We have strived to present information on this page that is educational and interesting to those involved in midwifery and birth topics. Several months ago we were contacted by supporters of Abbey Odom to present information on her case. We added a section " atrocity in California" to present the situation in that state revolving around her trial. We linked to her web site. From the information that was presented on the web it appeared that the midwives in her community had turned against her, and those midwives were not being supportive. After traveling to the West coast, Marilyn learned that there was another side to this story (there usually is!). Marilyn personally spoke to a representative of the San Diego midwives who told a different story. Her tale revealed many hours spent in peer review and a midwifery community unfairly portrayed to be uncaring villains in this unfortunate situation. When Marilyn returned we immediately removed our "atrocity" section. We have wished to present the " other side " of what had become a very divisive issue in that community. In keeping with this desire, we are publishing this letter. We feel it gives "voice" to those who have not been heard from. Any comments can be directed to the e-mail address at the bottom of the letter. We apologize to the San Diego midwives for jumping to conclusions and not seeking out their input. Marilyn supports the peer review process that they followed. It is our hope that this letter will help the healing process that needs to happen.

An Open Letter to the World ... A Global Perspective From Deeply Concerned San Diego Midwives

     We would like to set the record straight as to the course of events and issues surrounding the recent trial of Abbey Odam. There has been much criticism of our midwifery community surrounding this situation, and we believe this is due to a lack of understanding of the facts involved. We are all practicing midwives in San Diego County; many of us attend home births and many of us have birthed our own babies at home. We are dedicated to ensuring that the women of our community have choices and that all options for birthing remain available. We know that as midwives we have a responsibility to communicate, cooperate with and support one another. We also have an obligation to the families of this community to aim for the highest standard of midwifery care possible and to ensure that the care is both satisfying and safe. We are blessed to be living in an era that is rich with dialogue and "community" among midwives not only locally but also within our state and nation in the forms of our associations -- the California Association of Midwives and the Midwives' Alliance of North America. Through these alliances with other midwives, we have the opportunity to set our own standards. To this end we have embraced midwifery care that includes the following practices:

--that encompasses the whole woman -- not only her physical but also her psychological, emotional and spiritual being

--that provides or continuity of care through pregnancy and birth

--that upholds the right of the consumer to informed consent and self-determination within the boundaries of safe care

--that functions within a framework of midwifery practices approved by the midwives of her region and her state

--that provides for participation in ongoing peer evaluation

--that provides for professional disclosure statement and informed consent

An Open Letter to the World . . .

     Given our belief in the above standards many of us have had concern for the standard of midwifery care practiced by Abbey for at least the past nine years. This concern has taken many forms. There were many efforts made to provide one-on-one support and friendship to Abbey. These included many phone calls, letters of concern and encouragement for her to seek professional counseling. Throughout this period of time Abbey was invited to participate in peer review. She was unable to follow community standards of care or to embrace a commitment to group accountability. This resulted in a cessation of our peer review relationship with her. Finally in December 1994 an "intervention" meeting attended by at least twenty midwives and Abbey in which it was clearly stated to Abbey that we could not support her practice and warned her that if she continued we had grave fears about birth outcomes and legal reprisals. This has not been an easy situation for our community; we have been faced with difficult decisions at every turn and in the past have repeatedly attempted to provide loving support to Abbey. There has been more than one time that Abbey has agreed to change her practice and then has reneged on her commitment to us. We believe there has been much misrepresentation regarding many of our actions and intent. In addition there has been much confusion as well as lack of information regarding the actual facts of many of the births attended by Abbey. We have been accused of making judgments on "unsubstantiated rumors" and the "grapevine". In reality many of us frequently encounter former clients of Abbey's. Some of us have even attended births with Abbey. There are clearly satisfied women who have birthed with Abbey. There are also many who tell us their birth stories and express having been traumatized by their previous pregnancy/birth experiences. We have heard from mothers who have described their care in great detail and feel that they were "betrayed, abused and violated". Most of us are familiar with dealing with this from past hospital and physician-attended births but not from midwife-attended home births! The recent trial in no way reflects the actual numbers of women who have felt victimized. Each of us personally know several women who have required counseling and therapy in subsequent pregnancies in order to birth successfully after having been previously attended by Abbey. The statement of these facts are not meant to do harm but are stated simply here in order to provide information and understanding. Previous "silence out of respect" on our part has possibly added to the confusion. We believe that there are two issues at play in Abbey's situation that are of paramount concern to all midwives.

An Open Letter to the World . . .

     The first is that of Informed Consent. As midwives, we enter into a relationship with the birthing mother/family that requires us to act responsibly in providing information and guidance. In the intensity of labor when the birthing mom has entered the "otherworldly plane", she will naturally look to her trusted midwife for guidance as to the normalcy of the situation and for assistance in making decisions regarding the process. It is the midwife's obligation to provide accurate and factual information and judgment based on her knowledge and experience. We can predict that perhaps in 5-10% of all births there may be a complication that will arise... we must inform the birthing family of the issues, potential pros and cons of important decisions and thereby empower them to make educated decisions. This process of Informed Consent must be respected, and we must be extremely careful in the way in which we communicate with mothers and families. Each woman is a unique being and has her own special needs for the birthing process. Each woman brings to her birth her own belief system and world view. It is our responsibility as midwives to honor each woman's belief system and to assist her in drawing from that the strength she needs to birth successfully. It is extremely important that the midwife NOT impose her OWN belief system onto the birth mother. We must communicate clearly and utilize language that is not emotionally-laden with ulterior meaning. This is the foundation of true Informed Consent and the empowerment of the birthing woman. The second issue is that it is our duty as midwives to uphold and protect the normalcy of the birthing process. We are the guardians of normal birth; this means we have a responsibility to allow the birth process to unfold without intervention. We must trust the inherent wisdom of the laboring woman's body. If complications do arise, we must know when to appropriately intervene and only to utilize methods that we know can be used safety without adverse effects to either mother or baby. When medical interventions are used, the course of normal birth has been changed. Medications such as Pitocin, when used during labor prior to birth, carry inherent risks, and the birth attendant must be prepared to deal with the outcome of intervention. There are interventions that are clearly not within the realm of midwifery care within the home. The adherence to these standards is how we ensure the safety and continuance of home birth. We cannot endorse or support anything less than a commitment to these standards.

An Open Letter to the World . . .

     As midwives we have a responsibility to gather all information regarding issues facing our profession. When it appears that it is the legal system versus midwifery and/or home birth, we must be especially vigilant in seeking out all the facts involved before making assumptions. Even though historically midwives have been victims of witch-hunts, we must not automatically assume that prosecution equals persecution. This is a dangerous conclusion and may do more harm than good to the future of our profession. It truly is a time for us to move forward in midwifery in our struggle for acceptance. We must not lose sight of our wisdom and discernment.

Written by Catharine Miller and Susan Melnikow May 5, 1997

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