After yet another discussion about what “we” should do as midwives when parents go rogue and won’t take our advice, or acquiesce when “we” try to risk them out of home birth care, I had a lovely discussion/rant with Maryn about how frustrating it is to see this conversations happening time and again. “That woman is no longer low risk and it is reckless of her to go against the advice of her midwife to transfer care”. “It is a huge red flag that she won’t consent to what the midwife is telling her – why did she hire her if not to tell her when she was no longer a home birth candidate?”. “I would call 911 if I was concerned for her safety, and have her turn away EMS if she really won’t consent to transport, that way you are covered and no longer liable”. These are the sentiments that come up when discussing these real or hypothetical scenarios where these pesky women are saying a big F*** YOU when their midwife “risks them out”, and assert that if the midwife won’t help them, they’ll just have to do it themselves.
Most of the time when this happens in real life, the parents listen and go along with the risking out (sometimes for good reason I am sure!). It is rare for a mom to stand up and say “No Way Jose!”, and when she does she gets talked about on social media, chastised for being a reckless, mentally unstable person who doesn’t care about orphaning her children. Instead of saying, perhaps these women are intelligent human beings who DISAGREE WITH YOU. As if pregnant people are not allowed to disagree with midwives, since we are a saintly all knowing bunch who would never suggest transport unless it was “absolutely necessary”. But the question is, how do we know it is necessary? The same question resurfaces for me continuously – what is high risk? Is it a percentage? It is when transporting would save X% of babies? Or is it just when a pregnant person has a characteristic on a list, ignoring every other piece of information about that person’s health history, lifestyle, and circumstances. How can we be so pompous as to think that that list is THE list, and it will never change as we learn more, and that maybe, just maybe, we are wrong?
So with that, I’d suggest we stop using this language about “risking people out” and instead start talking about risking ourselves as midwives out. This is a much more honest way for us to talk about these situations that do come up. If you are uncomfortable as a care provider, you have every right to say that, and give your reasoning, and to even tell a mom that you can’t care for her anymore. You can step away from the relationship like any other relationship we enter consensually. We cannot call 911 on behalf of a non consenting parent. There is no ethical place for this in my opinion. We owe it to the people we are working with to treat them like adults that we respect (or we shouldn’t be working with them in the first place). Putting it this way, risking ourselves out as the midwife, allows pregnant women to decide what their next move is, rather than us telling her that she has been removed from the home birth box with or without her consent. So for the pregnant families out there that have been told or might be soon be told they have been risked out, tell your midwife to GO RISK HERSELF.