Drawing the Lines : Midwifery Politics in Arizona and Making the Case for Radical Action

June 11, 2013

The Truth About Gestational Diabetes
A Miscarriage Story
That time I had a freebirth at the Hospital
Now Trending:
We're Maryn + Margo

We are mamas and birth workers who decided to do birth differently– and bring others along with us. We are kind, fun to work with, and great at (lovingly) calling people on their bullshit. With 12 children and 20 years of midwifery between us, we’ve learned a thing or two along the way, and Indie Birth is our space to share it all with you.


Grab our free guides!
Free Doula Mini Course
The Student Midwife Primer

“Liberal feminists are asking for their share of the pie, a piece as big as anyone else’s. However, radical feminists are asking for a different pie altogether. Liberal activism (i.e. “We’re just like you!” activism) tends to be a conversation about assimilation and tolerance, and about being given a place at the table. Radical activism sees the existing system as broken and unsalvageable, and attempts to subvert, if not destroy, the system all together” – Leslie Kinzel

In my short time in the birth world I have seen second hand the way in which the state targets and attempts to eradicate midwives that are truly serving women rather than serving the state.  This is all very clear and obvious to me, and anyone else that looks critically at the history of midwives and the ongoing assimilation and watering down of “midwifery” by government regulation in collusion with egomaniacal OBGYN’s and their lobbyists.  It is the same plot as many recent Hollywood movies, except no one in our culture yet realizes that the traditional midwives, the unassisted birthers, the birth keepers are the ones to root for if we want the world to wake up.

But even worse, as we are now seeing in Arizona, “midwives” themselves are once again colluding with the oppressors, and digging true midwifery’s own grave.  If you aren’t up to date on this, see here, and here for some basic background.  The problem is that even people critical of the proposed changes, that seemingly have good intentions, don’t understand the larger political context, possibilities or the radical perspective of the events transpiring since so few are speaking out, and those that are, are being bullied and silenced for not staying in lock step with the mainstream, work-within-the-system, garbage.  So here is the Arizona situation as I see it:

The push to reopen the Arizona rules and regulations was an effort on behalf of consumers (guided by midwives) to allow midwives to attend VBAC births at home since AZ is one of the few backward ass states that excludes that from the scope of practice.  I believe this was largely a response to the aforementioned state targeting of a midwife for attending a VBAC, although no midwives or consumers spoke out in support, or even publicly made the connection between the rules opening and the situation, likely for fear of connecting themselves.

The group involved in reopening the rules and regulations mistakenly believed that going through the proper channels would win the trust of the Arizona Department of Health and help them achieve a wider and more autonomous scope of practice, which would make all consumers and midwives in AZ happier.  They were wrong on both counts.  The discussion of introducing space for voluntary licensure was poo-pooed over and over again, and those suggesting this were told that it was “too late” for that discussion.  All of the events, gatherings, public meetings, etc have taken place in Phoenix, the metro area of Arizona, making it very difficult for people in other parts of the state to participate except in token ways like online surveys and letter writing.  This led to a highly homogenous and mainstream front group that shaped the course and direction of all major decisions and interactions with the health department.  There have been many dissenting voices all along, but as with any “critical mass” movement they have been drowned out in favor of piecemeal “progress”.

Going through the prim and proper channels nearly always waters down the original intent of a group, and this particular group was already pretty watered down and assimilated to begin with.  In a predictable twist of fate, what they are now looking at with the new rules and regulations, is a document which even they actually think is WORSE than what they started with.  The board overseeing the changes has taken this opportunity to actually restrict and ban things that medwives care about like pitocin, when they started out hoping for cytotec to be added to the list of medications they could legally carry (which some already do anyways of course).  The board has also narrowed the scope further on who is low risk, what amount of informed choice is “allowed” before mandatory transfer of care and have added an insane piece that states midwives have to call their local labor and delivery ward every time a client goes into labor, so that they can be prepared in the case of an emergency if that is what the hospital asks of them.  And while VBACs and breeches are now “allowed”, the restrictions placed on them are almost comical in that no one will actually fit in the parameters set.  No VBAC for you if you have had more than one, or if your first c-section was due to diagnosed cephalo-pelvic disproportion (we all know that CPD is incredibly rare, but that OBs write this on most c-section charts). (Consumers and midwives in Arizona are freaking out, and wondering if they should just scrap the whole thing, and go back to how things were.  And as if that was the plan all along, Will Humble, the director of the department, has put that forward as an actual option.

I think Jeannine Parvati Baker explained it best –

“Too many Midwives
have identified with the oppressor,
learned to speak the conquerers language,
and otherwise been vanquished to emerge as
obstetrically-trained “Medwives”.

In other words,
many Midwives have given up being
guardians and keepers of natural birth at home,
in order to survive as professionals.”

Because this push was never radical, and never challenged the system at the core, they have ended up with this scenario in which all of their energy, money, time, has just been used to fuel the restriction of their medwives even further. Eventually, it will be to the point where we don’t even recognize real midwifery anymore, because it has be legislated away.  So this is the real lesson, that I hope some people can hear, and understand, and see in the real life context of the Arizona situation.  If we want REAL CHANGE and REAL AUTONOMY over our bodies, our births and our babies, we need to say NO MORE to state control of birth and midwifery!  We have to take back what is rightfully ours instead of asking permission, as mothers, as birth givers, and as those who other women ask to join them in birth.  The only piece of legislation we could possibly need is one that says women have the inherent right to birth wherever and with whomever they choose, and that those that they choose to support them do so legally by virtue of being asked. 

After all, many of the midwives pushing for reform are the same ones who were going outside of the rules and regulations anyways.  So why do we even have a scope of practice, or rules and regulations?  Why bother?!  Unlicensed midwives don’t follow them, and licensed midwives don’t follow them, so what on earth are they there for?  Rules and regulations don’t help moms. They don’t make the Western medical model respect midwives and homebirthers any more.  They don’t make anyone safer. If you think they do, then show me the study, because there isn’t one.  These ideas about licensing and safety are all based in cultural mythology about technology, professionalism, women’s abilities, and the extent of our freedom.

We need to become more comfortable with ambiguity, and different needs and opinions, rather than asking to be further standardized and mechanized.  We need to expand our imaginations, and ask much harder questions than we have been asking.  What are these rules there for?  Who do they serve?  Why are drugs like pitocin only available through a doctor to begin with?  Shouldn’t we, as informed competent adults, be able to purchase medication we need or want without the permission of a doctor?  Are women smart enough to pick who is invited to her birth, regardless of their credentials and licensing?  What about dangerous or untrustworthy licensed midwives since we have all heard or experienced these stories?   What is the role of policing within those who work with pregnant women and babies?  Because that is really what licensing is – the sanctioned policing of midwives and birthing families, and the subsequent branding of those midwives that the state deems “acceptable”.   What creative systems of accountability can we come up with?  Are we up to the task?

I ask these questions not because I have all the answers about how this system looks, but because I know that we can do better, that we are going to have to do better.

So what do you think?  Do you want a bigger piece of the pie?  Or should we bake our own effing cake?

+ show Comments

- Hide Comments

add a comment

  1. noncomplyintz says:

    Brilliantly written, Margo.  The licensing of midwives or attempts to make modifications in an inherently broken system will never deliver liberty.  It only serves to oppress others for the benefits of those making the rules or promoting the rules.

  2. […] half of my module…and I did some reading-mostly of my own interest, but I came across an article about the current midwifery legislation in Arizona that I really thought was topical to what […]

  3. […] half of my module…and I did some reading-mostly of my own interest, but I came across an article about the current midwifery legislation in Arizona that I really thought was topical to what […]

  4. […] on August 8, 2013 by preservingparentsrights June 11, 2013 By Margo Nelson 3 Comments […]

Leave a Reply

Your email address will not be published. Required fields are marked *

so hot right now

Meet the duo behind Indie Birth

We are mamas and midwives who decided to do birth differently– and bring others along with us. We are radical, fun to work with, and great at (lovingly) calling people on their bullshit to help move us all towards a new more beautiful world. With 12 children and over two decades of midwifery between us, we’ve learned a thing or two along the way, and Indie Birth is our space to share it all with you.

Read Our Story

Margo and Maryn

Taking Back Birth Podcast

Listen now

The Podcast

Visit the
T-Shirt Shop

Shop Now

The Shop

More Amazing Resources

Indie Birth Private contract association | Terms of membership

Want the latest tips, resources, and success stories (with some ancient wisdom sprinkled in) sent straight to your inbox?

Indie Birth offers radical midwifery perspectives and resources for powerful birthing women and aspiring birth workers. We provide educational courses, inspirational content, and coaching.


Head to the blog >

@Indiebirth >

follow along 
on Instagram: