Such an important question! I have so many thoughts and think about this often! Would make a good podcast interview or panel discussion.

Where I’ve landed is a mother must own her decisions and the ramifications thereof.

And that is true whether that’s following the advice of their chosen birth support, or choosing to go against that advice.

A midwife must be free to leave the mother if she can’t abide the mother’s choices.

The mother can’t demand the midwife stay with her if the midwife doesn’t feel safe to do so, and contractual terms around those issues must be made clear at the beginning.

The exchange of money, the perception of expertise, and the ability of people outside the provider-client relationship to litigate over the events all muddy the waters. A lot.

There’s an inherent power dynamic leveraged by licensure where when it comes to certain things, because a midwife essentially says if you don’t, I will leave either by choice or in order to comply with the law and the terms of our contract.

The mother has to then accept her decision to comply in order to keep care, or own that her decision not to comply leaves her to be left alone, or even to have outside professionals called in on her behalf whether she wants it or not in cases where mandatory report comes into the picture.

This is why I always recommend mothers read contracts carefully, and also request the full regulations of their provider early on in the relationship so they can understand and think about all the scenarios where legality creates hard lines in the relationship of the care offered.

I think the anger and damage to relationships often comes in when these things come up as surprises.