A visit to The Farm

The Farm Midwifery Clinic

I like to pretend I'm a rolling stone from time to time, but it sure does feel good to roll back to the piece of earth that's come to fit my contours over the years. I'm back in San Francisco after more than a week traveling in Kentucky and Tennessee. My most significant excursion was a trip down to The Farm, a hippie commune that's managed to persist in fine fettle since 1971. They don't do a lot of farming at The Farm, unless you count growing forests, and deer, and meadows full of ground-nesting birds. What they really focus on down at The Farm is growing people, and officiating the front end of this process is a coven of midwives. These are the women I went to meet - they offer a radically different mode of maternity care. It's a form of medicine that would shock and dismay hospital administrators around the country. It's low tech, often taking place in the woman's own home, far away from the transfusions and pain medications and operating rooms that hospitals rely on to save lives when something goes awry. In theory, this midwifery center should be producing a higher than average number of catastrophes. But that hasn't happened. In the 40 years they've been catching babies, the midwives have accumulated a significant corpus of data (about 3,000 births) and the results are fascinating. The birth safety record is far, far better than the national average.
But is this a comparison of apple and apples? There's a certain amount of self selection that happens - ie it's only fairly bourgeois, health-conscious women who would even think to seek out a midwife. (There's a similar cause and effect mix up with multivitamins: People who take them are healthier, but only because unhealthy people usually don't take 'em). And that's probably affecting things at the farm a little bit: There are women who have flown in from as far away as Tokyo, and Cairo, to give birth there. Those mommas have got to be A. Far more committed to going the extra mile for health in every way, and B. Rich enough to pay for quality care and live without a lot of stress. But when I got to The Farm and started talking to people it became clear that there were two counterbalancing factors. First, some of the people traveling to The Farm are attracted because the midwives there are some of the only people in America who can reliably do higher-risk births (like breech babies, twins, and birth after a cesarean) vaginally - so they attract a more difficult population. Second, about one third of the babies born there come from the (economically depressed) surrounding area - a lot of these are Amish women who wear their long dresses through the entire birth.
Ina May Gaskin, the head midwife, says that about a third of the births are Farm babies, a third are from the surrounding areas, and a third travel in from farther away. I understand that the midwives are organizing their data for a report - I hope they include information about the demographics of their patients to allow this kind of parsing. But regardless of demographics, the statistics are impressive. They seem to indicate that, for a healthy middle-class woman, this can be a superior form of care. There's another impressive indicator: The Farm Midwifery Clinic is still in business - which (I think) means that they've never been sued. If this form of natural birth really was causing more cases of baby brain damage - or any sort of catastrophe - I think you'd see some lawsuits over the course of 3,000 births.
I'll be writing more about my visit - hopefully before all the mosquito-bites I got there fade away. But for now I've got to catch up on the work I left when I went on the road - while enjoying the feeling of air that's not 90 degrees and 80 percent humidity.