Interview with Barbara Herrera

A few weeks ago I decided to ask Barbara Herrera, one of the midwives that I follow on the blogsphere, to be a guest on my blog. She is better known in the online community as the Navelgazing Midwife. She is an LM (CA) and CPM in San Diego, CA and continues to write thought provoking, controversial, and timeless articles on women's healthcare, history, and advocacy.

I invite you to pull up a chair and enjoy learning just a little more about the Navelgazing Midwife.

What led you to midwifery?

I wasn't led; I was dragged into it. Growing up, I never liked kids. They were messy, noisy and stank; I didn't want anything to do with babies. But, starting when I was 18, friends began asking me to help them when they were having their babies. After I'd been to a few, I thought I should learn a thing or two. It wasn't until after I had my second baby, at home, that I was bitten by the birth bug. Once I got going, there was no stopping me!

What does midwifery mean to you?

I serve women. Midwifery is serving women. The mission gets all jumbled up with the law, insurance, odd educations, inept midwives, overbearing doctors, interminable technology and minimal societal support. Those of us who keep moving forward despite the obstacles *really* want to be midwives. It isn't an easy "occupation" (calling?).

What is your hope for all women you attend?

There's an underlying belief that midwives empower women, that we have the key to helping them find their inner strengths, giving them the power to transform their lives. In reality, women empower themselves. Simply by choosing to birth at home, to hire a midwife, to remove themselves from The System... all of these actions are her empowering gifts. She gives them to herself. My hope for women is they discover and, if possible, embrace aspects of themselves they never knew existed before. Tapping into these previously unknown strengths buoys us along as mothers, as parents. It is not uncommon for women to remember their laborious journey and be able to take another deep breath and say, "Okay, I did that, I can do this."

I notice that you help women in the hospital setting too. What are your feelings on hospital vs. home birth?

People do like to say "home versus hospital" as if it is a contest, one that will be won by whoever has the best/most natural/least interventive/most (or least) painful/etc. birth experience.

There is a birth place for everyone. For most women in our culture, that place is a hospital. The latest statistics seem to show out-of-hospital births are increasing, but they are still a fraction of those hospital birthing mamas. I support women wherever they choose to birth. I really enjoy working with hospital birthing women. It's totally different than my homebirth clients, but the joy is identical.

What types of situations would lead you to transfer a woman to the hospital?

I use the term "transfer" if we go to the hospital in a car. A "transport" is going by ambulance. There are far fewer reasons to transport than to transfer since those are absolute emergencies. A postpartum hemorrhage, a baby that needs more than basic resuscitation and a baby's heart tones (while the baby is still in the uterus) that do not resolve are the most common reasons for a transport. A transfer is slower, less urgent and can be because progress in labor has stopped, because mom wants pain medication or if her blood pressure begins climbing. I also have no experience delivering breech babies, so would transport for a surprise breech (and I have).

Do you stay with women during transfers/transports and, if so, what is the vibe you get from the medical institution during these transfers?

Absolutely! Any midwife who leaves her client is unethical as far as I'm concerned. If she cannot stay because of legalities, then she needs to have a doula go with mom. Sending a mom into the hospital without support is cruel.

In all the years of transferring and transporting women, I have had really good relationships with the nurses and doctors -except for one doctor/hospital. I acknowledge that the hospital staff will be wary of me, probably won't know me and will probably distrust my charting. I meet them where they are. I answer each question as it comes to me, even if it is the same one 10 times. I know that the fewer the waves, the better the care for my client. I would do anything to help her; I can take anything the hospital dishes out. As long as they are kind to my client, I don't care how they are to me.

Do you "take on" "high risk" women? If so, which do you take on and which don't and how do you treat their 'risks'?

Ah, but risk is in the eye of the beholder, isn't it? To some midwives, a woman with Gestational Diabetes is too high a risk for her to take on, whereas another midwife (me) has no problem with the diabetic, but won't take a mom pregnant with twins. Our skill sets are different, we all excel in different areas. Knowing our skills and our limitations is vital as a midwife.

Our law is pages long outlining who we are legally permitted to accept as clients. With informed consent, a midwife with specialized skills is able to accept someone who falls into the (legally) "high risk" category. For me, the main complications that I am not able to attend to, merely because of lack of skill/education, are breeches and twins. I can refer a client to another midwife who does do them at home, someone with more skill and education than I have in those particular situations.

If women have specific questions... post-dates, large babies, prolonged rupture of membranes, high blood pressure... these sorts of things are worked out on a case-by-case basis. Little of midwifery is absolute.

What is your view on childbirth itself?

That's an interesting question to ask a midwife. I work with clients to allow birth to unfold as it is supposed to, as it is meant to, to not try and write a script that will, 100% of the time, not be followed. As a midwife and care provider, I believe I am required to do the same... to allow birth to unfold in front of me without my manipulating the experience for the woman/baby/family. I am hired as a consultant with years of experience, a woman who has specific skills to keep mom and baby safe if things step out of the realm of normal. I use my skills when they are called for and sit back quietly when things are moving along perfectly fine without my help.

Childbirth is magical, base, gritty, loud, fills the senses to the brim and is shared by millions and millions of women around the world -and a connection with mothers from all of time. Birth is as we make it - and what it makes us.

What is your view on the state of women's health care in the U.S.?

Oh, don't make me cry! I've worked with migrant and inner city teens and have listened as women share their stories of medical neglect, of not having insurance so putting aside even very serious illnesses, of women who don't know how to maneuver through the maze of free-care offerings. It's just all so sad. Women who have one type of insurance who are strapped into a birth location or a birth provider they want nothing to do with and women who fall in the inbetween... no insurance, but make too much for any assistance. Oh, my. It's just all so sad.

What would you like to see changed at a national level and how do you see this being accomplished?

Well, of course I'd love to see Licensed Midwives be a part of the healthcare team around the US... nationally recognized... not parcelled out into state legislatures. I'd love to be able to take Medicaid/MediCal. I'd love to have hospital privileges.

It's going to take an enormous shift in the medical model in order to accommodate the specific niche an LM/CPM can offer. Increasing the number of midwifery organizations in our country, lobbying and educating the public as well as those in control (docs, hospital administrators, insurance companies) all move us incrementally forward. While I can see this lovely, idyllic world in my head, I don't quite know how to traverse to it with my feet. But, I keep trying.

Who am I?

Over the years, I've added dabs of skills, interests and hobbies to my basic skeleton of woman. I'm a mom of four kids (first born in the hospital, second at home, third in the car, and the fourth is a life-long step-child), all grown and all the dearest friends a mom could ask for. My spouse Sarah and I met in 1986 (when my youngest was 2 days old and she was 7 months pregnant) and are still so in love. We've gotten legally married each time we were able to, this last time seeming to still be legal (as of today). I'm vocally pro-choice, tend to write controversial posts and articles and apparently enjoy rocking people's boats.

I love writing, have been published a number of times and have been doing amateur photography for 20+ years, but sold my first photo to "Mothering Magazine" last year. I love teaching and spend a great deal of time teaching student midwives and apprentices (as well as birth junkies) via my blog and in Facebook. The Internet has transformed every aspect of my life.

To end where I started... I serve women. That's what I do and who I am. I serve women.

Thank you Barb for your time!

You can find Barbara both at her blog here, as well as her professional website here.

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