After 23 years, I left my job as the nurse-midwife in Bar Harbor. I loved my work and the women I cared for. I was not ready to retire, but I can’t accept the direction in which women’s health is heading.
Maternity services are being eliminated, especially in rural areas. Disadvantaged women, often poor with multiple problems, must travel long distances for basic maternity and gynecological care. Citing that “maternity care is expensive” as the rationale for this is gender discrimination. Bad roads, weather, traffic, poverty and lack of transportation are forcing women to travel sometimes two hours for a prenatal appointment.
When I arrived in Maine, our profession was misunderstood. Work was required to demonstrate that nurse-midwives were safe and skilled providers. We are advanced-practice nurses with graduate degrees in midwifery and women’s health, not uneducated grannies doing home births. While home birth may be incorporated into our practice, the majority of us attend births in hospitals. We are independent providers caring for women throughout the lifespan, not only during pregnancy and childbirth.
Medicine is rapidly changing, and women are affected disproportionately to men. The U.S. is one of eight countries where the maternal mortality rate is increasing and three times higher than in 1980. The cesarean section rate in this country is astronomical, and many are unnecessary. Surgery can save the lives of mothers and babies, but it is by no means the safest mode of delivery.
Obstetrics requires long and unpredictable hours. There is temptation to expedite births with intervention, creating risk and consequences. For many years vaginal birth after cesarean, or VBAC, was standard of care. Women who had a C-section before were given a trial of labor, and the success rate was as high as 88 percent. Over the past decade, the economics of allowing a trial labor has made it unfeasible for small, rural hospitals. While it is well documented that vaginal birth is the safest mode of delivery, the recommendation for VBAC is that the surgical team be available during labor. This increases costs dramatically, and many small hospitals could not provide this service. Women are forced to succumb to surgery they don’t want or need, exposing them to increased risks.
How did the opinion about safety get so misconstrued? Money and convenience. Surgery is more profitable than sitting and waiting. It is more convenient to schedule surgery during the day than call a surgical team at night. I used to refer to this as unnecessary surgery, but now I call it what it really is: mutilation. We are mutilating women for convenience and profit, and those women often suffer long-term complications and sometimes death.
A patient of mine traveled to Bar Harbor from Sullivan, more than an hour each way. She and her husband worked full time in physically difficult, low-paying jobs, struggling to support their family. They shared one car. This winter, she often missed appointments. The Ellsworth hospital was closer, but pediatricians there refused to care for her baby because of specific health risks. She’d had a previous cesarean for breech, but her chances of delivering vaginally were excellent. She struggled to find someone to allow that option. I advocated for her safety and right to a vaginal birth, but under pressure she agreed to an unnecessary C-section, putting her at increased risk of blood clots, infection, chronic pain and death.
This woman was not well served by any stretch of the imagination, and she is only one example. The poverty and social issues in this state manifest themselves in long-term and dangerous health problems. Programs to address these are nearing extinction.
In the midst of health care reform, it is imperative our directives not discriminate against women. A lack of accessible maternity services, as well as the alarming increase in maternal mortality, raise a clarion call to reorder our priorities for women’s health.
Midwives are a solution to this problem. We give safe care, advocate for women and teach women to advocate for themselves. As I leave my beloved practice, I am looking ahead to a bigger picture of improving the care that all women in this state need and deserve.
Linda Robinson is a nurse-midwife from Bar Harbor and author of “Sunday Morning Shamwana, A Midwife’s Letter’s From the Field.” Her website is lindaorsirobinson.com.