Welcome to the “Ask Her Anything” Series at The LightHouse Birth Collective!
(Spoiler Alert: It’s the most fantastic Interview Series you’ll ever read. I’m just telling you now.)
“Ask Her Anything” is the fresh, brutally honest cousin of ‘The Boring Old Interview.” In this unprecedented opportunity, The LightHouse is merging nearly three whole centuries of our Members’ combined birth experience with the chance for prospective clients to be brave and ask the questions that are really on their minds.
One by one, our Midwives, Doulas, and Birth Photographer are answering all kinds of questions that were submitted by our followers – real reader questions that deal with pregnancy, partners, childbirth, and beyond. The questions are intimate, they’re vulnerable, and they’re raw – much like the childbearing year itself – but if you know “birth folks,” you’ll know that they love a good challenge, and our Members didn’t hesitate to tackle even the toughest questions.
It’s hard to know how to introduce a midwife like Karen Webster. All of the standard things come to mind, of course, like “Certified Professional Midwife, Licensed and Practicing in Delaware and the Greater Philadelphia Area.” Maybe “Nationally Certified and State Licensed.” “Mother of Eight, and Midwife for 38 years.”
I could go a little deeper, too, and introduce Karen as a trailblazer – as the first practicing CPM in Delaware, or as the midwife who fearlessly and singlehandedly took on the State in defense of the rights of the families she serves. I could share with everyone that she’s helped create precedent-setting midwifery legislation in multiple states, and that she’s been a highly respected preceptor to students for several decades.
All those things are true about Karen, of course – but that’s not why Karen has been so successful as a home birth midwife. Those well-earned accolades are not why her clients are so fiercely loyal to her. That resume isn’t why her home is always buzzing with the busy warmth of mothers, babies, clients, family, and friends. It’s not why, against all of the odds, Karen Webster has survived.
In this intimate “Ask Her Anything” interview, we’ll find out why midwives are so much more than their resume – even when that resume is 1,000 babies long.
Ladies and Gentlemen, without further ado – Mrs. Karen Webster, CPM-DE.
- Why are there so many rules about home birth midwives attending VBACs at home, or about attending twins? Do you think those rules are evidence-based, or not? How do you feel about twins or VBACs at home? – CH
This is an interesting question and one that has been central to my practice for many years. Here’s the short answer: midwives are trained to attend twins, and VBACs, who fall into a low risk category. As midwives, we have protocols and the training for safely facilitating these births. If you’ve had a previous c-section it is a good possibility that you will be a candidate for a home birth or HBAC. Those at lowest risk have had one previous c-section, have a low transverse incision, eat a healthy diet, don’t smoke, and have waited a year after surgery to become pregnant. If you’ve already had a VBAC, that’s another plus.
Because of the very steep rise in C-sections in this country since the 90’s, I believe home birth midwives are seeing many more first time mothers choosing home births, because among other good reasons, they want to avoid a primary c-section and they know that staying out of the hospital is their best bet for accomplishing a healthy, safe, normal, vaginal birth.
While some larger hospitals do allow a trial of labor with an intent to VBAC, the restrictions they impose on women make it very difficult to actually accomplish a vaginal birth; An IV in place, intermittent or continuous monitoring with an electronic fetal monitor (EFM). Induction by hormonal means increases the likelihood of a repeat c-section, as does imposing an end date to the pregnancy prior to term, which is defined as 37 to 42 weeks. In many states, smaller regional hospitals don’t even offer VBAC as an option, citing the lack of 24 hour on site anesthesiologists. It makes you wonder what might happen at one of those regional hospitals if they received a serious car accident victim in the middle of the night.
A healthy, low risk pregnant woman desiring a VBAC has about a 8 – 11% chance of achieving that in a hospital that ‘allows’ VBAC. In my own practice, the rate of successful VBACs has been fairly consistent at around 80%. I have kept my own practice statistics since 2000.
Twin births at home are a tough subject; I believe there are only 2-3 states that allow midwives to attend twin home births. In Pennsylvania, where CPMs and other non nurse midwives remain unregulated, there are many twins born at home. Many of those twin births take place in the Amish and Mennonite communities. While twins have some unique risks, they are still considered a normal variation in birth and midwives are trained to care for low risk twin pregnancies, and yes, twins can and are often born safely at home!
Remember, our health care system is not driven by evidence, but by liability issues. My true opinion is that if we had a health care system that was evidence based and driven, and women knew they could expect to receive truly supportive, evidence-based care, not biased by the institutional fear of litigation, then women could expect to have VBACs and twins, and perhaps even vaginal breech births in the hospital. Look at the research and practices in other countries, such as Canada and Germany, with regard to breech births. The medical guidelines have changed in both those countries because evidence points to vaginal breech birth as safer than surgical birth, for both mother and baby.
- Have you ever had a miscarriage yourself, or lost one of your own babies? Do you think that experiencing that loss has an impact on who you are as a midwife, or not? – MG
I had a fetal demise at 20 weeks between my first two children. I was young (20) when I had my first baby. I was nursing exclusively but at 10 weeks postpartum, found out I was actually pregnant when I went in for my postpartum visit. What a shock! That taught me not to rely on breastfeeding as my only mode of birth control. In any case I carried that pregnancy to around 20 weeks when I began bleeding heavily and then cramping. I went into the hospital and because of the heaviness of the bleeding, was given a D & C. Apparently I had had a fetal demise at around 18 weeks and my body was not ready to let go.They did not give me a transfusion, so I was kept in the hospital for 3 days, and I’m sure I was severely anemic. That was over 43 years ago and at that time they did not provide breast-pumps so my exclusively breastfed daughter, then 6 ½ months, was not even taking a bottle and we had just introduced her to a sippy-cup. It was a very tough time for all of us.
I did have 2 more miscarriages, fairly early in pregnancy, and my body completed those very efficiently, though the labor was shockingly like laboring with a term baby. Those miscarriages gave me a very different perspective on how well our bodies work, most often, to complete miscarriages as well as to give birth. Our bodies are well designed and if we can take a watchful approach, with good support, we are most often able to complete miscarriages with little or no intervention.
Those experiences formed the way I have been able to support women through miscarriages, and if they wanted my physical presence, I was very comfortable being ‘with women’ through miscarriages, as well as births. I have to say that I really can’t remember a time we had to transport into the hospital to complete a miscarriage, but of course there are exceptions and I wouldn’t hesitate to transfer to a hospital if we needed to. I think that women need as much support with miscarriage as they do with birth, and sometimes more, because of the unique emotional aspects that a miscarriage brings. I have also midwifed a few mamas through fetal demises at home and that is a very humbling experience. Every birth I witness teaches me how incredibly strong women are and how beautifully designed we are. Birth is powerful.
- Have you ever been pulled over for speeding on your way to a home delivery? What did the police officer say when you explained why you were driving so fast? – NC
Why, yes – I have most definitely been stopped many times while on the way to births, and most often, once the officers learn my purpose, they send me off with words of caution. Twice I was actually given tickets, though. One of those times, I actually missed the birth because the officer wouldn’t let me go. He suggested that the parents should just call 911 and go to the hospital where babies are supposed to be born. Amazing…
- I know it’s very common for midwives to be divorced. Are you divorced? If not, how has your marriage survived the grueling lifestyle when so many others have not? – RT
I have just entered my 48th year of marriage, so I’m an anomaly among midwives. I married young and that first year was rough, for sure! For the first ten years I was a wife & mother, as well as school volunteer, baker, saver of wounded people, etc. I entered the vortex of midwifery through the home birth of my eldest son; my first midwife-attended birth. From that moment on, I was a changed woman, and have continued to grow in ways that I know were challenging for my husband and family. I am not the person my husband married, but I think we’re both stronger and work more as partners than ever.
You know that saying ‘it takes a strong man to be married to a midwife’? It’s true; but it’s also true that a midwife’s husband has to be compromising, empathetic, have a listening ear, and a damn good sense of humor. And we fight, oh yes, we do. But here we are.
The way it’s worked for us is that I have checked in often, with my husband and children, to see if I needed to take time off from midwifery & birth activism, because the ride I took them along on was often very bumpy. They never wavered, through some pretty rough times. I won’t recount for you how many days & nights I got called out when I had a sick kid, or had to miss one of my children’s birthdays, or dance performances/horse shows/ school awards ceremony/fill in the blanks. Somehow my family has remained steadfastly supportive, and I’m still married to the same guy after all these years. And there’s no one I’d rather be with than my kids and grandkids, though, as an active midwife, I don’t get to hang out with them enough.
I have carefully kept my practice small enough so that I haven’t sacrificed my marriage and family, though we all get pretty stretched sometimes.
- What’s the most beautiful family tradition you’ve ever seen upheld during a birth experience? What’s the most unusual? – CL
Well, I have two stories to tell about this. The first is that I have caught 10 of my 12 grandchildren, at home. (My other two grandkids are adopted.) It has been such a pleasure to watch my 6 daughters and two sons care for each other during the births of their own babies! In our family, everyone is involved, if they want to be. I was very careful not to impose my beliefs about home birth or any expectations that my children would choose home births with me as their midwife. But what a wonderful thing it has been for our family.
The second story is one of a young couple having their first baby with me. The labor and birth went well. The couple decided to give birth at their family’s home and so were surrounded by so many loving family members. Of course for the actual birth, I think it was just the midwives and maybe a sister or two in the room, but after the baby was born and everyone settled in, I had a repair to do. It was early evening, and the tear was a bit complicated, and took some time. Our set up for suturing was a bit awkward, with me positioned on the bed bending over. My legs fell completely asleep!
Not too long into the process, two or three of the mama’s sisters came into the room and stood behind us and sang the most beautiful A Capella hymns, in amazing harmony. Even the mama joined in and I have to say that the sense of peace & wellbeing that unfurled in that room was something I’ve never experienced. It’s hard to really describe it but it’s a birth I will never forget.
- What do you think is the best compliment that you as a midwife can receive from a client, and why is that specific thing so meaningful to you? – JJ
Well, this one is an easy one for me; having given birth to eight children myself, I am fully aware of who does the work of birth! As a midwife, my purpose is to be a guide, resource, and guardian of the birth process., but the most important thing I can do is to make the woman the center of power at her birth, so that when the baby is born, the woman’s husband, midwives and children can marvel at her strength and power, and everyone knows who gave birth! The mother!
So the best compliment I can receive as a midwife is to just step back and watch the family welcome the new baby, in confidence,with wonder, knowing they are safe and they did this together! If any mother says to me after her baby is born ‘I couldn’t have done this without you’, then I have failed, because as a midwife my job is to hold the space for women and their families to do the work of birth, not to direct, or take credit for what they have accomplished.
Don’t get me wrong; it’s lovely to be welcomed into so many families as an honored guest, but that is really what we are – guests in their home & lives for a short time. And yes, sometimes, my expertise is very valuable and even life-saving, but most often birth unfolds at it’s own pace and mothers know how it works best for them… Midwives make sure that birth unfolds safely and if we need to step in, we do. If a situation is going outside of our curve of ‘normal’ and we can’t steer it back to normal with low tech-support and intervention, then we transfer to the hospital.
I have a rich, full life of wonderful memories because of the work I do, but first, I have a wonderful family – and my priorities are based around that.
Karen Webster, CPM-DE is the owner and traditional midwife behind WomanWise Midwifery, and she serves families all over DE (and the Greater Philadelphia Area). You can view her professional profile and contact information here, on her LightHouse page, and follow WomanWise on Facebook. Don’t hesitate to reach out to Karen to schedule a consultation for your upcoming home birth – and if you loved her interview, let her know!