By Allie Conti
By Keegan Hamilton and Francisco Alvarado
By Jake Rossen
By Allie Conti
By Kyle Swenson
By Chris Joseph
By Michael E. Miller
By Frank Owen
Fitch stands on a traffic island at the intersection of Federal Highway and SW 62nd Street, shouting at passing cars through a megaphone. With her delicate features, dancer's body, and flaxen ponytail, the midwife looks placid, even when draped in a sign that reads "ACOG: Out of My Uterus." When a group of medical personnel in scrubs emerges from the hospital, the militant midwife calls to them: "One out of every two women that come to this hospital [to give birth] will be cut open by cesarean." Seeing the group pause, Fitch presses on: "Women are twice as likely to die from a C-section as from a natural birth."
By temperament and birthright, it seems, Fitch was destined to be a midwife. She was born in 1974 in the converted school bus where her parents lived on the Farm, the famous commune established south of Nashville in the 1970s that also happens to be known as the birthplace of modern midwifery. She was delivered under the watchful eyes of Ina May Gaskin, a leader in the natural childbirth movement and author of the influential book Spiritual Midwifery. Ten years later, the Fitch family moved to South Florida along with two of the Farm's most capable midwives. Mother Claire Fitch, a biologist and lab technician who assisted the midwives here, would come home with vivid stories about each delivery. Her daughter would listen spellbound.
As an adult, Fitch returned to the Farm to apprentice with Gaskin, whose practice boasts a 2 percent cesarean rate. That experience inspired Fitch to enroll in the midwifery program at Miami-Dade College, where her mother taught the section on prenatal and postpartum lab tests. She graduated in 1999, then completed her studies to become a registered nurse a year and a half later. This year, Fitch opened her own practice, called Birthright, in South Florida. When she learned of the national day of action against ACOG, she took it upon herself to mobilize her clients, fellow midwives, and friends. "Women are being misled about cesarean as a choice," Fitch explains. "I thought Miami should definitely be involved [in the national day of action] to make people aware."
The 300 pamphlets that Fitch had printed up for the protest run out quickly, and a second batch copied on the fly disappears within the first hour. Fitch drew much of the material for her pamphlets from the writings of Henci Goer, author of The Thinking Woman's Guide to a Better Birth and one of ACOG's most outspoken critics. "No objective person can believe that one in four women needs major surgery to be a healthy mother having a healthy baby," the medical writer tells New Times over the phone from her office in California. Not content to let the numbers speak for themselves, Goer reviews childbirth research and claims to have analyzed more than 3,000 studies. She contends that scheduling C-sections, rather than waiting out the unpredictable and often-prolonged course of vaginal delivery, allows hospitals to charge more for the surgery while reducing the cost of maintaining a round-the-clock obstetrics staff. Doctors also save time and ward off potential malpractice suits. The patients' well-being is not a factor because, Goer argues, "The people who benefit by the [ACOG] guidelines are writing the [ACOG] guidelines."
Dr. Laura Riley, chair of the ACOG committee on obstetric practice, points out that the organization's positions do not directly dictate medical procedures. "ACOG can only provide guidelines; how people actually use the guidelines is not something we can control," she says. "We're trying to provide education so that doctors can provide the best care."
Riley believes that critics have misunderstood the organization's position on elective cesarean. The October 2003 document, she says, "was not about cesarean delivery." Rather, it was a discussion of the ethics of talking to patients about elective surgery and "used elective cesarean as an example." As an obstetric practice, she clarifies, "At this point, we don't agree with elective cesarean delivery."
Had the Valentine's protest been on any other day of the week, Janessa Wasserman would have been there, holding one of the purple balloons that read "Bring Back VBAC" (for vaginal birth after cesarean). Adhering to her Orthodox Jewish faith, Wasserman keeps the Sabbath on Saturday, so she sat out the protest at home with her husband and three children -- the youngest delivered by Fitch less than two months before. The 30-year-old attorney/homemaker first heard about the rally when she called the midwife in a panic; her obstetrician had tried to dissuade her from having a VBAC, suggesting she schedule a C-section instead. She had delivered her first son by cesarean and never wanted to have that experience again. "I was so naive," she remembers. "You grow up and you trust doctors: 'They know you better than you know yourself. '"
When Wasserman gave birth to her son at Mount Sinai Hospital on Miami Beach in 1998, she had a fairly typical hospital delivery. She was given Stadol for pain relief and Pitocin to speed up labor. She was hooked up to an internal monitor to keep track of the baby's heartbeat. Drugged up and plugged in, she felt detached from her body. It didn't help that her family began to ignore her, watching the monitor instead. "I could be screaming, but they would say, 'It's not that bad,' because that's what the machine says," Wasserman recalls.