Student: Elizabeth D

My feelings around complex birth are…complex. I’m excited to provide the option of
support to women who fall outside of commonly set parameters for homebirth and
have in the past served VBACs, one set of twins, a couple breech babies, and many
long labors and mothers in their forties.

I am the only option for midwife-supported breech or twin birth within a couple hours drive, and I feel confident that I can provide skilled care in collaboration with my mentors. I don’t have a lot of experience with either of those variations, but I have training in both.

Last year I took Breech Without Borders breech birth course, and that, combined with the study I’ve done over the last ten years and now this course, has increased my confidence and made me more open
to attending planned breech birth for the right person.

Last year a woman in my community wanted me to care for her at home during the birth of her mono-mono twins. This led me into deep study on twins and I called several twin homebirth experts around the country, who were very generous with their time. It really gave me more confidence about twin birth in general, though I ultimately advised against delivering mono-mono twins at home. That situation is a good example of my conflicting feelings about complex births.

I want women in my community to have support for almost any decision their make about their births and their babies. I believe they have that right. I also believe I have the right to decline to be involved in births that I think have a high potential to develop complications beyond what I can help with at home. It feels difficult to strike a balance between two attitudes, the first summarized as “I’m in charge and if this deviates from my protocols or community stand of care, I’m out of here” and the second as “I will be present and support you no matter what you choose, even at the expense of my own health and safety.”

In the case of the twin birth last year, the mother was planning to stay home and give birth unassisted if I
wasn’t willing to help her, and I really struggled with the idea of her giving birth alone when I could support them. Who am I to say what is “too complicated”? Birth is never 100% safe and considering the other option was fairly abysmal care in a hospital, why should I refuse to care for her?

On the other hand, my agreeing to be present does indicate my support, and I felt uncomfortable. I also couldn’t ignore the fact that these were diagnosed mono-mono twins who had already been under the care of an obstetrician for some time, so in the event of a transfer for any reason there would probably be an investigation launched into the family and anyone involved.

In the end the decision was made for me because, once I shared with her the advice I received from the twin experts I called, she made the decision to give birth in a hospital setting. While I’m still struggling to balance my needs and those of my community, I am excited to continue gaining experience with more complex pregnancy/birth/postpartum situations. I am very grateful to have mentors and more experienced midwives who have generously given me their phone numbers and encouraged me to reach out any time I need guidance.

I hope to be that person for others someday.