoided at all costs, and that you have to sterilize yourself (at least temporarily), so women can’t think straight about it.

MM: And what about the IUD? A lot of women have decided that the pill isn’t right for them because it has an impact on their moods, bodies, or libidos, or because they just don’t feel comfortable taking hormonal birth control, so they’ve opted for the copper IUD instead. Do you think that’s a good alternative?

MLS: Again, I don’t want the option to be taken away from women, but the copper IUD is uncomfortable for most women. The IUD insertion process is a very uncomfortable, usually painful experience. It’s interesting to me, having observed a few vasectomies and having inserted hundreds of IUDs, how a vasectomy is a quicker, less uncomfortable procedure than an IUD. There’s this normalization of the idea that being female means you have to go through painful things.

When you have the copper IUD, even if you’re not being affected by hormones every second of every day, there’s a constant inflammation in the uterus due to having a foreign object in there. And I worry about what that does to women’s immune systems. I know women anecdotally who developed autoimmune and pain issues very soon or within a few years of getting an IUD. For some of them, their symptoms significantly improved after taking the IUD out. So there’s that aspect of putting a foreign body inside a woman, as compared to vasectomy, where it’s a quick incision and snip. The man doesn’t have to live with that. I understand that a vasectomy is permanent while an IUD is temporary, but it’s such a contrast what women are expected to put up with versus what men refuse to put up with. The copper IUD causes heavy, painful, crampy periods that can lead to anemia, loss of work, loss of income, debilitation, and depression from having a 10 day long period. It’s not a benign thing to do with a woman.

MM: I’ve seen women who critique hormonal birth control and advocate for alternatives such as the rhythm method or tools like Daysy, which is a fertility tracker, attacked pretty badly by liberal feminists in the US. Amanda Marcotte, for example, called Holly Grigg-Spall’s work on this issue “bizarre” and “half-baked.” Why do you think liberal feminists are so incredibly dismissive, to the point of attacking the work of these legitimate feminists? Why are they so dismissive of critiques of birth control, Big Pharma, and medical interventions in women’s reproductive health, more broadly?    

MLS: I wish I understood why people fall for liberal marketing that sells us something that is not necessarily empowering as empowering. Because the personal is political and because, with women, when we start to critique how we’re being forced to engage with patriarchy and the choices we’re making in that engagement, eventually people’s feelings get hurt. My analysis of how the pill is not good for women gets turned around into, “Hey, why are you hating on women who take the pill?” So, there’s some of that classic liberal vs. radical dynamic going on.

Women also have enormous allegiance to the medical industry. We’re brainwashed into it from the time we’re young — that the pill was liberation, that doctors can help us, that we can be rescued from our bodies, that our moms almost died in childbirth, thank god for medicine, thank god for pain relief. People don’t want to disengage with what is, in many ways, an abusive relationship with Big Pharma and medicine. We all know what it’s like when women start to come to consciousness of an abusive relationship. Often, the reaction is to defend the abusive relationship first. In her work, Holly Grigg-Spall says she really thinks the pill has addictive qualities. Women become physically dependent on it, having withdrawal symptoms when they stop, feeling as though they can’t live without it… So that’s probably leading to some of the allegiance as well.

MM: I think the first point you made is relevant in a number of ways in terms of those debates between liberals and radicals. Critique of a system or norm that has been accepted by mainstream feminism is construed as an attack or as judgement or shaming. Maybe some women get defensive because they’ve made these choices that are being critiqued. I wanted to come back to midwifery for a little bit because there have been some controversies in the field recently — one of those being the issue of men in the profession. I’ve noticed that there have been some men entering into the profession, here and there. What do you think about that?

MLS: Personally, I believe midwifery is a women’s tradition and men have no place in it. I think once midwifery got professionalized and stopped being about women’s health in women’s hands and became a capitalist profession, it was inevitable that men would want to colonize that. You see the same thing with nursing — once nursing became a respectable profession where you could make a decent living, suddenly there’s this influx of men. It’s become a job now, which makes it very difficult to defend why you believe in “sex discrimination” and who gets to do that job. Part of it is also that men have always wanted to control birth — it’s the root of patriarchy; men want credit for the magic birthing power. I think lot of the men attracted to midwifery are patriarchal men (who often call themselves feminists), who want credit for what women do.

MM: Another controversy is in terms of this new trend of using gender-neutral language to discuss women’s reproductive capacity and women’s bodies in general. So organizations like Planned Parenthood and some midwifery organizations have begun to use gender-neutral language like “menstruators” or “pregnant people” in order to accommodate and be inclusive of trans-identified people. How do you think using this kind of language to discuss women’s reproductive health and bodies impacts women and the feminist movement?

MLS: I think it’s very concerning. I think a lot of well-meaning people are pushing this and not stepping back to think about what gender ideology actually means in terms of our ability to fight patriarchal oppression and our ability to name sex-based oppression. Most of the people pushing this in midwifery are well-meaning people who truly want to be inclusive, and some of them just want to be cool. There’s no question that gender ideology is being relentlessly marketed by big moneyed forces — there’s nothing grassroots or subversive about this. Magazines like People and Good Housekeeping are selling it. I wish liberals could step back and understand that if Good Housekeeping is selling it, it’s not about women’s liberation!

It’s brilliant how it’s being marketed as the right way to think and as “cool.” We see this a lot in capitalism, like, “commodified cool.” People don’t step back and look at the forces shaping this cultural phenomenon, which is obviously widespread and well-funded. What I would really like from people who are on the fence and are willing to discuss why radical feminists have an issue with gender ideology, is to consider how it destroys our ability to talk about sex-based oppression and how patriarchy developed and continues to be a system where male-bodied people control female-bodied people because of our ability to reproduce.

If you want woman and female to mean “identities” now, I would be willing to give you that, if you can tell me the concise name of the people I fight for who are oppressed on the basis of biological sex. These people are aborted in the womb because vulvas show up on ultrasounds. They’re smothered in infancy because they don’t have a penis. They’re sold to men as rape and breeding slaves and the world calls it child marriage. They are abducted by Boko Haram and forcibly impregnated and used as rape slaves. In the United States, they suffer court-ordered caesareans. They are denied abortions. They go to jail for suspicious miscarriages. Could the genderists to provide a concise name for that group of people? And if they can’t, I want them to examine how it may be hurtful to that group of people to no longer have a name for themselves and what they are collectively experiencing because they are of the female sex.

MM: The reproductive rights movement in the United States is up against so much. But you’ve talked about how in many ways, what they’re fighting for is misguided in terms of legislation and what genuine female empowerment would look like. So what would you suggest advocating for instead? What should the reproductive rights movement in the US be doing?

MLS: People in the reproductive rights movement in the US who are interested in working politically on those structures need to stop being apologetic about abortion. We need to go back to rallying for abortion on demand and without apology. We need to put pressure on primary healthcare providers and OBGYNs — anyone who provides primary healthcare for female people should be offering abortion services in their practice. We shouldn’t have this abortion ghetto where women have to travel 300 miles because all the providers in their town are too cowardly to offer abortion.

If people say that “abortion on demand without apology” is too much, my response is: If you disagree with abortion on demand and without apology, which women should be forced to gestate and give birth against their will, and which women should be made to feel terrible about it? Because it’s a very basic statement and it’s exactly what we need to be advocating for. Instead, we’ve fallen into focusing on how we need [abortion] to be safe, but rare, and this idea that all abortions are tragic. But abortions should be like any other healthcare procedure. When you have a problem with your health, you can go get treatment for that problem. A lot of that stuff is not pretty to watch. For a lot of it, we wish the problem didn’t exist in the first place… But we don’t say, “Nobody likes mastectomies, but sometimes they’re necessary to prevent breast cancer,” or “No one really likes having tonsils removed.” It’s a medical procedure; we should stop apologizing for it. An unwanted pregnancy is a treatable medical condition. At the level of advocating for social and political change, I’d like to see people being unapologetic and pushing for a full spectrum of women’s healthcare without restrictions.

On a more radical level, I’d like to see more women learning about their bodies and rediscovering self-abortions. There is a growing home abortion movement that I’m very excited about. We’re social animals — women, especially, are social creatures — like bees, like dolphins, like so many of our primate relatives… Abortion and birth are things females do together. We have to break out of the individualism of capitalism. It’s safer for you to do this with a friend or sister, not because our bodies are dangerous and will develop all sorts of complications, but because our species has always done these things in groups of women. So I’d love to see groups of women forming, and learning about their bodies — getting speculums, learning self-exam, and learning how to visualize their cervix. My mentor Carol Downer says, “Once you realize the cervix is two inches away and has a hole in it, it’s a total game-changer on how you think about abortion.”

And then moving from self-exams to practicing menstrual extraction and learning about safe self-abortion methods and helping each other with that. Because, if we know how to do it ourselves, the authorities have a much harder time taking it away from us.

MM: So, say there’s a young woman listening right now. She lives in the US, she wants to take control of her own reproductive health and her own body, and she wants to help some of her friends do that as well. What’s the first step? What do they do?

MLS: I would recommend they start by looking at all the information out there, that’s been left by our wonderful foremothers. There’s a book called Natural Liberty by the Sage-Femme Collective that is an incredible resource for women (you can get a free PDF online if you look for it). It covers self-abortion methods, from herbs to acupressure points, to high-dose Vitamin C supplements, and also details how to do menstrual extraction and early suction abortion, and talks about how to safely use the medications. The book has everything from, “I don’t have any equipment or any drugs — what can I do?” to “I want to take this further and help other women — how do I assemble a home abortion machine. It’s a great book. Look for books like that — A Woman’s Book of Choices, A New View of a Woman’s Body, etc. there’s also a website called Sister Zeus that has a lot of information about this.

We need to realize that we have to heal ourselves from this hyper-individualism of capitalism and this horrible wound of patriarchy where we don’t trust other women. Find one woman you trust and get to the point in your relationship where you can show each other your cervixes. Women who do that have their minds blown and really want to spread the gospel of self-examinations, so it will spread out in the community that way. Breaking free from individualism and getting back into community is so important. We can’t do this as individuals — we have to do this as sisters.

Meghan Murphy
Meghan Murphy

Founder & Editor

Meghan Murphy is a freelance writer and journalist. She has been podcasting and writing about feminism since 2010 and has published work in numerous national and international publications, including New Statesman, Vice, Al Jazeera, The Globe and Mail, I-D, Truthdig, and more. Meghan completed a Masters degree in the department of Gender, Sexuality and Women’s Studies at Simon Fraser University in 2012 and lives in Vancouver, B.C. with her dog.

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  • shy virago

    This is extraordinary. In the middle of so much destruction, I feel energized reading this.
    I’m past having to worry about pregnancy, yet I had no idea that the cervix was only 2 inches away.
    And I’ve been feminist my entire life!

  • Alienigena

    “Critique of a system or norm that has been accepted by mainstream feminism is construed as an attack or as judgement or shaming. Maybe some women get defensive because they’ve made these choices that are being critiqued”

    I think you had to have been born in an era in which children were not considered fully human and have had to receive medical treatment during that era to understand how much medicine is not on the side of the patient especially if they are vulnerable like children and if they are part of an oppressed group, like women. I was a patient in a hospital as a 1.5 year old and don’t believe I was treated for pain at all for something that was extremely painful (based on the fact my pain and crying was enough to prevent my nurse mom from visiting me in the hospital), a staph infection of the lymph nodes in the groin. Though I would have possibly died without antibiotics or surgery (to drain the infected area) I would never suggest that antibiotics should be used without careful consideration of their effectiveness. That is the same for any reproductive treatment or preventative treatment that women receive. No one is suggesting we should abandon birth control or abortion, hence the support for abortion on demand. But if we can’t completely remove the risk associated hormonal birth control or use of other devices we should at least share it. As in, men should take hormonal birth control and accept the risks and adverse reactions that women have been expected to accept for a few decades. The kinds of things that women are just expected to accept as a ‘penalty’ for being sexually active in and outside of formal marriages boggles the mind. The criticisms of medical interventions are leveled at pharmaceutical companies, physicians and medical associations and industries not individual women or even women as a whole. People act as if medicine is some sacrosanct profession that cannot be questioned but that is just ridiculous. Any group of people who has control over life and death should be subject to public scrutiny.

  • MermaidJayne

    This was amazing! In Australia there has been a recent surge of Midwifery, infact it became one of the most popular degrees at my local university. So I’m hoping that the topics in this amazing conversation become a common talking point for this new generation of midwives.

  • Hanakai

    Through most of human history, women were not attended in childbirth by medical personnel, but by midwives. And before the era of modern medicine, as many as 1 in 8 women died of childbirth complications. In places like Afghanistan, parts of India and Nigeria, the death rate remains that horribly high. With modern medicine, the maternal death rate from childbirth has fallen remarkably. Canada, for example, has a maternal childbirth death rate of about 11 per 100,000.

    While I generally favor the movement toward the use of midwives in childbirth, I also advocate sufficient medical training and licensing for midwives, coming to this position after a young mother here died a stupid and unnecessary death because the home-birth midwife did not recognize signs of preeclampsia in her patient. In another recent case here, one baby died and another is paralyzed for life, which outcomes would have been avoidable had the midwife transferred the mother to the hospital in time. In the USA, different states have different criteria for midwifery; the states that require more training have better results.

    Here is the American data coming in on midwife births. Home births attended by a midwife have a mortality (death) rate for the mother and newborn of four times the rate of hospital births; the death rate is twice that of hospital births for midwife-attended birthing center births. (Births outside a hospital attended by police, taxi drivers, etc also had a mortality rate four time the hospital rate.) Now, here is the interesting data: Hospitals births attended by a midwife had the best outcomes and the lowest mortality rates of all, lower even than hospital births attended by a physician.

    Other countries with a long tradition of trained midwives may have different results. The reality is that most births are relatively straightforward and uncomplicated. For the births where complications are present or develop, the mother and the neonate are best served in a medical setting where emergency intervention is nearby if needed.

    • Omzig Online

      I was about to point out these same statistics until I saw your comment. I’m glad I’m not the only only one that sees some of the dangerous limitations of midwifery.

      Midwifery offers a wonderful model of care…until it doesn’t. In my area, there are a couple of prominent birthing centers, but neither of them have staff that are Pediatric Advanced Life Support (PALS) certified. They don’t have crash carts at their facility. They don’t believe in continuous fetal monitoring, which involves nothing more than the mother wearing a belt around her belly with a sensor attached to detect fetal hypoxia/fetal distress. Note: some birthing centers practice CFM, but the ones near me do not. They are also philosophically opposed to pharmacological pain management (I know this is a controversial topic among women).

      There was a time when I considered getting a practitioners license and working as a midwife. But then I was personally involved in a resuscitation effort of a newborn with an Apgar score of zero, and I had a very swift and very powerful change of heart. What began as a textbook labor/delivery became a heartbreaking and terrifying event. If we had been outside of a hospital, waiting for an ambulance to arrive, that newborn would have died. I realize that my experience is anecdotal, but that’s when I knew that if you’re not prepared for the very worst, then you’re simply not prepared.

      I’m not sure why there aren’t more midwives working in the hospital setting. It seems like the laboring woman would get the best of all worlds: coordination between professionals of all disciplines, and a relatively seamless continuity of care in case things take a turn for the worse.