|Peggy Vincent: Conversations with a Modern Midwife|
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.
Crescent Blues: What's the story behind your decision to write separate chapter length anecdotes instead of weaving the stories into a continuous, chronological narrative?
Peggy Vincent: 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.
Crescent Blues: How difficult was it to embark on a writing career relatively late in your professional life?
Peggy Vincent: 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.
Crescent Blues: Do you come from a storytelling background?
Peggy Vincent: 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.
Crescent Blues: How accurately have you portrayed the characters and events? Are they factual reproductions of the events and people, or archetypes and composites?
Peggy Vincent: 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.
Crescent Blues: What kind of reception have you received from the publishing world?
Peggy Vincent: 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.
Crescent Blues: How many nurse-midwives are there in the U.S.? How does that compare to when you were in practice?Peggy Vincent: 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.
Crescent Blues: What training and background prepared you for this career, and why did you choose this profession?
Peggy Vincent: 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.
Crescent Blues: How would you describe your midwife practice? Were you totally independent or did you work with a doctor?
Peggy Vincent: 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.
Crescent Blues: How do current home birth practices compare with those of the era you write about?
Peggy Vincent: 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.
Crescent Blues: How critical was the support of the Berkeley, Calif., medical community to your midwife career?
Peggy Vincent: 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.
Crescent Blues: Of the more than 2,500 babies you've delivered, which delivery do you consider the most memorable and why? The most harrowing?