Midwifery Museum Event  ~ Felton Library, Oct 13, 2021 ~

Midwifery Museum Event
~ Felton Library, Oct 13, 2021 ~

Original (longer) Version

Before talking about the 5,000-year history of midwifery, I’d like to introduce myself and tell you how I, as a former L&D nurse in the 1960s and ‘70s, became involved in the practice and politics of California midwifery, first as a lay midwife and political activist for a mfry licensing law in the 1980s and after passage of the Licensed Midwifery Practice Act in 1993, a state-licensed midwife.

Before tackling the intertwined politics of midwifery and obstetrics in the United States, I’d like to describe my personal introduction to childbirth. which ultimately lead me to become a childbirth activist and eventually a politically-active midwife.

How something as big as a baby got out of that little tiny place

As a small child I was fascinated by my mother’s pregnancy and the idea of a miniature human being inside her body. In particular, I wanted to know how something as big a baby could get out of that little tiny place often referred to by us a children as “you know down there”. But in the 1950, sex was not something talked about in our neighborhood. My mother and grandmother were equally mum on the topic of childbirth, and there were no picture books or internet satisfy my curiosity.

So I had to wait until I enrolled in nursing school after graduating from high school before finally I got to see a baby born; I have been fascinated with childbirth ever since.

At seven in the morning on the first day of my clinical rotation in the all-white L&D unit on 5 North, a 16-year-old an unmarried mother walked into our 5th floor L&D room. She’d had been dropped off in front of the hospital by her embarrassed parents and wandered around trying to find the maternity department for the better part of an hour, too embarrassed to ask for help. Apparently walking was good for her labor, as she was already pushing when she arrived at our door. We quickly got her on a stretcher, raced back to the delivery room and got her to slide over to the delivery table.

At that precise moment, a nurse-anesthetist walked from the back of the delivery room and stood at the head of the stretcher, out of sight of the new mother. Without saying anything, the nurse-anesthetist suddenly placed a black general anesthesia mask very firmly over the young woman’s mouth and nose. The young woman jerked away and began shaking her head wildly from side to side while the nurse-anesthetist kept trying to strap the mask over her face as she said: “You have to have this, otherwise it will hurt so much you won’t be able to stand it”.

Just then, the senior OB resident walked into the room, and seeing the struggle said: “Let her go. She’ll be sorry but she’ll know better next time.” This reinforced the nurse-anesthetist’s comment that without anesthesia normal childbirth was as unbearably painful as falling down a long flight of stairs.

Then the most extraordinary thing happened: The mother gave another push and suddenly this cute little 7 & half pound baby girl just slipped out of her vagina, no fuss, no muss, no blood-curdling scream of pain. Contrary to what the nurse and resident said, the mother didn’t look or act like she’s been in a train wreck or suffered agonizing pain. Instead this young woman just quietly laid there looking at her newborn who was lying between her legs in a pool of clear warm amniotic fluid.

This serene moment suddenly ended as we realized that something was very wrong. The umbilical cord was pale, flat and still which meant that freshly oxygenated blood was no longer pulsing into the baby’s body. Instead of crying, the increasingly pale baby lay wasn’t lay perfectly still with no movement and making no effort to breath. At that time, babies that didn’t breathe spontaneously at birth were thought to be genetically defective and were not usually resuscitated. The cord was quickly cut, the body wrapped up in a blanket that covered her face and head, and set aside on a table in the back of the room.

Afterwards I asked one of the L&D nurses why this apparently perfect baby died, and she simply said: “Some babies don’t make it, we don’t know why.” An article about stillbirth in the Baltimore Sun in 2002 described the continuing the mystery of this heart-breaking phenomena and inability of obstetrical medicine to prevent such tragedies.

L&D Nursing all-white Ward on 5 North

My long journey into mfry began as a Labor and Delivery nurse in a racially segregate hospital in the deep south. Our hospital had two entirely different ways to manage normal childbirth, depending on whether the mother-to-be was white or black. The only thing that was the same for both white and black labor patients is that they had absolutely no say in what was done to them.

At that time hospitals classified their labor and delivery units as a surgical suite restricted to special personnel who changed out of their street clothes and into surgical scrub suits, caps and a face mask.

The double swinging doors had a sign in big black letters that read:  “No Admittance – Hospital Personnel Only”. When a laboring mother and her husband showed up at the door, the nurses instructed her to give her purse her husband and kiss him goodbye, since family members were not permitted in the L&D.

As a labor patient, she would  not see any family member during the many hours, or in some cases, 2 or 3 days, that she was in labor. These same surgical protocols also meant that fathers and other family members were not allowed to be present when the baby was being born.

On admission to the labor room white labor patients were given Twilight Sleep drugs, whether they wanted them or not. This was a mixture of scopolamine, which is a hallucinogenic drug that also causes amnesia, and a big dose of narcotics.

Profoundly depressed baby born to mother given Twilight Sleep drugs during labor & general anesthesia during a forceps-assisted delivery

Injections of these potent drugs were repeated every 2 or 3 hours for the entire length of labor. This was the equivalent of a chemical lobotomy that eliminated the mother’s normal mental function. For the unborn baby, the repeated doses of narcotic & other drugs given to its mother, and the use of general anesthesia, caused a profound respiratory depression at birth so a significant number of babies never breathed.

Laboring women medicated with Twilight Sleep drugs often tried to climb out of bed or became combative, punching and biting the nurses. The nursing staff solved this problem putting large leather restraints on the mother’s wrists and ankles and attaching them to the four corners of her bed. This forced these women to lay spread-eagle on their backs, unable to move for the duration of their labor.

When it was time for the baby to be born, the heavily drugged mother was taken by stretcher to an OR-style delivery room.

In 1910, when American obstetrics officially became a surgical specialty, the new standard of care was conduct to normal childbirth as a surgical procedure to be “performed” under general anesthesia by a physician-surgeon.

This routinely included as many as five surgical procedures, beginning with an episiotomy. This was followed by an extremely dangerous form of fundal pressure in which the doctor directed the nurse to stand on a stool and push down as hard as she could on the top of the mother’s uterus while the doctor pulled from below and delivered the baby with forceps. Then the doctor inserted a gloved hand into the mother’s uterus to remove the placenta and finished up by suturing the episiotomy incision.

This included the “husband stitch”, which was supposed to make her husband happy by making her vaginia tight, and theoretically his restoring wife’s virginity.

After the baby was born it took a several hours for the new mother to recover from the drugs and anesthesia. As these women drifted in and out of consciousness, they would rouse enough to ask: “what did I have?”. We’d say “you had a boy (or a girl)” a dozen times before they finally remembered the gender of their baby and they wouldn’t get see her newborn for the first time for many more hours.

While the mother was recovering in the L&D, her excited family was jubilantly standing around the nursery window and admiring the new baby while the new dad bragged and passed out cigars.

Unfortunately, rendering labor patients unconscious with general anesthesia meant the mother-to-be was the one person who was not allowed to be present at the birth of her own baby.

Black Mothers on One South

All of this was in stark contrast to the experience of our black mother who were admitted to One South, an all-black ward in the basement. Our segregated hospital didn’t provide L&D facilities for black mothers, so as labor patients they were never given Twilight Sleep or other pain medications during labor. This meant they could move and change positions, get out of bed, walk around their room and even walk up and down the hall. This make their contractions easier to cope with and helped their labors to advance.

As a student nurse my next memorable birth was that of an experienced black mother having her 6th baby. Our hospital didn’t provide separate L&D facilities for black women, so when a labor patient began to make pushing sounds, we quickly dragged her on to stretcher and raced down the hall to the elevator. The plan was to go up 5 floors to that same delivery room on One North. However, Mother Nature often had other ideas.

When this happened, we’d stop the elevator so the door wouldn’t open to a crowd of visitors suddenly being surprised by the birth of a baby. After having spent weeks watching white women moan, cry out, and even howl under the influence of Twilight Sleep drugs, and then having their babies dragged out with forceps, it was a surreal experience to see these black moms efficiently, and without indication of great pain or anguish, push out a healthy and crying baby in the elevator. On those occasions the baby was expertly “caught” by the nurse, who simply handed the baby up to its mother and cover to them to keep the baby warm. Then we flipped the elevator back on and continued to 5 North so the placenta could be “properly” delivered in the delivery room.

But unfortunately, this kind of idyllic birth was NOT what the vast majority of childbearing women, regardless of ethnicity, were experiencing in America.

Institutionalized Obstetrical Harm

Deeply depressed baby at delivery, umbilical cord pale & drained of blood, no longer pulsing

As an L&D nurse, I saw the institutionalized and systematic harm caused by an obstetrical system. Harm to both mothers and babies was was a direct consequence of “wrong thinking” in two areas. First was the built-in misogyny of the day that treated mentally competent adult women like pediatric patients – children who have no say in how they are treated.

Second was  a self-serving definition of normal birth as surgical procedure. This included narcotizing the mother during labor and then giving her general anesthesia so sequential surgical procedures could be routinely “performed” — episiotomy, forceps and manual removal of the placenta. As a result, the maternal mortality rate in the US was triple that of  countries in western Europe that did not “medicize” normal birth.

Unfortunately, this “birth as a surgical procedures” also resulted in newborn babies too drugged to breathe. Again, the US had abnormally high rate of stillbirths when compared Scandinavian countries, the Netherlands and England. Even worse than stillbirth were the many babies who suffered mental retardation, cerebral palsy and other lifelong brain injuries as a result of being seriously damaged by the use of forceps or after-effects of all the drugs given to its mother during her labor and the surgical delivery.

Having created a system in which only MDs trained in obstetrical surgery could attend a normal childbirth was an efficient and extremely successful strategy for eliminating the practice of midwifery in the US. However, the American obstetrical profession ascribed the use of these drugs and surgical procedures as mandated by the new scientific practice of medicine, insisting that routine hospitalization and use of surgical interventions made childbirth ever so much safer than the bad old days of midwives and country doctors who delivered babies at home.

Unfortunately, the MMR for the US at the time this bragging going on was two or three times higher that of other industrialized countries. Even more astonishing is that the MMR in the US continued to be 3-fold higher than comparable wealthy countries throughout the entire 20th and two decades into the 21st century.

Today epidural anesthesia giving during labor and the birth has replaced twilight Sleep drugs and general anesthesia, while forceps were replaced by vacuum extraction and Cesarean surgery.

The newest obstetrical technology which began to be used in the early 1970s, is continuous electronic fetal monitoring (EFM). The obstetrical profession was immediately convinced that the routine use of continuous electronic fetal monitoring to detect fetal distress, in conjunction with immediate access to Cesarean section to rescue the baby, could prevent newborn brain injuries and thus eliminate cerebral palsy. Unfortunately, the scientific literature unequivocally refutes this idea.

Reputable studies, including the American College of Obstetricians and Gynecologist’s 2003 ‘Task Force on Neonatal Encephalopathy & Cerebral Palsy’, concluded that:

  • Since the advent of fetal heart rate monitoring, there has been no change in the incidence of cerebral palsy.
  • The majority of newborn brain injury does not occur during labor and delivery.
  • … most instances of neonatal [brain injury] and CP are attributed to events that occur prior to the onset of labor.
  • If used for identifying CP risk, a non-reassuring heart rate pattern would have had a 99.8% false positive rate….
  • The increasing cesarean delivery rate that occurred in conjunction with fetal monitoring has not shown … any reduction in the cerebral palsy rate…
  • A physician would have to perform 500 C-sections … to prevent a single case of cerebral palsy.

In the 50 years since EFM was introduced it has become the number one technology used during labor. In the five decades since it became the standard of care, all scientifically conducted studies that compared the use of continuous EFM with the use of one-on-one auscultation by an L&D  nurse or midwife found that EFM no benefit to mother or baby but did identify a statistically significant increase in the Cesarean section rate for women monitored by EFM.  The second most cited reason for performing a unplanned Cesarean was “non-reassuring fetal heart tracing” from the EFM. Compared to vaginal birth, women delivered by Cesarean surgery have a 3-fold increase in maternal mortality. It’s worth noting again that the second most cited reason for performing a unplanned Cesarean was “non-reassuring EFM tracings” of the fetal heart. Preventing unnecessary Cesareans reduces the number of mother who die unnecessarily  during or after childbirth.

According to an article by a practicing obstetrician published in April 2011:

“ . . . intrapartum fetal heart rate monitoring is the most common obstetric procedure performed in the United States. Despite the widespread use of EFM, there has been no decrease in cerebral palsy. … trials show that EFM has no effect in perinatal mortality or pediatric neurologic morbidity. {1}

Citation #1. “Heart Rate Monitoring Update” The Female Patient, April 2011

Link to references ~ http://faithgibson.org/mayday-scientific-paper-fetal-monitoring-creating-a-culture-of-safety-with-informed-choice/

Maternal mortality rate associated with elective Cesarean Surgery three time higher than normal vaginal birth

Currently the the US ranks 128th in the rate of maternal mortality. This is far below countries that are NOT known for any great scientific advances in medicine.

This list includes Turkey, Uruguay, Tajikistan, Saudi Arabia, Russia, Iran, Albania, Bahrain, Chile, Hungary, Kuwait, Korea-South, Kazakhstan, Canada, Bulgaria, Bosnia-Herzegovina, Estonia, Qatar, New Zealand, Portugal, Croatia.

As for the safest place for baby to be born also in NOT the US, which is number 33 out of 36 countries, or 3rd from bottom!

Understanding why the American obstetrical model doesn’t work very well for anyone & does so at an annual cost of $1.600,000,000,000

How to have a baby like those lucky black mothers?

In this system, the only way to have normal birth like those black mothers who delivered precipitously in the elevator was to give birth unattended before being admitted to the hospital.

Choices I made when pregnant with my first baby

When I got pregnant with my first child, I was 120% certain that I did NOT want to have the standard Twilight Sleep drugs, anesthesia or have my baby dragged out of my body with forceps.

When I told my obstetrician, who truly was a very nice man, he said: “well, Just don’t come to the hospital, because that is what hospitals are for – drugs and anesthesia.” He didn’t qualify that by saying “for you white women” but that is what he meant.

My plan was to wait till the very last minute before going to the hospital and pray that the baby would be born before they could do anything obstetrical to me. I misjudged by a couple of blocks and gave birth @ 37 weeks to 5# 12 oz baby girl in the back seat of our Renault in the hospital driveway on January 18, 1964 at 11 pm on a Saturday night.

My daughter is all grown up now and lives up the hill in Bonnie Doone with her family and was able to be here tonight. Shawn, can you stand up or give a wave?

Back to the politics of obstetrics & midwifery

Now back to the questions of midwifery, which is to say how I became involved in what used to be called “women’s lib” and went on to become a politically-effective midwife.

The right use of obstetrics is for treating women with complications. The wrong use of obstetrics is using these same interventions on women who don’t need or want them.

In America, we have institutionalized the wrong use of obstetrics – the routine use of induction, Pitocin to speed up a normal labor, continuous EFM and the insane idea that Cesarean surgery is the safest way to have a baby. That is the current obstetrical standard of care in the United States. Physiological management of labor is not taught in medical school and not talked about by doctors or L&D nurses.

Unless and until that changes, the only safe alternative form of maternity care is the physiologically-based care provided professional trained midwives.

Now I’d like to tell you about the long and glorious history of midwifery.

Midwifery is the very first organized healthcare disciplinewith historical roots that trace back 5,000 years to ancient Egypt as documented by many Egyptian hieroglyphics.

However, I’m going to focus on the history of midwifery in California from 1850 to 1993. Other presenters will talk about the mfry licensing law passed in 1993 and what has happened since then.

California became the 31st state in the Union on September 9th, 1850. At that time midwifery was a totally lawful but unregulated activity practiced by empirically-trained lay midwives.

1917 – First Mfry Licensing Law (AB 1375)

But in 1917, doctors asked the state legislature to add a midwife licensing law to California’s Medical Practices ActAB 1375 created a new category called a state-certified midwife. To qualify for a mfry license, applicants had to graduate from a midwifery school that had been approved by the California Medical Board.

However, the state Medical Board never approved any midwifery training programs in California, although they did approve schools in several other states and foreign countries including Japan, Italy, and Russia. As a result, the great majority of the 217 California-certified midwives were Japanese-Americans trained in one of the 27 professional midwifery schools in Japan before moving to America or went to Japan for mfry training and returned to practice in California.

Unfortunately, AB 1375 did not expand the California licensed midwife’s professional abilities. Instead this law created two opposing categories – boy toys vs girl toys. The use of “boy toys” – that is, drugs, anesthesia and surgical procedures such as episiotomy, forceps and manual removal of the placenta – were restricted to MDs. Under AB 1375, it was an illegal practice of medicine for a midwife to do any of these things, even to stop a potentially fatal postpartum hemorrhage in an emergency or when a doctor was not available.

The category of “girl toys” – things midwives were allowed to do – was barely worth mentioning, as it mostly consisted of giving doses of castor oil to the mother and catching her baby.

1949 Repeal of California’s Mfry Licensing Law

In the summer of 1949, the state’s medical lobby decided to sponsored a bill that would dismantle the state’s midwifery licensing program. SB 966 was also supported by the California Medical Board. All of this occurred without the knowledge of the midwifery profession.

To justify the state’s repeal of midwifery licensing, the Director of the Medical Board, James Arnerich, stated in his July 1949 letter to the Legislature that midwifery was “almost a dead class”. Without any public announcement in newspapers or notification of practicing midwives, SB 966 quickly and quietly eliminated the Board’s authority to issue new mfry licenses.

1973 MBC began undercover sting-operations,
Arrests of lay midwives for the “crime”
of illegally practicing medicine

Kate Bowland and another Santa Cruz midwife

The next historical event happened in 1973 when the MBC conducted a 6-month long undercover sting operation of the Santa Cruz Women’s Health Collective and its lay midwife staff. A pregnant Medical Board employee using the pseudonym “Terry Johnson” pretended to want a midwife-attended home birth.

She received prenatal care from the health center for several months and then called lay midwife Kate Bowland in the middle of night, claiming to be active labor. When Kate and two other midwives arrived at her house, there were several agents of the Medical Board hiding in a back room and half a dozen Santa Cruz police officers in the living room who immediately arrested, handcuffed and jailed the midwives.

It is our good fortune that Kate is here tonight – can you stand up or wave your hand?

The Bowland Decision triggers political action

The arrest of these midwives resulted in a three-year legal case that unfortunately ended in 1976 with a very negative decision by State Supreme Court. Known as “the Bowland Decision”, it ruled that the practice of midwifery without a state-issued mfry license was an illegal practice of medicine.

However, the state of California no longer had ‘direct-entry’ mfry licensing program. This forced families to choose between unnecessary obstetrical interventions in the hospital or giving birth unattended at home. Both were a bad deal.

This triggered an enormous amount of political activity by lay midwives and women’s groups hell-bent on finding a “legislative remedy” that would either de-criminal traditional midwifery or create a licensing program for non-nurse midwives. Over the next 15 years, groups of midwives and mothers convinced six different legislators to sponsor a mfry licensing bill between 1977 and 1992.

Whenever there was a public hearing for one of these bills, the midwifery community packed the legislative chamber in the Capital building to the rafters with as many as 500 mothers, breastfeeding babies, children in strollers, dads, grandparents, midwives, mfry students and a few reporters.

After many hours of testimony by dozens of mfry supporters, four white men in suits would be invited by the speaker of the Assembly to sit at the long table at the front of the chamber. These men were lobbyists for American College of Obstetricians and Gynecologists, the California Medical Associations, the American Academy of Pediatricians and a California association of attorneys.

One by one, each lobbyist told the legislators that normal childbirth even in healthy women was so intrinsically dangerous that no one but a board-certified obstetrician in a well-equipped hospital was adequately trained and equipped to safely deliver a baby. All four of these men said the only way to keep mothers and babies from dying in the hands inept midwives was to kill the pending mfry bill. Between 1978 and 1992, these obliging legislators voted ‘no’ six times in a row.

Arrest & 20 month criminal prosecution  Faith GIbson ~ 1991-1993

Me and my 3 month-old Godson Joshua Arrant, 1992

In August of 1991 I was arrested in my home in the presence of my youngest daughter by two agents of California Medical Board and charged with 5 counts of practicing medicine without a licensed as a lay midwife. I was handcuffed, jailed and held on a $50,000 bond at a time when the famous boxer Mike Tyson’s bail after being arrested for rape was only $30,000. After being bailed out, I was criminally prosecuted for 20 months, included 16 different court appearances.

During these long dark months, I frequented the county law library. I eventually Xeroxed the 8 different versions of the Medical Practice Act beginning with 1876. After putting them in a 3-ring notebook, I went over each page with a fine-tooth comb and big yellow higher, and concluded that the California Legislature had never passed any law that made the practice traditional mfry a crime.

After i finished, I created a 35-page report documenting the legislative facts leading me to conclusion that it was never the intention of the California Legislature that traditional non-medical midwifery be treated as an illegal activity. I gave the report to my attorney — Anne Flower-Cummings who;d also been Kate’s attorney. At one pre-trial hearing, while we wait for the judge, Anne told the Santa Clara County assistant district attorney (Paul Seidel) who’d been assigned to prosecute my case,  about the research I”d done, my report and its conclusion, based on the State’s actual legislation, that non-medical mfry was not crime.

At that point, Mr. Seidel said

“I called up those guy at the Medial Board and told them that if they wanted me to keep prosecuting midwives, they’d have to get some new legislation passed”.

Because the criminal prosecution of my case went on for so long, it generated a lot of public interest and several midwife-friendly newspaper articles. This eventually this tipped the scales in our favor.

The next time we appeared in court, April 29th 1993, the DA surprised us all by officially dropping all the charges against me. Five days later (May 5th), the San Jose Mercury published an editorial calling for the California Medical Association to stop blocking mfry licensing bills and scolding the MBC for wasting its resources by going after “caring professionals like Gibson” and stop harassing midwives when they should be spending their time and money going after the hundreds of bad doctors licensed in the state.

Dismissal of charges triggers Midwifery Licensing Legislation

The DA’s decision to drop the criminal case against me, accompanied by the S J Mercury editorial and other favorable news stories, provided a political opening for Sen. Lucy Killea to write a mfry licensing bill. She negotiated an agreement with the CMA that they would NOT oppose passage of SB 350 as long as it included the same mandated physician supervision as the 1974 Nurse-Midwifery Act.

The result was a licensing law – the Licensed Midwifery Practice Act of 1993 that defined licensed midwifery as “equivalent but not identical” to nurse-midwives.

Unfortunately, that included the poison pill/ legally impossibly of physician supervision of home birth midwives.

The four Amendments to the LMPA ~
2000 (SB 1479),
2002 (SB 1950),
2006 (SB 1368),
and 2013 (AB 1308)