Peggy Vincent: Conversations with a Modern Midwife

(Photo by Colin Vincent, Courtesy of Peggy Vincent)

First time author Peggy Vincent lives life large, pursuing her interests on fast forward in the progressive-thinking San Francisco Bay area. In her memoir, Baby Catcher: Chronicles of a Modern Midwife, we see her passion and enthusiasm for life as well as her humor, pathos, disappointments and joys in the decade she served Berkeley as a midwife specializing in home delivery.

Almost as exciting as her midwife memoirs, the publishing of her first book quickly developed into a Cinderella story. Her first venture into publishing began with a rare six-figure advance from a major publishing house, followed by one achievement after another, including a listing as an alternate in two book clubs. Now as Vincent prepares to step out on her first ever book tour, she pauses to answer a few questions.

Crescent Blues: Congratulations on receiving positive reviews from Publisher’s Weekly and a starred review from Kirkus for Baby Catcher. What prompted you to write your memoirs?

Peggy Vincent: For years my college roommate had been nagging me to write down the birth stories she heard me tell. I brushed her off, saying, “Yeah, yeah, yeah. Someday.” But I was so busy.

But there was a brief window of time (1984-1993) when we midwives felt life was about as good as it gets. (Little did we know how right we were.) Finally, I just started to write. I wanted to document those magic years when all the stars seemed to be aligned to our advantage. The childbearing population wanted exactly what midwives can offer. We had affordable malpractice insurance that covered us for both home and hospital births. We could get hospital privileges, allowing us to move a woman with a complication from home to hospital and continue to manage her care. There were a few doctors who were willing to make it possible for us to practice independently, and they didn’t charge us much for their backup.

I have a good memory for this stuff. I never kept a journal during my midwifery years. I sure wish I had. It’s mostly from memory with jogs from a line or two at the end of some of the home birth charts where I wrote down a memorable event during the birth, or something funny or poignant that a child or someone else said. Or I recorded something I perceived as unique about that particular birth. I never imagined I’d use it myself. Those little snippets were in the chart strictly for the family’s benefit, because I always gave them a copy of their birth records. Of course, I kept a copy myself, so, indeed, some of those one or two sentence comments were occasionally helpful to me, once I was heavily into the writing.

What’s the story behind your decision to write separate chapter length anecdotes instead of weaving the stories into a continuous, chronological narrative?

I didn’t start out to write a memoir; my initial intention was to write a series of unrelated birth stories in which I would be only a minimal character. When I realized that it would turn into a memoir, it seemed to make sense to keep most of the stories in separate chapters. But they are not strung together like beads on a necklace. Each is capable of being enjoyed separately, but they come together to make a different kind of sense when read as parts of a whole.

How difficult was it to embark on a writing career relatively late in your professional life?

Not difficult to “embark.” But learning the craft of writing was trickier than I’d expected. Writing the tales down was easy. Editing, revising, and tightening them so that others could enjoy them and want to continue reading was a challenge — as I think it is for any writer. But I’ve been a writer all my life. The only difference is that this is the first time since perhaps college that I’ve written anything meant to be seen by other than friends and family. So I had a lot to learn.

Do you come from a storytelling background?

Oh yes. At family dinners, after everyone’s finished eating, we’ll sit around for another hour or more, telling family stories. Many of them have risen to the level of myth, with the truth of what really happened long obscured by multiple retellings. When I worked in hospitals, on a slow shift the nurses would gather around and say to me, “Okay, tell us a story.” And they usually meant a childbirth story from some unusual birth I’d attended. There were times I felt like a storyteller doll in a Santa Fe tourist shop window with eager children hanging all over me, listening to every word.

How accurately have you portrayed the characters and events? Are they factual reproductions of the events and people, or archetypes and composites?

Most of the individual birth stories are altered to protect patient confidentiality. (Some former patients have given me permission to share their births in a more factual way, but most people I can no longer find, so I had to disguise them.) Everything “happened,” but the time frame, gender, family history, past history, names of course, where they lived, etc. — some of these were altered for the sake of privacy.

What kind of reception have you received from the publishing world?

All positive. Four publishing houses were interested in purchasing the manuscript, and three ended up bidding for it, so it was a pretty exciting couple of days as the bids kept coming in. I have had two different editors at Scribner’s, and have had great experiences with each of them. I have nothing but high praise for the support I’ve received from the publicist who was assigned to me.

How many nurse-midwives are there in the U.S.? How does that compare to when you were in practice?

About 8,000, according to the statistics from the American College of Nurse Midwives (ACNM). But that figure applies only to CNMs (certified nurse midwives, those who have been registered nurses previously, have attended a school of midwifery recognized by the ACNM, and have passed both state and national requirements for licensors). Every year there are more midwives in practice.

I was Midwife No. 208 when I became licensed in 1980. I believe there have now been 700 licensed in [California] alone. Of course, some drop off each year as they retire from midwifery, but there are definitely more in practice now than when I was practicing. Lots more. The big difference is that very few of them are in private practice and very few are doing home births. Most are regular hours, benefited employees of physician groups, hospitals, or HMOs. Also, that 8,000 number doesn’t include the unlicensed or direct-entry or lay midwives. Many of them operate illegally and don’t want their existence to be known, so it’s difficult to get a fix on their numbers. If I had to guess (and this is a wild guess), I’d say there are maybe 2000 of them.

What training and background prepared you for this career, and why did you choose this profession?

For 12 years after graduation, I worked as a nurse in labor and delivery (having graduated with a Bachelor of Science in Nursing from Duke in 1964). Then the alternative birth center phenomenon began (around 1976), and I became the first director of the Alternative Birth Center opened in the East Bay (Oakland/Berkeley/etc.) Quickly I came to realize that I needed to become a midwife in order to be true to my determination to protect women from the relentless use of obstetrical technology that was undermining their confidence in themselves.

How would you describe your midwife practice? Were you totally independent or did you work with a doctor?

Independent practice, in the sense that patients or their insurance carriers paid me. I didn’t work for a doctor, wasn’t paid a salary. I paid my office rent, malpractice insurance, and my family’s medical insurance. I had no benefits, except those I paid for myself. But in order to comply with the law, I had to have “an arrangement” with a physician. He signed a set of standing orders under which I practiced and which defined the limits of my scope of practice. He would, of course, take over when a patient became too complicated for me to continue caring for, and he did Cesareans or forceps/vacuum deliveries. But I was always present and resumed care of the woman as soon as possible.

How do current home birth practices compare with those of the era you write about?

Home birth has, for the most part, returned to the hands of direct-entry midwives — those who received their training through apprenticeship, as opposed to CNMs, who are registered nurses (RNs) and attended midwifery schools accredited by the ACNM.

For nearly 10 years, CNMs could not buy malpractice insurance to cover them while doing home births. During that time, CNMs joined the work force and became salaried employees as opposed to private practitioners. A trend developed. Now new CNMs coming out of midwifery schools gravitate toward salaried jobs. Very few open their own practice and offer both home and hospital births.

Even when I was practicing, it was difficult to find physicians supportive of a midwife going into private practice — physicians willing to offer back up to such a midwife. They couched their reluctance in many ways, but it was strictly competition. Bread and butter. Money.

It’s difficult/impossible to know how many home births (which have remained fairly constant at around 5 percent of total births for about 20-plus years) are attended by midwives. Many states now ask the parents to sign as “attendant” in all out-of-hospital births, so in statistics, these births are counted as “unattended,” lumped in for statistical purposes with those babies of crack moms who are born in alleyways. So it makes home births, on state records, appear to be risky. Physicians hoping to denigrate home births love to cite those records. There is currently no way, from a perusal of birth certificates, to pull out those planned home births with qualified attendants from all out-of-hospital births. This is a disservice to midwives of all persuasions and their clients. It appears that about 5 percent of women will continue choosing home birth.

What has changed is that the most universally recognized group of legal midwives, the CNMs, has been culled from the pile and co-opted into the business of obstetrics, back under the control of doctors. When I practiced, I felt I worked alongside my back-up doctor, not under him/her.

How critical was the support of the Berkeley, Calif., medical community to your midwife career?

One hundred percent. The majority of physicians wanted nothing to do with midwives (and still don’t). But there were a few who made our lives and practices possible. The Federal Trade Commission was threatening to withdraw federal funding from the hospital if they didn’t open to applications of midwives, so the hospital was under the gun. They made the conditions of practice so offensive that they hoped no midwives would apply. But with one physician’s support, I did apply. (I had been an employee of the same hospital, so at least all the resistant docs knew me and knew I was a safe practitioner.) Over the following year, we worked from within the system to change the guidelines to allow us to practice freely.

Of the more than 2,500 babies you’ve delivered, which delivery do you consider the most memorable and why? The most harrowing?

Can’t possibly think of the most memorable. Well, I guess it would be my own home birth! The most harrowing were the three times I discovered a prolapsed umbilical cord and had to make a hair-raising trip to the hospital by speeding car or ambulance.

Now that you no longer deliver babies, what connections do you maintain with the medical/midwife community?

Some of my best friends continue to be the nurses (some are now midwives) who functioned as my assistants during the home births we shared together. But whereas my nursing and midwife associates used to make up my group of close friends, they have now been replaced by writing friends. One of the pleasures of writing this book is that it has put me back in contact with those people from my past, including a large number of former patients (or clients, as most midwives call them).

What do you see as the necessary factors for a revival of interest in home birth? What’s working against that possibility?

I’m not sure. Malpractice insurance is again available to cover midwives to do home births, so that’s not the issue. But fewer doctors are willing to offer backup to midwives now. And the country is heading toward care by HMOs, and they don’t pay midwives as a rule, so midwives have less access to receiving insurance fee-for-service payments. Epidural anesthesia was rare for normal vaginal births until about 1990, and I believe with its availability now, fewer women are interested in natural birth. And midwives themselves, those coming out of midwifery schools now, seem to want “a life.” They don’t want a solo practice, being on call 365 days/year, etc. They want regular hours, benefits, a regular paycheck…

How important is the birth experience for the mother, father and child?

My gut instinct tells me that it’s very, very important. It’s too powerful and potentially life-changing an experience to treat it casually or callously. But in any discussion of this nature, it gets down to the unanswerables of nature vs. nurture. The studies done on the subject are soft science, so we don’t have good data on either side to support the claims of hard science. Indeed, there’s plenty of evidence of well-balanced adults rising from dreadful beginnings — and the opposite, people with solid and loving beginnings who go badly astray.

I guess my response would be that giving a baby a start in life that is cradled in love and that supports the natural process surely can’t hurt, in the long run, and who knows? It really might help more than we now even comprehend. The concern over bonding, in my opinion, has been both overrated and underrated. I’ve seen women give birth to severely depressed (this is a medical term, not psychiatric — it refers to cardiac and respiratory depression, a low-APGAR baby) babies, and obsess about bonding and breast-feeding issues when a whole crew is working to get the baby’s lungs to work. Healthy and emotionally babies can still be the end result of a difficult stay in the intensive care nursery.

On the other hand, the definition of “normal” in both obstetrics and newborn care has become so narrow (medical paranoia) that far too many babies are separated from their moms/dads/families to “treat” conditions that probably don’t even need treatment or to do procedures that could easily be dealt with while the baby lies in its mother’s arms. A huge advantage of home birth is that the babies are never separated from the family unless hospital transport is indicated, and that was so uncommon it hardly bears mentioning. With one-to-one attention, it is very easy in a home birth setting to do whatever is needed by the newborn right at the mom’s bedside or in her arms.

What does home birth provide that can’t be found in a hospital setting?

Oh my. Everything. Freedom to behave as you please. The assurance that there will be no one at the birth who is not there by personal invitation. The world revolves around the birthing mom; everything is arranged for her comfort and confidence. Hospitals are arranged to function around the needs of the organization; the priorities of the laboring mother are way down on the list. [In home births] guaranteed there will be no medications used except as needed for “situations.” Definitely no narcotics. Guaranteed there will be no separation of mother and baby. Labor occurs in a familiar setting. The mom doesn’t have to decide when to go to the hospital. She stays home and the world comes to her. Her needs are not secondary to the needs of the hospital to function on an efficient and convenient routine.

In a number of the stories, doctor appear to be the villains of the piece. In your opinion, do doctors victimize women in childbirth?

I don’t believe this is actually true, or at least not in more than a couple of instances. There are far more instances in my book of the support of my back-up physicians. If doctors do “victimize” women, which is not a term I would choose to use, they certainly do it unintentionally. I think the issue is that many physicians don’t believe in the concept of normal birth. They are fearful of the process, fearful of being sued, and they intervene too soon, too aggressively and the intervention itself can too often contribute to the downward spiral of labor. All this helps contribute to the execrable 25 percent and higher Cesarean rate in this country. I believe very few doctors in the US have ever seen a home birth, and until they have, I don’t believe they can say that they’ve seen a true “natural birth.” Witnessing it can be a life-changing experience, and too few doctors ever have the opportunity.

What can women do to ensure that the birth is good for them and their babies?

Choose a midwife with experience, skilled assistants and a solid relationship with a backup doctor and hospital. Choose other support people to be in attendance who understand and will respect the mother’s wishes.

How has the medical community responded to your book?

To date, to my knowledge, only two physicians have read it in entirety, and they were both already strong advocates for home birth and midwives. They were both extremely positive about the book, from every aspect.

How has the publishing world reacted?

Too soon to tell; it hasn’t even been published yet. But the reviews from Kirkus and Library Journal were excellent. I’d say Publisher’s Weekly gave it a “B+.”

Do you plan to follow up this memoir with a book on how “your” babies grew up?

I’ll write other books, I’m sure, and I’d be surprised if each (whether fiction or nonfiction) doesn’t have a birth scene in it. But no, I doubt that I’ll write about the further lives of the babies I delivered. There are too many of them.

When you closed your practice, you passed the mantle to a young Muslim woman. Are you still in contact now that she’s returned to the Middle East?

No, but I talk to her mother-in-law every so often; she spends part of each year with her son, his wife, and their five children.

Have you followed the progress of her practice in the Middle East?

She is a health educator in her community, but having five children under the age of twelve — and home schooling them — doesn’t leave her much free time.

What other career paths have you followed besides nursing, midwifery and writing?

For five years I was an athlete, but no more. I completed the AIDS bike ride (560 miles in six days) from San Francisco to Los Angeles, but that was my swan song.

I’ve been told you can tell a lot about a person by what they keep in their freezer. Tell us what’s in your freezer — or has been in your freezer?

In addition to the normal stuff (coffee beans, home made soups and sauces, nuts, batteries, candles, leftover sourdough bread, pizza crusts, CostCo® steaks and chicken breasts, etc.), I also have three canaries (dead, of course) and two Lady Gould finches in my freezer. [Lady Gould finches] are the size of a canary but have the coloration of an Amazon parrot. Unbelievably beautiful.

I used to always have a spare placenta or two on hand, used for educational purposes, but sometimes we had people who wanted us to save healthy placentas for them. They ate them for various health reasons.

The birds are a little harder to explain. I really liked them, and it seemed rude to just toss them in the trash. On the other hand, it seemed like a bit too much to dig a deep hole (so raccoons or dogs won’t dig them up) for a three-inch long bird (minus tail) that weighed about two ounces. And it was winter and raining when the first one died, so digging a grave was not at option at that moment. While I tried to decide what to do, I put him in a baggie in the freezer. And that’s where the next one went. And the next one… Now it’s become a conversational topic whenever we have guests. I don’t think my kids would let me toss them out.

You mention an Internet group in your acknowledgments. What role did this group play in the development of Baby Catcher?

The Internet group I became involved with was helpful in many ways: editing, tightening, making me aware of passive verbs and places where I needed to explain what were to me common obstetrical terms but were foreign to non-medical people, places where I lapsed into clinical language, and restructuring some of the chapters to make them flow better.

What authors and books influenced you?

When I’d written about ten chapters and was beginning to read them to others, almost invariably someone commented that they were reminded of the structuring of James Herriot’s books based on veterinary practice. But I didn’t set out to write the midwife’s answer to All Creatures Great and Small. It just turned out that way.

I see author and fellow Californian Anne Lamott (author of Operating Instructions) wrote a blurb for your book. How did you meet?

Annie is the personal friend of the woman from whom I took my first-ever writing class, four years ago. Also, the doctor who delivered Annie’s son used to be a nurse-anesthetist in the hospital where I worked, so we had that connection, too. Our mutual friend gave me Annie’s address. I sent her a brief letter, and she agreed on the spot to read the galleys and write a blurb.

Reviewing your life and achievements from the perspective of your 60th birthday, what would you do differently if you could choose to live your life over again?

Have a fourth child.

What advice do you have for other writers?

Write! And don’t believe the people who tell you it’s almost impossible for an unknown author to get published.

Anything else you’d like to add?

Readers with further questions might like to visit my website where the first chapter of my book can be read under “Excerpt.” I’d like to thank Felicia Eth (my agent), Jane Rosenman (the editor who bought the original manuscript), Jake Morrissey (the editor who nurtured the project to completion) and all the other writers in my life who urged me on when I thought I was stuck. No one ever promised I would get published, but no one ever told me I wouldn’t, either. To new writers, I’d say, “Keep the faith!” If I can get a book on bookstore shelves, so can other unknowns.

Dawn Goldsmith

A multi-published writer of non-fiction and short stories, Dawn Goldsmith also reviews mass market books for Publishers Weekly.

Readers Respond

I just read the write up by Dawn Goldsmith on Peggy Vincent’s first book Baby Catcher. What a wonderful article! If I didn’t already have the book I would run right out and buy it today! I have purchased three copies of this book besides the one that was given me as a gift. I plan to give each of my daughters one for mother’s day. Ms Goldsmith is a wonderful writer in her own right. Thanks so much for the article and review!

Mary from Ohio