excerpt – The Midwife: A Biography of Laurine Ekstrom Kingston

The Midwife: A Biography of Laurine Ekstrom KingstonPreface

When I met Laurine Kingston, I knew that she represented the type of woman I had studied in my graduate research at Northwestern University and that her profession answered a deep personal quest for an alternative to hospital birth. I could not easily overstate the intensity of dissatisfaction I had experienced with my first obstetrician. In fact, I can document my subsequent search for a better way through the arc of my experiences in giving birth to five babies. I can now see that in each case, I moved closer to finding what I assumed had disappeared with the railroad, which is to say midwives. I was in my mid-thirties and about to deliver my last child when I met Ronna Hand, an associate of Laurine’s, and then Laurine herself.

I was so enthusiastic about my discovery and so pleased with how my last birth went, I applied to work for the Domiciliary Midwives of Utah and was hired to teach classes for them in the psychology of family relations and communications. My Ph.D. was in psychology, and a primary interest had been in the psychosomatic aspects of childbirth. When I met Laurine, she was already legendary as a driving force in the midwifery movement in Utah, and she was impressive. As I watched her teach and assist women in giving birth, I noticed how competent and cool she was under pressure—and I saw her as a role model for young women in a subculture that did not value them. I thought she was the quintessential Utah midwife, and she is! Whereas I had assumed my own life path had been unpredictable and colorful in its various twists and turns, her story outdid mine as a meaningful, adventure-filled odyssey.

Let me explain a little about myself and how I came to have this fascination with midwifery and with one of its key advocates. I was born in the 1940s in the little town of Salina, Utah. My parents, Fae Peterson and Stanley Burgess, were born at home. In their day, people did not know anything different. By the 1940s when I was born, things had changed and most everyone was born in a hospital, even in my case where it meant having to travel far from home. For those who are not from Utah, Salina was on U.S. Route 50, which was famously constructed through the middle of the state without touching any significant population areas. In 1990, Interstate 70 was built, which misses Salina by a few miles. Salina is about 150 miles southeast of Salt Lake City.

We were one of those sleepy outback communities the government disregarded in the 1950s and 1960s when it detonated atomic bombs in the West Desert, letting the fallout drift northeast and land in our gardens. Some of my neighbors contracted leukemia and breast cancer. I noticed recently that one-third of my high school graduating class had died—far too many people for my age group. The Atomic Energy Commission wrote a report that said they chose this area to test atomic bombs because people in the area were “low-functioning members of society.” My father was a multi-millionaire cattle rancher with bachelor’s degrees in animal husbandry and economics. All my aunts and uncles are college graduates. Governor Scott Matheson came from the county, as did the inventor of television, Philo T. Farnsworth. Utah writer Terry Tempest Williams has written about the experience of passing nearby when she was a child and observing one of the pyrotechnic displays in the desert, after which the fallout rained down on the family car. As a result, her family became what she called the clan of one-breasted women. We were all Downwinders.

Aside from radioactivity, Salina had benefits. I wore cowgirl boots until I was sixteen. By five, I was able to drive a tractor and could back up a wagon full of hay into the feed yard. That backing-up ability served me well in my later urban driving experiences. In fourth grade, my public education teacher sent me home and told my mother I was “mentally retarded” because I could not learn the times tables, which the class had supposedly spent all year learning. He said I had wiled away the time reading books instead of paying attention in class. When I arrived home, my mother took me down to the basement and told me to climb up on the wringer clothes washer. She told me I would not be allowed to get down until I learned the times tables. After two hours, we came upstairs. The next day, Mother took me back to school and re-enrolled me, showing the teacher that all I needed was a little motivation because I had learned the times tables in two hours.

I attended Utah State University and then Boston University, where I met and married Eric Olson, a Harvard student. After graduation, Eric was required to serve time in the military in Berlin, Germany, and I was soon commissioned as a first lieutenant in the U.S. Army Reserves. I worked at the military hospital. It turned out to be a famous facility where the Nazis had performed experiments on people. When I gave birth to my first child, Eden, I felt like another victim as the obstetrician gave me drugs, kept Eric outside the room, and took my baby away after it was born and quarantined it because it had a slightly yellow hue. My parents had traveled to Berlin to see the baby but were sent home disappointed, and even Eric and I were sent home to wait for the medical staff to cure our baby of what is, in fact, a normal phenomenon in newborns.

With our next baby, I made demands. There would be no drugs, I said. The nurses, who had never seen a natural birth before, winced during my labor. This was not very helpful. We insisted that Eric be allowed to participate and that the baby not be carried away after birth. They agreed, but put me in a vacant ward so other patients would not see what was happening. The staff thought we were crazy. Contrary to expectations, I delivered Erica without complications and then we happily returned home the next day. We were so happy and convinced we did not need the assistance of doctors, we decided to have our next three children at home.

In 1972, Eric and I were both accepted to graduate school, he at the University of Chicago to study Egyptology and I at Northwestern University to study psychology. My major professor, Niles Newton, had a research emphasis in the chemistry and psychology of breastfeeding. She was known to have almost singlehandedly brought breast feeding back to the United States in the 1960s when her research helped motivate the founders of the La Leche League. What she discovered was the role of oxytocin in human physiology. She called it the “hormone of love” because it contributed to sexual intercourse, as well as to birth and lactation. This had been exhaustively studied in animals because of their economic value but not yet in humans.

Dr. Newton was fascinated to learn that I had polygamous ancestors. She had also noticed that I brought my baby with me to class, breastfeeding her during the lectures, which may have been normal enough in Salina but not in Chicago. Dr. Newton encouraged me to study, as my dissertation was ultimately titled, “The Family Structure and Dynamics in Early Utah Mormon Families between 1847 and 1885.” When I traveled to Salt Lake City to use the Mormon archives, I was told I could only use the resources if I promised not to use the word “polygamy” in my title. That was fine with me because a scholar would call it polygyny in any case, but such was the sensitivity at that time to a topic the Church of Jesus Christ of Latter-day Saints (LDS) was trying to put behind it. Things were more complicated than I can mention here because I received an LDS fellowship for my research, with help from Church Historian Leonard Arrington, who nevertheless would not let me consult the works of early Mormon leader Heber C. Kimball.

When the time came to give birth to number three, I made inquiries in our Hyde Park neighborhood about what my options were and was referred to a prominent physician, Mayer Eisenstein, who had become a home-birth advocate when his own baby was dropped on the floor in the hospital. Dr. Eisenstein said he would be pleased to be my birth attendant. Everything went well. Seth came into the world, I rested for two days, and the next day Seth and I participated in my graduation at Northwestern. Knowing I was recovering, the dean of the medical school escorted me across the stage. We all flew to Utah the next day so Eric could begin teaching at Brigham Young University in Provo, where my fourth child was born.

Trying to find someone to assist me in this birth, I was told that Dr. Roger Lewis was unconventional enough that he might be persuaded to help with a home birth. My neighbor made an appointment and accompanied me, but was surprised by his attire when he entered the room without a smock. She asked if he was really a doctor, at which he hurried out of the room and returned a minute later wearing a white smock. I liked the idea of a physician wanting to meet the requirements of his patients in that way. He said he had never seen a home birth before but would be happy to assist. When the time came, he and my husband, along with our friend Jan Tyler (a godparent we called our goddess mother) and three children, all joined in helping me deliver little Abraham. Dr. Lewis was so satisfied with this, he advertised that he was available for other home births until he was opposed by Provo’s obstetricians and had to retract this offer.

My husband and I returned to military service in Berlin, where we lived and worked for three years. When I decided to have my final child, Zachary, in Utah, it was then that I met Ronna, without whom I would not have been able to deliver a twelve-pound son at home, drug-free. Today Zachary is studying to be a nurse practitioner at the University of Illinois in Chicago. (As a proud mother, I cannot help but mention that Eden is a psychologist, Erica is head of a high school science department, Seth is a retired dancer of thirty-five years and now in nursing school, and Abraham is an attorney who spent many years in the army as a JAG officer.)

I have continued my association with Utah’s midwives. My research prompted me to write The History of Homebirth and Midwifery in Utah, of which Laurine’s career and activism constituted a major part. When I showed the manuscript to Signature Books, they expressed interest in having me expand on Laurine’s life and write a biography of her. I enthusiastically agreed and spent about two hours at a time, twice a week, for a year interviewing Laurine, through her great patience and cooperation, and looking at the photographs and documents that verify her family history. We were thus able to piece together the facts and I was able to offer some interpretation to general themes that emerge as the major focus of her life’s work. Aside from being an advocate for midwifery, I was devoid of any agenda in approaching this project. However, as we got to know each other—even better than we had previously known each other, that is—my admiration for her grew. She is not only a genius, but she is a model for many older women who aspire to age gracefully and remain self-actualized. I have tried to retain a degree of objectivity throughout the book, but attentive readers will notice my hero worship showing through at times.

4.
Midwifery

A midwife can be an obstetrical assistant or a wise woman who has a sixth sense about things. She may be female or male despite the fact that the terms midwife, sage-femme (French, wise woman), Jordmor (Danish, earth mother), and so on traditionally implied women. In some cultures, such as among the Guatemalan Mayans, midwives are also spiritual guides who not only help deliver the child but also predict its future. In most places in the world, throughout history, there have been women who have assisted other women in giving birth. A hundred years ago in the United States, 95 percent of all babies were born at home. Around the world, 70 percent of all deliveries are homebirths, according to Marsden Wagner, a representative of the World Health Organization who spoke in Salt Lake City in 1996 at a midwifery conference.

Home births result in fewer deaths than hospital births, in part because midwives let the hospitals treat complications; but even so, it is worth noting that midwife-assisted births are safe. They are also inexpensive. A midwife charges about $1,000 per birth, including pre- and post-natal visits, while a hospital’s charges begin at about $8,000 for the same services. Another advantage to home birth is the avoidance of technology which, although heaven-sent when things go wrong, create an impersonal and intrusive environment in place of a more comfortable family setting. In fact, there are unintended, harmful effects for some medical treatments women can be subjected to in the hospital, including risks associated with over-medication or over-zealous surgical intervention, which tend to balance out the risks associated with home births separated from the life-saving assistance of medical personnel.

As midwives like to explain, in a hospital environment time is money, so a woman who has been in labor too long will need to have the birth artificially induced. Once that is done, one thing can lead to another. For instance, the woman will probably be given an epidural analgesia, by which opiates are injected into the spinal column, eliminating sensation in the lower body. This lessens a woman’s ability to control her muscles and means that the doctor will probably have to remove the baby with forceps or a suction cup called a ventrouse, if not by caesarian section. All of these procedures have unusually high rates of occurrence in Utah, according to Dr. Wagner.

From the standpoint of a midwife, the mother should deliver her own baby, with only as much intervention from the midwife as is necessary. Midwives have a saying that “mothers give birth,” not health care providers. To a midwife, birth is a natural phenomenon, more like sneezing or some other bodily function than a disorder that requires surgery. They have a high tolerance for extended periods of labor, false starts, and longer recoveries if necessary. They see birth as a peak experience that a mother should fully participate in. As she gives birth, her body produces oxytocin, which creates the strong bond between mother and child. If the mother is overwhelmed by drugs or medical technology, she misses the effects of her body’s natural drug. Birth involves pain, but it can be managed more comfortably at home, all things considered. For example, squatting is more comfortable for a birthing mother than sitting upright or lying flat. Lying in a hospital bed is convenient for medical personnel, not for the mother. In studying births cross-culturally, researchers have found that mothers giving birth in natural settings most often kneel or squat to give birth.

There is a formal career track in the United States to becoming a Certified Professional Midwife (CPM) involving a rigorous written exam and an evaluation of the midwife’s performance in the field. Tests are administered by the North American Registry of Midwives in about half the states. There are also Certified Nurse Midwives (CNMs) who receive a B.S. degree accredited by the American College of Nurse Midwives. The CNMs assist obstetricians in the hospital. The University of Utah was one of the first schools in the country to initiate the CNM degree. In addition to these, there are lay midwives, who are uncertified birth assistants. They sometimes refer to themselves by other terms such as Christian birth guides or community midwives. In any case, they resist government regulation of their craft. As an LPN, Laurine was a special case. Although initially it was difficult for her to navigate the dangers of serving the polygamist community, for whom many births are themselves evidence of a crime, eventually she became certified with the state (CM) through the Utah Midwife Association.

Laurine entered midwifery as an assistant to Rulon Allred. Other lay midwives take this route of learning at the hands of an experienced midwife through a multi-year apprenticeship. Those seeking formal training enroll in a university curriculum, and the level of schooling determines whether a midwife will practice in a hospital and rely mostly on modern medicine or practice out of their home (including sometimes a tent, teepee, yurt, or cave) and rely more on herbal antidotes. Some midwives wear gloves and some do not. Traditionalists sometimes accompany the birth with prayers, chants, or aroma therapy. Lay midwives are keen observers of a mother’s state of being and derive what information they need from auscultation and various body measurements, which they follow up with nutritional herbs, massage, and good advice, not only for the delivery but for life in general. Auscultation refers to listening to the baby’s heart through the uterine wall.

A good midwife makes plans for emergency support if things go wrong. If she can tell during a consultation that a birth will likely involve complications, she often refers the woman to a clinic, hospital, or mental health facility, depending on the need. Midwives also refer women to lactation stations and other resources. They will generally decline to assist in the birth of twins, births to diabetic mothers, premature births, ectopic (fallopian) pregnancies, prolapsed umbilical cords (when the cord precedes the baby), and placenta previa (bleeding). However, if the mother is within the 95 percentile of normalcy, the midwife will provide a safe, harmonious birthing environment that includes accommodation for the woman’s husband, parents, and in-laws, who also need attention during the birthing. Midwives know that it is difficult for the baby’s grandmother to see her daughter go through birth. If the grandmother’s anxiety can be turned into a calming influence, it will be passed along to the nervous mother.

For some women, home birth meant a stay at Laurine’s house. Like Blenda and Ernest Ekstrom before them, Laurine and Leon Kingston offered their house to anyone who needed it to give birth and convalesce, as in this instance. It sometimes involved a consideration of privacy for polygamous wives.

A short history
After World War I, there was a significant increase in hospital deliveries in the United States, and beginning in the 1930s home birth, breastfeeding, and midwifery went into decline. Americans had come to worship science and the so-called “specialist care” provided by doctors, most of whom were male. The beginnings of Board Certified Obstetricians emerged, most of whom did not want to travel to people’s homes because it was not cost-effective. Family doctors continued to perform home births along with other emergency calls but did not have a lot of time to devote to it. Obstetricians came to think that their services were indispensable, not just for difficult births but for normal deliveries, and that women were more or less incapable of giving birth on their own.

Prior to this development, hospitals were the places one went to die or nearly die. In that sense, it improved the hospital’s image to include birth in its repertoire. Health insurance companies proliferated during this time and preferred the efficiency of hospital staffs, especially in managing paperwork. This was also the era of a new drug cocktail called “twilight sleep” (Dämmerschlaf), a type of anesthesia developed in Germany whereby women were injected during labor with morphine and scopolamine and the baby was pulled out with forceps. When the mother recovered, she retained no memory of the birth. Doctors referred to this procedure as the “knock-out, drag-out” approach.

Later, intravenous drugs were replaced by “epidurals” injected into the epidural space in the lower back. As Grantly Dick-Read, a famous British obstetrician, put it, epidurals made it possible for a doctor as “magician” to deliver a baby through “a paralyzed birth canal.” Of course, women don’t want to experience pain in birth or otherwise and are understandably apprehensive about being able to withstand the intensity of it. They enter the hospital afraid that the pain may become so intense, they will regret not having asked for anesthetics. In contrast to this, midwives prepare women for the pain through exercise and mental tasks that are partly designed to help them with their fears. The women are reminded that by giving birth naturally, they protect their baby from the bad effects of the drugs they would otherwise be subjected to. Once a drug is delivered into the mother’s system, it affects the baby just as much as the mother. Nor is the drugged woman able to fully participate in the birth process, which is less than ideal. If she can report on and interpret the pain, her feedback is important to the midwife.

A naturally occurring morphine-like substance, beta-endorphin, saturates the mother’s and baby’s bodies during labor and delivery. With oxytocin, it helps create a euphoric peak experience that at least momentarily overcomes the pain of childbirth and is enjoyable. Christiane Northrup, an MD who writes about women’s health issues, calls this feeling one of “joy, love, and ecstasy.” The feeling is abbreviated in the hospital experience where everything is hurried up, the sensations masked by pain relievers, and a woman only spends, on average, two hours and fifteen minutes with the obstetrician, including pre- and post-natal care, according to the Wasatch Childbirth Educators Association.

One argument people give for hospital birth is cleanliness, but despite appearances, homes are generally more germ-free than hospitals. Sick people bring a constant infusion of fresh pathogens into the hospital, whereas at home, the fetus is already accustomed to the germs the mother encounters there. According to a 2011 American­ Association of Retired People Bulletin, there are about 100,000 deaths each year in the United States from infections that are contracted in hospitals. Who would want to have a baby there? Especially since a hospital room is less comfortably appointed than a living room or bedroom. Through the 1950s, hospital birth became even less comfortable when fetal monitoring machines were introduced like something out of a futuristic horror movie. The laboring women were strapped to the fetal monitors, making their labor even more unpleasant. A survey in Britain in the early 1980s showed that many of these machines did not work properly anyway, but doctors loved them. For the mother, it wreaks havoc with her ability to bond with the emerging child.

Midwifery in Utah
There have been famous midwives in Utah history. Many people know of Patty Sessions, for instance, who traveled long distances to help women deliver a total of 3,977 babies. In pioneer times, the midwives knew more about birth than doctors, who often lacked proper training, and the midwives were more trusted in any case.­ ­Patty’s low opinion of doctors is well-known, as is the support she enjoyed from Mormon leader Brigham Young,­ who thought it made perfect sense that women should assist women in childbirth. For a similar reason, he promoted the training of female obstetricians in the l870s. Eliza Snow, one of Young’s plural wives, said at a meeting of the Women’s Retrenchment Society that women should­ become doctors in order to keep men out of delivery rooms.

The first Utah woman to earn a medical degree was Romania Pratt. In the fall of 1874, she traveled to Philadelphia and entered the Women’s Medical College (WMC) of Pennsylvania. Founded in 1850, it was the oldest and most prominent college in the country to offer M.D. degrees to women. Another Utah woman, Ellis Reynolds Shipp, enrolled in the same college in 1876. As a polygamist, she enjoyed the support of three sister-wives who raised her children while she was away. She gave birth to her sixth child in 1877 in Pennsylvania, where she hired the landlady to look after her baby while she completed a residency at a nearby hospital. Dr. Shipp would eventually have ten children, so her obstetrical work was enhanced by her own experience.

Ellis’s sister-wife Margaret (“Maggie”) enrolled in WMC in 1875 but soon returned due to homesickness. Upon Ellis’s graduation and return to Utah, Maggie found the determination to go back east and re-enter the college, earning her medical degree in 1883. In Salt Lake City, Dr. Ellis Shipp opened a School of Obstetrics and Nursing in the fall of 1878 to raise up an army of midwives, as she said, to provide for birthing mothers in every Utah community. By 1893, one hundred graduates had been certified for obstetrical work. The Utah State Board of Registration licensed a total of 467 midwives between then and 1906, leaving no doubt as to the thriving demand for their services.

From 1877 to 1881, Dr. Ellen Brooke Ferguson practiced medicine in Utah and taught classes to “ladies” in anatomy, physiology, obstetrics, puerperal disease (infection relating to the placenta), and diseases of children. She was a suffragist and defender of polygamy, which she believed gave women with the aptitude for a career the opportunity to work outside the home. While one woman went to school or worked, a sister-wife could care for her children while another did the housework, each one performing tasks according to her interests and abilities.

Male physicians were getting as much schooling and experience as the female doctors by 1920 but did not immediately replace midwives. They either worked as general practitioners and left birthing to the women or specialized in fields unrelated to reproduction. Dr. Shipp continued to teach her obstetrical course through the 1930s, although a circular issued in 1927 indicates that her school shifted its emphasis to nursing. This was a reflection of the advancing medical professionalism in Utah, which nearly squeezed midwives out of the picture. Obstetrics as a field of specialty was offered to men in the 1930s, and over time they began to take over the discipline. There was a growing sense in the twentieth century that women belonged at home and that men should be the wage earners in the family. This was a concept that had not previously prevailed in America as an explicit expectation where colonial women had helped run the shops and taverns and do the farm chores alongside the men. Even at home the women ran cottage industries, manufacturing sausages, candles, clothing, and soap and running such errands as taking grain to be milled.

The resurgence of home birth in the late 1960s came by way of the hippy, natural food, and anti-industrial trends of the day. One of its Utah advocates was David Warden, an army flight surgeon who had been to Vietnam and was now the base surgeon at Fort Douglas, overlooking Salt Lake City, as well as being a member of a Mormon bishopric. His wife, Mary Lou, a nurse, was equally enthusiastic in promoting natural birth. They answered people’s questions about technical issues surrounding home birth; for this, they were often denigrated by other physicians, and David had the impression that some opposition came from the Mormon Church, which took advice from prominent members who were physicians and were advocating modern medical practices. The Church was concerned about appearing backward or odd in promoting anything outside of the mainstream of American life.

In 1974 at a seminar on home birth in California, Dr. Warden and his wife met Ronna Hand, who herself had years of experience in home birth and had worked as a midwife apprentice to a physician whose specialty was high-risk pregnancies. She was a Latter-day Saint, so he encouraged her to come to Utah. After being in the state a short while, Ronna was surprised to discover how much hostility she encountered from physicians opposed to midwifery. She nevertheless organized the Domiciliary Midwives of Utah to train midwives and childbirth educators. Home-birth folks comprised an odd coupling of hippies, polygamists, progressives, and Old World traditionalists, all of whom found their way to her Birthing Center in Kaysville after its inauguration in May 1980. Laurine joined the Domiciliary Midwives and sat in on some of Ronna’s classes and even tried unsuccessfully to learn Spanish; she offered her help as a midwife for some of the births at the center. She enjoyed the home-like atmosphere of the center and the support from a handful of physicians who would step in when nurse- and lay-midwives encountered complications. The center also energized the opposition by obstetricians, who insisted that home birth was foolhardy and counter-cultural. Home birth had done an about-face since the days of Brigham Young.

In spite of this opposition, the home-birth movement became increasingly popular. Even at the start in Utah, at the first meeting Warden and Hand organized, about a thousand people attended. By 1997 the Associated Press could report a thawing in the initial chilly reception obstetricians had given to midwives, who that year had assisted in some 200,000 hospital births, in addition to helping a growing number of mothers deliver at home. Nearby New Mexico, due to its culture and encouragement by the state, had the highest number of home births in the country, 20 percent.

The legal fight
In 1981 the Utah State Legislature entertained an attachment to a bill making home births illegal. The support for this bill waned after opponents asked the legislators who had been born at home to stand. The majority of older members stood. The legislature decided to create a committee to investigate the matter, and that was the end of the issue for the time being. Another effort was made in 2005 to ban home birth, but proponents of natural birth rallied support and saw House Bill 25 pass, legalizing lay midwifery and making it easier to give birth at home. It seemed that whenever attacked, the midwives gained ground rather than losing any.

The new law established education and training requirements for midwives and listed medicines they could administer. For example, the Rho(D) shot, which is used when the mother’s blood type is Rh negative and the ­father’s is Rh positive, was allowed. Oxytocin, which increases the intensity of uterine contractions during a slow birth, was put on the list of medications a lay midwife can administer. It was illegal in the past for them to use any synthetic drugs or even forceps—not that they were ­eager to use either. Most of them are, to various degrees, opposed to artificial ways of controlling birth and many have resisted the certification that is required to administer RhoGAM, Pitocin, or other manufactured drugs. In that sense, they are in agreement with the Utah Medical Association (UMA) efforts to modify the Direct-Entry Midwife Act of 2005 to keep high-risk births away from midwives. By “direct-entry,” the act refers to midwives who enter the profession without formal medical training, directly from the general population.

Despite some continuing opposition from obstetricians, Utah now sees about 600 home births each year, according to the state Office of Vital Records. This means the state has twice the national average, even without estimating the number of births that escape detection by Vital Records. It means that home birth remains an attractive alternative for healthy, low-risk women. For their part, lay midwives remain renegades in some ways, resisting bureaucratization and coming into conflict with nurse midwives, who resent the lay practice of medicine without having gone through the rigors of a formal education. Occasionally the state has prosecuted midwives for the unauthorized use of drugs. In 2000, Elizabeth Camp-Smith, a St. George midwife, was charged for administering Pitocin, though a plea bargain reduced the charges from felonies to misdemeanors.

Not all midwives are as competent or careful as King­ston. In March 2012, two certified midwives had their licenses suspended in Idaho when three babies died at their clinic. In two instances, the women had delayed calling for help. Laurine feels that a birth assistant should be careful not to “wait until the last minute before seeking medical assistance. Doctors make mistakes too and are disciplined for it. Midwives should be held accountable, according to their level of proficiency.” Laurine is quick to point out that “midwifery is by nature amateurish” and “not the same thing as the practice of medicine.” “Birth is natural,” she explains. “It is an individual’s right to give birth at home, assisted by the father and a midwife. This is simple and preferable to treating birth as a surgical procedure.” Where midwives and doctors are able to work together or in tandem, it produces a good result. When not, tragedy can occur. The real problem, though, may be that in Idaho there was already tension between the midwives and doctors, which is a shame.

Philosophy
Laurine describes the role of the traditional midwife as that of a dwindling minority. She says her clients, like the midwives themselves, were the “salt of the earth,” people who “chose to take responsibility for themselves” rather than turn over their health and safety to a bureaucratic medical establishment. She adds that “birth is 97 percent completely normal,” requiring little artificial intervention. Occasionally things go wrong, and “when you have a bad experience, it sticks in your mind and makes you cautious, sometimes overly cautious.” Of course, “this can happen to anyone in any profession.”

“When I enter someone’s home,” she continues, “a child will sometimes announce the arrival of what she calls ‘the baby doctor.’ I say, ‘No, I am not a doctor. I am the baby lady.’” In homes where she has helped deliver several babies, the older children know that her presence suggests the imminent arrival of a new member of the family. Laurine sees herself as “a loyal friend” rather than a doctor. She is there to help “clean the house, get the washing done, prepare food, make phone calls, and do whatever it takes to help. I have medical training and have taken classes to prepare for home-birth emergencies, but my list of teachers includes husbands, grandmothers, babies, and even animals.”

She has found that she loves “all kinds of people. I look deep into their hearts for whatever needs and potential they have, and that awakens a desire to nurture. It gives me a zest for the adventure of life. The memories I have of people are priceless.” She says that if she were creating a woman’s body, she would not put reproduction and elimination in the the same area. She would put sensation under one arm pit and reproduction under the other and keep them both separate from elimination, which she would keep between the legs. It seems to her that having sensation, reproduction, and elimination all together in one area confuses the mind. There is no sexual sensation associated with pregnancy and childbirth. If reproduction were separate from sensation, then maybe people would make it a more conscious decision to have children. It would also be cleaner and more pure. But in this world, “we have to deal with reality, and it happens to be messier than the ideal we hold in our minds,” she says of beatific women blissfully nursing infants in filtered light.

“As I apprentice aspiring midwives,” Laurine reports, “I caution them that they should not work so hard that they burn out. It is a demanding practice that requires twenty-four-hour accessibility.” The divorce rate among midwives is high. Midwives, she says, are like goats among sheep, and “goats have more personality.” The midwife needs to be an entertainer and comforter. She likes to draw analogies between animals and humans, reminding women that animals deliver their babies without any assistance and do just fine. She adds, tongue-in-cheek, that it is a matter of superior intelligence that animals do not need doctors.

Her philosophy includes the traditional concept that the baby is imprinted by the circumstances of its delivery, including who is there and what the atmosphere is like. Those initial impressions leave a blueprint that remains with the individual until death. She also believes that the child is an important, sentient participant in the birth, too often taken for granted at the hospital. Sometimes when she is confused during a prenatal examination or birth, Laurine asks the baby what it is trying to tell her. She thinks the midwife needs to be able to feel the body and the spirit of the baby and considers it a privilege to be present at its birth. In some way, she says, the baby chooses to be born. She draws on an idea taught by Mormon founder Joseph Smith that human beings exist prior to their mortal existence as unembodied spirits which are intelligent and will themselves into the families where they end up. She believes the spirit enters the body at conception but loses its memory of a past existence and matures along with the body.

In order to be up to the challenge of assisting a birth and communing with spirits, Laurine feels she needs to be in good shape physically, spiritually, and mentally. She also needs to recognize the limitations of her abilities and ask for help when needed. She tells apprentices it is not a shame to step back and refuse to assist a birth they do not have a good feeling about or lack the strength to see through. They need to be able to introduce optimism into a home. She asks potential midwives if they can maintain a positive attitude in the face of tragedy, if they can accept God’s will over their personal desires, if they can tolerate stress with a clear mind—taking criticism without becoming discouraged and receiving praise in the same modulated way. If not, they might be headed in the wrong direction because midwives come from a tradition that draws on nurturing, spirituality, and healing as epitomized in the work of such pioneers as Hildegard of ­Bingen, Maria Montessori, Anne Hutchinson, and Elizabeth Fry, as well as more recent models such as Mary Breckinridge and Jeanne Prentice.

The “baby lady” with a newborn. Laurine understood that an infant leaving its aquatic environment and learning to breathe for the first time is in shock. She would whisper in its ear, reminding it that it was now on stage and needed to speak the first lines in the drama of its life.

Methods
Laurine considered herself and her clients to be a team, acting in concert as they followed the lessons of experience and of nature to produce a healthy baby. The mother was a thermometer gauge for the condition of the child. The child had needs that were sometimes obvious and sometimes not. The same was true for the mother. Through about 3,000 births, Laurine never lost a mother, nor a baby without first seeking emergency hospital care.

The way she ran her practice, she would begin by interviewing a client to determine whether or not the mother was suitable for home birth. If the woman needed financial help, Laurine would help her obtain it. She would tell a first-time mother she needed to undergo a consultation with an obstetrician and, for moral support, would often accompany the young expecting mother to the hospital as her “birth coach.” She would also insist that a young woman receive an overall physical examination and blood work before they proceeded further. The first baby will always be difficult for a mother, not yet knowing what to expect and not yet having experienced the changes her body will go through, after which it becomes easier for her to give birth again.

During the interview with a prospective client, Laurine­ would ask why the mother wanted a home birth. In addition to considering the answer, Laurine would watch carefully to study the woman’s body language to know how comfortable she was with what was to come. Laurine would ask about the woman’s medical history, especially injuries and surgery. It was important to know if the woman was prone to bruise easily or if she had any veins that bothered her. Laurine wanted to know about hormones, the thyroid gland, the general shape of the abdomen, and neurological problems. Allergies were considered, the results of the woman’s last gynecological exam or pap smear, and the condition of her teeth, eyes, ears, and nose. Laurine asked how many sore throats the woman got each year, if her skin had changed with the pregnancy, and what her emotional state was.

Sometimes when the husband was in the room, which Laurine encouraged, he would answer for his wife. Later, when Laurine was able to talk to the woman alone, for instance on the phone, she learned that the man wanted a home birth and the woman did not. If the woman answered questions differently on the phone than in front of her husband, this piqued Laurine’s interest to dig a little deeper to see whose thoughts were being communicated to her.

She also asked the client to provide a family medical history in areas that midwives know are predictive of a woman’s childbirth success, where a mother or sisters might have undergone difficult pregnancies, drawn-out labor, or c-section births. Laurine had young women ask their mothers whether they had taken synthetic estrogen (diethylstilbestrol) after giving birth. Although this was no longer done, it was indicative of a vaginal inflammation or some other problem. Laurine gave each woman a form to take home and fill out regarding birth control and sexual behavior, how they slept, whether they had a cat, and other probing questions. She asked them to think about a designated driver who could take the birthing mother to the hospital if necessary. Laurine asked the women how their family would react if she or her child died within their home. She was amazed by some of the answers, some of which were painfully honest and others remarkably superficial, all contributing to some degree to how Laurine proceeded with the client.

At prenatal visits, Laurine liked to invite the children, husbands, sister-wives, grandmother, and anyone else the mother felt comfortable about having on hand, all of whom were also told they could attend the actual birth if they so desired. Laurine told the children what a special event it was to have a baby. Speaking to the entire family, she would ask about the state of cleanliness of the bathroom, the bathtub especially, because, as she would explain, that is where the mother would need to bathe before and after birth. She would enlist the family members to help clean it, sometimes showing them exactly how to do so. She directed questions to the mother regarding the fetus’s movements, its personality, and how she was bonding with it. She checked the mother’s blood pressure and listened to the baby’s heart tone, also measuring the fetus’s growth. She showed the prospective mother how to weigh herself and check for protein and glucose levels in her urine.

A former client took notes on how Laurine led her through the birth of her child, including what occurred during the visits before and after the birth:

l. First visit. I filled out paperwork just like in a doctor’s office. She asked me about my:

a. medical history
b. birth history
c. family’s/mother’s birth history
d. why I wanted a home birth

2. Second visit. Prenatal examination.

a. We discussed the first trimester of baby development
b. She taught me Lamaze breathing techniques

3. Monthly visits.

a. She would ask if I had noticed any changes to my body, positive or negative. I would get a new assignment to practice for the birth.

4. Semi-monthly. After the thirtieth week since my last normal menstrual period, she wanted me to visit her every other week.

5. Thirty-sixth week. I began visiting her weekly.

a. She gave me a list of things to procure for the birth
b. She reviewed the procedure in case I had to be transported to the hospital, what to expect at the hospital, and which hospital we would go to.

6. Fortieth week. She occasionally telephoned and made herself available for calls.

a. She told me to call as soon as my contractions started, the mucus plug was expelled, or my water broke
b. She asked for directions to my home and visited me there

7. Labor. Laurine was in and out of the house every few hours, and after I was at about six centimeters she stayed with me.

a. She organized all of her equipment on a small table in my bedroom
b. She encouraged me to sit on the exercise ball and move around on it until I felt comfortable
c. I enjoyed being in the bathtub, so she showed me a technique where with each contraction she poured a pitcher of water over my pubic bone area. This helped to increase the effect and lessen the pain of the contraction.

8. Birth.

a. After I was at nine centimeters, she encour­aged me to find a position I liked and felt comfortable in for pushing
b. She stayed for an hour after the birth

9. Post-partum care. She came back twenty-four hours later.

a. She changed the baby’s diaper to check the color of the stool
b. She made sure I had my antibody titer count completed for a RhoGAM shot
c. She called every twenty-four hours and came back three days post-partum to see if my milk had come in and how the baby was nursing

… continued.