The Miracle Worker with Diane Barnes, CNM

My husband, Daniel, and I first met Diane Barnes last September. We came to her upon two referrals -- one via a new mother’s midwife in Kentucky and the other through an old friend who is now a nurse in Columbia, Missouri. We had researched birth in America and knew that natural childbirth was our ideal. Since this was the first child for us, we also knew we wanted guidance, encouragement, and attendance by someone well-versed in birthing. Little did we know that this choice would lead us to a most amazing woman.
Diane Barnes is a certified nurse midwife who has a private practice in Reed's Spring, Missouri, a quiet village nestled in the Ozark Mountains just north of Branson. She is well-known in Southwestern Missouri for people from four states seek her services. She is also well-known throughout the continent, having served as President of the Midwives Alliance of North America (MANA) for the past five years. What she is best known for, however, is assisting mothers in the birthing of their young.
Diane is warm, engaging, animated, forthright, strong, open, and caring. Her life is a testament to her strong spiritual beliefs. Her ideas are visionary, her sense of humor dry. She is the kind of person who stimulates adoration and controversy. She is a revolutionary in her own right; a pioneer in one of the oldest professions known to women -- midwifery. We wanted you to meet her.
During one of our prenatal visits, I asked Diane if she would consent to an interview for Thresholds. She was quite agreeable, and when we discussed a time she said, “We’ll have plenty of time when you’re in labor.” And indeed we did. -- Barbara Condron

Thresholds: Let’s start by telling the story of your history; how you became a nurse and how you got into midwifery.

Barnes: Well, I made it to this point by a really circuitous route. I never had any intentions on becoming a midwife in the first place.

Thresholds: What did you have intentions on becoming?

Barnes: A mother, just a mother. I wanted to be a good wife and a good mother. Back in the sixties when I was the yearbook editor in high school, we had a senior page of what our goals were for life. Everybody else -- the women -- were coming up with things other than nursing and teaching. You know, stretching, trying to do different things. I came up with the very original goal in my life to be a good wife and a good mother. I got really ridiculed for that goal but that’s what I really wanted. By the time I was twenty-four I had four children. We moved here to Missouri because we wanted to become more independent and self-sufficient.

Thresholds: From where?

Barnes: California, San Diego. We wanted to live in a community where people knew each other. We found out that we didn’t know our own neighbors in California, and heaven forbid you would say hello to somebody in California. They would stiffen up some. We came here and we’re really welcome in the community.

Thresholds: Where did you first move?

Barnes: Out in the country in Wentworth (Missouri). The town had a population of about 28 but we were out in the country.

Thresholds: Were you a nurse at the time?

Barnes: No, no. My youngest son -- we all got the flu and while we were all sick and not paying close attention -- he pulled a pan of hot grease over on him and burned himself very badly. On the way to the hospital he kept crying, “Kuk, really hurts Mom.” The biggest fear I ever had of anything was to have to deal with (my children's) burns. I don’t like burns. We went to the hospital in Monett and they treated it once a week for three weeks and it just seemed to keep getting worse. Someone finally told me about Dr. George and said he had a remedy that was from England that worked on burns. Well, I was ready for anything. I couldn’t change his bandage; my husband had to do it. We went over there and he slathered it with this yellow "goo" and wrapped it up and said leave it for a week.

Thresholds: Was he in Springfield (Missouri)?

Barnes: Mount Vernon (Missouri). Dr. George, Harold George. He was an old country doctor. Such an old country doctor that he was grandfathered into his license and that tells you something about what he did. He apprenticed as a doctor and then he actually grandfathered into his license.

Thresholds: He had already been practicing for so many years before the law took effect that they said just keep practicing?

Barnes: Right. He was a stodgy old codger. He kind of spent a lot of time on the phone yelling at people about his cows, and kept people waiting forever but he never turned people away. Anyone could come to his office at seven o’clock that morning, sign up for that day, and then you kind of figured when you needed to be back by the number of people that were already signed up. Then you waited. But he never left until he saw everybody that wanted to see him that day. You couldn’t get a real appointment with him.
He did more in that one week for the burn than all of the gook they’d given me, and all the trouble I had gone through, in Monett in a month. Then he just started talking to me and asked me why we were here. I said, “Because we want to become more self-sufficient.” He said, “You ought to go to work for me so you could learn how to take care of your kids better.” And I said, “I don’t see how going to work is going to take care of my kids better.” He kept bugging me about it and over the next couple of months he called me several times and asked me if I would go to work for him.
Summer hit. We still can’t figure out how we survived that summer. My kids, my husband, and I all remember going to the creek all of the time and swimming, but when did you work? How did we do that? So we knew that Hugh could take care of the kids...

Thresholds: Hugh is your husband’s name?

Barnes: Yes, my husband, Hugh. We fast the first Sunday of every month and find a purpose to fast for. Dr. George happened to call Saturday afternoon so we decided that is what we will fast about: “Am I supposed to go to work because he keeps on bugging me? And he offered me more money than he had offered anyone before who had worked for him which was $3.50 an hour?” So we decided that would be the topic that we would fast for and we felt good about it, but then we felt that that was what I was supposed to do.
So Hugh kind of took over taking care of the kids and I went to work for him (Dr. George) pretty much just to learn basic nursing skills that you could use at home. I found out that I really didn’t like it a whole lot. I was taking care of women that had radical masectomies and they were coming in to have debreeding of the wounds and it was pretty gross, you know not the sort of things I thought I really wanted to do. Then one day he asked me if I would be willing to be on call for the next few nights until he got somebody hired for nights. I said, “Nights! What do you do at nights?” He said, “We deliver babies.” I said, “Ok, I can do that.”
So he gave me the key to the door and told me that people would call me at home when they were in labor because that way he didn’t get called and woke up. I would come and meet them at the clinic and keep them company until they acted like they were ready to have their baby. Well he didn’t give me any real definition of what that meant.
That night or the next night I got called. Well I raced to the clinic, got inside and then panicked. What if they come in and they are pushing? What do I do? How do I handle this? They weren’t and they came in pretty much like you are and we kept each other company. We visited and we talked. I learned a lot about the couple, what brought them to Dr. George and what they knew about him. Pretty soon they were getting pretty uncomfortable and I called Dr. George. He came over and told me that I’d called him way too soon and went off to his little family room in the back of the clinic and went back to sleep. I kept them company some more.
He had a point-by-point check list of how to set up the delivery room and told me to go open the door to the cabinet and see the check list and do what it said on the list. I pretty much did. It was pretty old-fashioned -- newspapers on the floor and set up that way. She progressed to the point where she was obviously starting to push and so we got her over to the birthing room, the delivery room. There was a labor room and on the other side of the hall was a delivery room. Got her over there with her legs up in stirrups just like the hospital set up and I called him to come in. He said it was still a little too early she wasn’t quite ready to deliver.
I escaped and went out into the hall and I realized that I wasn’t at all sure what I was doing there. So I just said this little prayer that I wouldn’t pass out or throw up. The basics, you know, I thought this is a pretty special experience for this mother, it would not be appropriate for me to do that. So I went back in and I held her hand. Her husband held her other hand and the baby was delivered. I think Dr. George had to do some suturing. He had me give her an injection. His big thing was that nobody bleed. So everybody got an injection. He had this plexiglass box that he used for an incubator, his baby warming box, and it had a light bulb in it. (It also had) one of those thermostats that you put in a chick egg hatcher that was in there to turn the light bulb off and on and to keep the temperature right. It rolled over so it was the same heighth as the bed so the mother could look in the box at the baby. I was amazed at the entire thing! I didn’t pass out and I didn’t throw up and it seemed pretty normal to be there.

Thresholds: You hadn’t experienced birth this way? Naturally?

Barnes: It was real amazing for me because I’d had all my babies in the hospital with all the medical stuff that goes on. The only one (where) I didn’t have a lot of stuff is because I didn’t make it to the hospital in time for them to do it.
I didn’t believe it when I got there and the mother looked up at me and said, “You must have done this for a long time,” and I knew it was where I belonged. It just felt good and it felt right.
So I worked for him the rest of the summer, days and nights. I was averaging about a hundred and ten hours a week because I didn’t know that he did 300 to 400 births in a year. Finally in the summer I said I can’t do it during the days because my husband is going back to work but I would be willing to be on call evenings and weekends. I still put in over a hundred hours a week after that and I worked for him about three and a half years. He treated birth like it was normal. It was the best basic training I could ever have. He wouldn’t hire nurses because they were too medical -- I think they charged too much too -- his excuse was that they were too medical and he couldn’t unlearn them. It wasn’t until after I started out on my own that I realized that we rarely did a heart tone (listening for the fetal heartbeat) and I can’t remember doing a blood pressure. It was probably six weeks into doing births with him before he taught me how to do a vaginal check so I wouldn’t call him too soon. He didn’t turn anyone away. He had absolutely no risking out at all...

Thresholds: “No risking out” means sending the woman to someone else, to a hospital or something?

Barnes: For specific risk reasons. I mean he did a lot of breeches. He did a lot of twins. He did a lot of moms who had had a lot of babies. He did a lot of older mothers, really young mothers, poor health mothers, all kinds. He just took care of everybody. He had an innate sense, part of which I have taken upon myself, that some more medical midwives that come in question whether I’m checking this or that. When this physician was here (at her clinic, WomanCare) visiting it was like, “So do you check for edema?” And I said, “Yeah I do. And I look at them. You know you can tell a lot by what you see and how people walk and what they are doing.” Dr. George was able to do that. He had just a terrific intuitive sense. He also was rather rough and during a delivery he rarely spoke to the mother. It was such a normal event that he would pass the time with the dad. Whatever occupation the dad had that’s what they would talk about over the birth and mom was busy doing her job, “just do your job, we’ll talk.” It’s like this conversation went on during the birth. It was a little bizarre and eventually I had...

Thresholds: I bet it kept the dad calm.

Barnes: It did. It kept them both calm. Some moms got irritated and thought they oughta be the center stage...

Thresholds: They were being ignored.

Barnes: ...being ignored. But it was just so normal that no big deal.

Thresholds: Your experience with Dr. George gave you a rich background that led to midwifery?

Barnes: Yes. Eventually I had a group of nine women come to me saying they were going to have their babies at home. They had read the book Special Delivery and they were hiring a midwife from Utah to come out and teach them -- in one week -- how to be midwives to each other . (They asked) did I want to take a class with them. I couldn’t afford the class. It was like $500 for the week. I couldn’t afford $500 but I thought maybe I’d at least take a day and come see what they were learning. I ended up actually paying for one half of one day because that’s all I could figure out how to afford to do. She was teaching accurate principles and it was all the right information. But the thought that recurred in my mind is “until I’d actually seen a birth and seen the color of the baby’s head and the shape that it comes out in would I have panicked if it hadn’t been for Dr. George standing there acting so calm?” I wondered how these mothers would take it because it wasn’t at all like the plastic doll that she was shoving through her plastic simulated pelvis. It wasn’t going to look like that.
Out of the nine women they were all pregnant. They had enlisted another friend of theirs that was an RN, who hadn’t practiced in eighteen years, to come and take the class and be their midwife and they would help each other. She was really nervous about the whole thing too. The RN ended up calling me and asking me if I would come observe the births just to see if it was normal and take them to the hospital if it wasn’t. I kept telling them “no.” Why don’t you just go to Dr. George because he charged $350 for the entire prenatal care and delivery and postnatal care and go home. It was like why wouldn’t you do that? It’s less than what you are paying this midwife to teach you how to do your own midwifing -- it didn’t make sense. They didn’t want to go there because he also took care of sick people in the same place that he delivered well babies. That was his surgery room and he did surgeries there and then he would deliver babies there. Well I understood what they were saying in theory but I thought it was a little extreme.
They finally called me one night and said they were having this birthing would I come? Kind of on the spur of the moment I did go. All the way there I told myself, “Now you’re not working for Dr. George and you’ve got to be quiet and mind your own business. It’s their thing. You’re just to observe.” I got to this birth and all nine pregnant women were there. It had one of these living rooms with a little partition at the end of the parlour room and then you could see the kitchen beyond that. Sitting on the couch I could see through the three rooms and the nine women were milling around. It was, you know, this real visual image, a new meaning to “milling around’ and I couldn’t tell which one was in labor. Some were making tea and some were just “milling.” Finally I said to the group, “Well how far along is the mother?” Hoping they would kind of point to her and I’d at least kind of get an idea of which one was in labor...

Thresholds: Give you some clue.

Barnes: ...and they kind of all turned en masse to me and said, “We hoped you’d tell us.” I said, “You haven’t checked her yet?” They said, “Well we weren’t really sure how. We didn’t feel confident at it.” I had this little tiny emergency kit in my car in case someone was delivering in the parking lot when I would get to Dr. George’s, so I went out and got that. One of the mothers laid down on the bed, I had my kit open, I took one glove out and I turned around and she had the baby. It was like “Oops we’re doing this now.”

Thresholds: You mean the baby was already out?

Barnes: No, as I turned the head was coming. I had one glove on and one glove off, and out popped this baby It was about a little over a ten pound baby and over an intact perineum. It did really well. It was a beautiful birth. All of her sisters were there, four sisters pregnant, and then all these friends. It was sun up and the sun was coming in her bedroom window over the back of her and it was just a beautiful setting. It was beautiful. We got everything cleaned up and the baby was in her arms. Her kids woke up, and they came in and they were thrilled. It seemed so natural. I left and I thought this is nicer than Dr. George’s because he would only let one person in. I mean he had some rules that he went with. It was a small place so you couldn’t really hang on to a lot of people but he would let one person come in.

Thresholds: Did he have his place in a house or was it a clinic?

Barnes: No it was an ugly green block building with tile floors...

Thresholds: It was an old store front type building?

Barnes: Yeah, it was just an ugly, little clinic building. Not becoming at all. Hospital beds, two hospital beds, in the labor room and the delivery table across the hall. He was an osteopathic physician so he did a lot of chiropractics too so he had relaxer tables and those kinds of things. It was just a little place. This was much nicer for her (the new mother) to be in her own bed and be more comfortable and not have to move and not have to travel back. It was just so different.
I ended up agreeing to attend the other women but I only wanted to attend them if I did prenatal care. I really wanted to know blood pressures and other things along the way so I started out attending my first births with a stethoscope, a blood pressure cup, and a hemoglobinometer. Those were the first tools that I had. Then little by little I picked up more tools and bought books and studied on my own and tried to teach myself. As a birth would occur then I’d ask “what did I learn from that” and “what should I learn from that” and I would look up in books to see what I could have done differently. I did it as a Christian service because being a midwife was illegal in Missouri. I was teaching a religion class before school to high school students five days a week and I thought it would be kind of odd for me to teach religion and do something illegal at the same time. I couldn’t deal with that. One of the ministers in our church was also a lawyer so I talked to him about it. At that time in Missouri where there was no renumeration or no pay there was no practice of medicine. So we decided that was how we would do it.

Thresholds: Was that the early seventies?

Barnes: Late seventies to early eighties. I started in 1975. My husband bought all the equipment for me and provided me with a car. I bought all the supplies. Moms came to my house for prenatal and I went to their house for delivery. Eventually I had attended about 600 births. Another midwife got arrested in Rolla for practicing medicine and it went all the way to the State Supreme Court. They found her guilty and then the Supreme Court said that she probably was not practicing medicine but she was at least practicing nursing therefore she was guilty. Her lawyer turned to me and said, “Diane you will be the next test case.”
In the meantime we had left for a year and a half and went to Colorado. I worked with a physician back-up out there who just happened to have a next door neighbor that was a physician and he found out what I was doing. He didn’t want to do home births but they were more adamant about wanting home births there. He interviewed me and he said he would refer people to me. He could not compete with home birth. He didn’t think there was anything wrong with it -- he was more comfortable in the hospital -- he could compete with home births but not with free so he referred people to me and he told them what to pay me. It was amazing. The first mother who paid me I went out and bought bikes for my kids. I was really thrilled. I found out that I could accept money for what I was doing and still be able to keep that spiritual feeling that I had at the birth. It was a two way thing. It wasn’t taking so much away from my children.
When I came back and asked a physician in Monet if he would support me as a midwife and he said, “No.” Very bluntly, “No.” My husband was sitting with me, a little bit intimidating. I had him put on his dark suit and go with me like he might be a lawyer; just sit there don’t (say anything). He just sat there and this doctor just kept on looking at my husband and looking at me, back and forth, and he said he wouldn’t support me as a midwife. And I said, “Well if I have somebody that I think is too high risk can I refer them to you?” He said, “No.” “Will you suture if someone plasterates more than I feel like suturing?” He said, “No.” “Will you do a circumcision if they decide they want a circumcision or check them for newborn care?” And he said, “If I hear the word home birth or midwife I will not assist in any way whatsoever.” I said, “Well what about the Hippocratic oath?” and he said, “We don’t do that any more. I left the Philippines because the midwives took over my practice. I came here to make money and if I do anything to support you at all I will lose patients and I’m not going to do it.” And I said, “Well at least you’re honest."
I left in utter frustration. A friend said, “You know that eventually they are going to have a law here that will license midwives but I bet that it will require at least nursing so you oughta go to nursing school.” Well like most girls born in the ‘40’s I thought I would be a nurse or a teacher when I grew up so I decided I’d go to nursing. That was it. That was the two jobs so I said ok.. I’ll go to nursing school. My two daughters were teenagers and they went with me over to Missouri Southern in Joplin. I went up very timidly because I had never gone to college at all. I was college prep qualified and had been accepted to San Luis State College but got married instead. Even had the G.I. Bill and I could have gone to school and been paid to go but I had a baby or was just recovering (from having) a baby every semester so I just never did go. Walked in there, very timid, I just wanted to have a little information about the nursing program. They said, “Well there is a whole stack over there of pamphlets, just pick up one of those and you can have it, but before you get into school you have to take your ACT Test. It’s upstairs in ten minutes in room 210. It costs $10 and you pay at that window over there.” I said, “Well I didn’t intend to do that and I didn’t even bring any money.” My daughter said, “I did!” They paid the $10, walked me up the stairs and shoved me in this room. I walk in this room and they were in the middle of giving the instruction. It was like would you please sit down. I sat down and took the ACT Test, went home and told my husband what I‘d done and he said, “Well if you want to go to school just go ahead and just go.” I said, “Okay,” and I did.
Two days later I was in school. Then I thought “what am I doing here...I don’t belong here...I have children at home...I shouldn’t be at school.” The friend that talked me into it had a four year old and I had a four year old so, not knowing college at all, I signed up for classes from 8-12 a.m. and then she was going to school in the afternoon. I didn’t know that you don’t put classes right back to back. Most students don’t because you study in between and get from class to class. I had no idea how big the campus was so I had classes with a ten minute break and every one of them were opposite ends of the campus and I was running back and forth. My first semester I took four classes and with teenage children I had to be an example to them so I studied until I thought I was going to die. I got my first and only 4.0 average that semester which helped me get applied to the nursing school in the next semester. They get anywhere from 200 to 300 applications and they accept 35 students. No one gets accepted the first semester or very few get accepted the first semester but I got an “A” in Zoology, which is very close to being Human Anatomy and Pathology, and the teacher personally spoke for me to the nursing board and nursing school that I should be accepted and I was accepted. Every step of the way it was like it was supposed to be because I didn’t really want to go to school. I really had no intentions of going to school. It was because this friend challenged me to go check it out, my daughter paid the $10 and shoved me in the door, and my husband belligerently said “just go ahead and do it,” and I did. Then the whole time it was like why didn’t anybody say, “no don’t do this.” If anybody would have said “no don’t do this ” -- my kids, my husband -- I wouldn’t have done it. If the nursing school said “no you’re not good enough to get in class” I would have just quit right there but they accepted me. It was almost disappointing to me (laughing) that I got accepted because I really didn’t want to do all this stuff. I went through school and finished. The last year and a half that I was in school I worked for Bremen Hospital in Joplin in labor and delivery so I could get more experience because I wasn’t... I never wanted to work in a hospital but I thought that would be the best way to get all the hospital experience I could while I was in school. Plus it would pay some of the expenses for going to school.

Thresholds: You couldn’t get a G.I. bill at that time, by then it was too late to get?

Barnes: Yes, it was too late. So I worked for a year and a half. You get evaluated every three months as a student and I got exemplary evaluations. It was time to graduate and all my classmates that had student jobs at the hospital were being offered positions. I hadn’t been offered one. I was a little amazed. They asked me to make formal application so I had applied and I told them that I didn’t want to work in labor and delivery because I was debating -- should I go on and be a midwife or should I go ahead and be a nurse -- because we had adopted two more children and so we had six kids by then and my husband was working hard. I thought maybe it’s my time to really help him some. I told them that I just couldn’t work in labor and delivery because I couldn’t watch any more unnecessary C-sections and really mistreatment of women in general. (I hadn’t liked) listening to a lot of crude jokes and bad behavior from the physicians and the nurses at the nursing stations and having them just tell me, because I would just quietly leave and go stock shelves or do something when they would start that stuff that “I could go stock now.” I said that’s fine with me. So I applied for ICU (Intensive Care Unit) and ER (Emergency Room), Onocology and as a last choice, postpartum because I felt like I could be a good nurse. I had learned a lot and enjoyed being challenged -- learning more and doing things. If I was going to do it I didn’t want to work in labor and delivery because I really felt like they just abused women there. I went through all the interviews and I didn’t get called back. Everybody else is getting these jobs and I didn’t get called back and didn’t get called back. But finally this really doofus classmate got offered a job and I decided if they got offered a job and I still hadn’t then something is going wrong. So I got on the phone and asked them why and they said, “We actually do have a job offer for you.” And I said, “Oh really, what is it?” In the interview process they had asked me if there was any place that I don’t want to work and I said, “Yeah I don’t want to work in the pediatrics unit because it’s such a low level department...that I did more than that with my own kids at home.”

Thresholds: So after your schooling they offered you a job in pediatrics? The exact area you said was your last choice you didn’t want to work?

Barnes: Yes, they offered me eight hours in pediatrics. I didn’t want to work there and nobody got full time because they could go without paying any benefits. Everybody was getting 32 hours, 36 hours and they offered me eight hours a week in pediatrics. I said, “I’ll be there in 30 minutes at the personnel office. Have the nurse manager there.” I went in and sat down with them and they were being very patronizing. I didn’t understand it. I’m usually not very assertive in an authoritarian situation. I really back down but I was really angry. I wanted to know what was going on ‘cause I’d had all good evaluations. I couldn’t imagine why they wouldn’t offer me the job. But I had prayed about this. This is what I’m supposed to do and it will all come together. If it isn’t, I won’t. But I hadn’t thought about that, I was just angry at that point that they were...

Thresholds: Treating you that way.

Barnes: Yeah, it was very insulting. They kept on telling me that it was okay. “This was the only position that was open,” and I said, “No, it’s not the only position that’s open. I was hired before some of the other students that had already been offered jobs and so I had more tenure than they did already so, you know, this just isn’t right.” And I finally said, “I am going to make a scene if you don’t tell me what is really going on. There is something that you are not telling me.” They finally looked at each other with this knowing look and then looked over at me and at each other again and said, “You were blackballed by one of the obstetricians. He felt you were not aggressive enough.” I got up out of my chair at that point and I said, “I never was told that aggression was the proper quality for any nurse. But thank you because now I can go and do what I know I was supposed to do in the first place and I’ll leave now.” They followed me to the hall and begged me to take the job -- that I should take this job -- I could prove myself and then they can move me to some other area. I said, “I don’t need to prove myself to you or anybody else in this hospital. I’m done. Thank you very much, good-bye, you can hand me my check.” And I left. I don’t even remember telling anybody that I had made that decision but within a couple of weeks their were 34 women coming into my living room for prenatals. We lived in an earth room house....

Thresholds: An earth room house?

Barnes: Earth room, you know three sides under earth. My husband’s business was in the A-frame upstairs and his business was across the street. I was using my living room for a waiting room and my bedroom for a prenatal room. It was getting to the point where you couldn’t get through the living room. It was very crowded in there.
Within three months of graduating from school and starting my practice I got investigated by the Board of Human Rights for practicing medicine.

Thresholds: But you weren’t giving any medicine, you weren’t using any medicine...

Barnes: Well, they were treating midwifery as medicine. That was the argument.

Thresholds: That’s not medicine.

Barnes: Well it got more convoluted than that because at one point physicians put in a legislative bill saying that they wanted to change the definition of pregnancy. That pregnancy was a “disease of predetermined length.”

Thresholds: Oh, my God.

Thresholds: You’re kidding.

Barnes: A disease of predetermined length. It was obviously not a normal human condition for the body so it had to be abnormal.

Thresholds: For a male maybe (it’s) not (normal).

Barnes: Fortunately the legislators laughed that one right out of the room. But I immediately called Cheryl’s lawyer, who had run for the Attorney General’s Office by then, Mike Wolfe, and told him what was going on...

Thresholds: Who’s Cheryl?

Barnes: The one that got arrested and went to Supreme Court. Her lawyer’s name was Mike Wolfe, from St. Louis. He had just recently run for Attorney General and lost by 500 votes. I called him and told him that I had gotten this inquiry by phone (from the Board of Human Rights) and the man said he wanted to come and talk to me. I asked Mike should I talk to him? Mike said, “When he calls you back, tell him to call me.” So I said okay. He called me back and I told him to call Mike Wolfe. Then Mike Wolfe called back and said, “Don’t talk to him. The man speaks with a forked tongue.” I said, “Oookay.”
So Mike was then my lawyer and represented me and agreed to charge me a maximum of 500 hours at $50 an hour and out of pocket expenses. I ended up spending about $8,000. He answered the inquiries back and forth. They demanded 150 of my charts randomly chosen out of my stacks. I told them that I would burn my records before I would give them to them. Mike told me I couldn’t do that, that a professional had to keep records. I said, “Well I didn’t consider myself a professional and I didn’t know if I wanted to use that word, or not.” But my license says registered professional nurse so I was a professional. I said, “Well, I’ll give it to them.” But my big concern was that I had had some mothers that had had abortions, younger, and had changed their lifestyle and maybe either their husband didn’t know it or their family didn’t know it or whatever and it was nobody’s business. That was that woman’s private life and she was honest with me. I didn’t want anybody to ever feel that they couldn’t be honest with me because it might get turned over to the public. So I copied all the records, obliterated all the notes and addresses. What they wanted was the charts so you can look at all my charts. I didn’t touch anything on the charts; I just blacked out the names and addresses. Well they were really irritated about that. So then they got a court order that I had to give them the names, so I gave them the names. One hundred and fifty names. But I didn’t connect them with the charts. They proceeded to personally visit some, call some, and write all of them -- wanting to know if I had performed Cesareans, abortions, vasectomies all sorts of bizarre things you know, was I doing surgery and had I ever professed to being a physician. It went out on the grapevine what the Attorney General’s Office was doing. Pretty soon they called me and asked me if I would call people off because they were getting so much mail that the office was being inundated which I don’t know how much that was but they were making it like it was really a problem. I told them I didn’t call them on so I couldn’t call it off and that they would have to do that.
Months and months went by. Actually it started in 1984 and the settlement was finally reached in 1987. I went through two ten-hour days in depositions at the Federal Courthouse in Springfield (Missouri), and the first day was just negative. It was a real silly thing. They’d take a chart and open it up and they’d say, “Can you tell me how much this woman weighs?” “Yes she weighs 187 pounds.” “Would you consider that obese?” “No, personally, no.” It was like that over and over, “How much did she weigh, how much did she weigh, how much did she weigh?” You know, “we could probably shorten this day up a lot if I just tell you I’d rather take care of fat people than skinny ones. Ones I know eat well rather than ones who don’t eat or who are anorexic or something.” And they told me no we have to go through each one and then they came to a chart and they told me, “Can you tell me how much this one weighs?” I said, “Well the chart says she weighs 313 pounds but my scale only went to 300 so we just guessed that last little bit that was left on there.” “You don’t consider her high risk?” I said, “No.” They said “Well how would you describe her?” “Well she was grossly obese. So were her mother, her father, her sisters, her brother, her aunts, her uncles, it ran in the family line. She had no problem.” He said “You don’t consider that high risk?” “Well I didn’t say that. I said I didn’t consider her obesity high risk.” Then they really looked at me strange and I said, “You didn’t notice on the rest of the charts that she’s had a previous C-section - for twins.” But they didn’t notice that. They didn’t even read that. Just that she was fat. I refused her as a primary VBAC because she had twins as her first pregnancy. She went to the hospital and they didn’t believe she was in labor and let her labor through the night thinking she wasn’t in labor. They were going to do a repeat section in the morning. She delivered in the bed while one doctor was trying to start an I.V. and the anesthesiologist was trying to start an I.V. in the other arm and her husband had to announce, “Ah, the baby is on the bed.” So if it got to that point before, she could have the baby at home. So we had her second baby at home and her third baby at home. I answered most of their questions. “Didn’t I consider this high risk?” I said, “Well, no look at the outcome. It’s fine. If I thought it was high risk I shouldn’t have been there. And I didn’t. And it wasn’t so why are you frustrated with it?” Because I had only worked with Dr. George, I really didn’t consider some of the things medical hospital people would consider high risk and I hadn’t seen any evidence to make it that way so I refused to make myself paranoid over it.
The second day I was interrupted. I had to leave somebody in labor and go to this deposition -- which irritated me in the first place. I got there a little on edge and was trying to be polite and get through it. Then Debbie (her daughter who assists her) beeped me and I could tell she was pretty agitated. The mother had delivered and had a baby that had cleft lip, cleft palate. The midwife that had taken over was a nurse midwife, medically oriented nurse midwife, and she wanted this mother out of bed. Right now! Get going! Get this baby to the hospital. Well there’s no -- that’s not a crisis situation -- there is no reason to do that. The mom should have been stabilized well. So when they hurried mom around she ended up hemorrhaging. So I was very irritated and then I said, “Would you just please get to your question and get me out of here because this is a waste of my time and I should be where I ought to be -- taking care of mothers.”
At the end of it, the Assistant Attorney General asked me if he could come and tour my birth center some time and I said, “You can follow me back right now and see it if you want.” He said “Well, you know, don’t you need to go and clean it up or something.” I said, “If it is good enough for a mother to come in it’s certainly good enough for you.” He followed me back to Monett walked through the building, looking at the ceiling most of the time, and commenting on how clean it was and how he’d even bring his wife there if she didn’t have to have C-sections because she had really bad health problems.
It ended up I did get a consent agreement to practice. They presented it to me that I was signing “a consent agreement because it was a new practice in the state of Missouri and they needed to have statistics to validate the decision to support” me doing it. So the agreement was that I would provide them with an update annually on my protocol manual, that I would have consulting physician agreement updated once a year, and that I would provide them statistics every six months. I would do that for five years and we negotiated it down to four. So I did it for four years. Had another nurse midwife come in and review my charts and my practice. She would send a letter and I’d have the update for the physician’s consulting agreement and my statistics. Unbeknownst to me it wasn’t an agreement, it was a probation; that is the official words that were on it. So that will follow me and trace me down now that I was on a probationary thing and it affects getting insurance because they ask if you have ever been on probation and all this stuff. Which wasn’t the way it was presented to me originally but that was what it literally was. So I followed through on that and was able to get the agreement because at that point our Nurse Practice Act said a nurse can practice to the extent of her training.

Thresholds: The agreement in court. That was what they decided.

Barnes: Well that was what the Nurse Practice Act said. We were fighting that it did not say that the extent of the training had to be university based.

Thresholds: I see.

Barnes: They did not identify that. My argument was that I had the training. I have the skills. I have the documentation. I have the births that prove that I am capable of what I am doing. So that is why they were reviewing all my charts and trying to interview parents and see was I exceeding my training. So they had to give me the consent agreement. All along they would be interviewed and tell the media that this was a “precedent setting case.” The day they gave me the consent agreement the first statement out of their mouths was “this was not a precedent setting case”.•

In the July issue of the Wholistic Health & Healing Guide, our interview with Diane Barnes continues -- her continuing fight for the right to natural childbirth, a bit of the history of midwifery, and how she came to be president of Midwives Alliance of North America (MANA).

Three other nurses got a consent agreement that was worded exactly like mine except that their names were where my name was and they got five years instead of four because they didn’t fight for four and they all eventually were not able to keep it up. They were closer to Jefferson City and the problems that can occur in just being able to have the little medical police running around and get you. They kept blindly saying things like “Well I was allowed to be down here because I was down in the rural southwest Missouri, and there was not enough health care.” Which was true. I was the only prenatal health care provider in Lawrence County, or Barry County or in Dade County and surrounding areas. Eventually Dr. Andellin came into Lawrence County so we had one care provider there and within two to three months he wasn’t accepting any new patients because he had more than he could handle. I kept telling them that more than fifty percent of the people that came to me came from the medical mile. They would leave Springfield and go all the way to Monett because they wanted an alternative. Eventually because of all the legal things I got in contact with the national midwives organizations with how do you handle this, what do you do? Well it (the legal precedent) was just for me and I didn’t know that. I thought it was this well established, well oiled running machine and it wasn’t. It (The Board of Human Rights) had opened in 1984 and that was the same year that the investigation started. By the time I settled it they were three years old and I was three years old as well. I got involved with MANA (Midwives Alliance of North America) and became a regional rep. Then I became their membership chair. I did a convention, I sponsored a convention for them, and became president.


Thresholds: What year did you become president?

Barnes: Let’s see this is my fifth year....

Thresholds: 1990.

Barnes: We had the convention in Kansas City that year and I gave up being regional rep and membership chair and did the convention. Gave that up and became president for a two year term, and then I was reelected and they changed it to three year terms. I’ve been very involved with national and international midwifery politics since then and my experience with the state puts me heavy duty into the interest of laws that are being made across the country. Because I was in that, I was invited to be a part of an inner organizational group that was funded by the Carnegie Foundation and we met with six members of the Midwives Alliance of North America which is the group I’m president of. MANA is an umbrella organization for all midwives but it’s primarily home birth midwives, out-of-hospital birth midwives whether it’s parts of areas in Mexico or midwives in northern Alaska or illegal midwives or legal midwives. We all bunch together and we all support each other and try to provide education networking and communication, improve the standards; we have standards and guidelines developed. We’re particularly in support of out-of-hospital births and trying to step back from technology and step back from male-dominated leadership in midwifery. The other group that was invited was the American College of Nurse Midwives. By their very title they are nurses. To get into the organization you have to be a certified nurse midwife. They all have to have physician protocols, a majority of them in-the-hospital births. They don’t support out-of-hospital birth. Their insurance company will not insure a midwife that does home births. So they are eliminating home birth and out-of-hospital births by requiring nurses to have insurance to belong to their certification -- if you are certified and you are doing births you have to have insurance, and if you have to have insurance you can’t do home birth. So they are cutting off their legs and their membership is scooting over to our organization pretty heavily.

Thresholds: Same way they did with osteopathy. Where osteopathy used to be their own separate doctor school and then they merged with the AMA (American Medical Association) and then the AMA just made them regular doctors basically.

Barnes: Right, they have the same schooling and everything. That was the biggest fight I ever got into when I was on the steering committee for the state for trying to get the midwifery law passed and this steering committee had representatives from the AMA, from the Osteopathic Society, and from the nursing board. The osteopaths were absolutely the nastiest ones there. I mean the Board of Healing Arts guy was definitely silver-tongued -- you know, the arm-around-the-shoulder and we need to get together then (slit your throat gesture). The osteopaths were just plain nasty. Finally I spoke to them kind of aside during a break in the meeting and I said, “I don’t understand your attitude I mean as a person to person I don’t understand it. Your profession, osteopathy, was not that long ago in the same position we are -- fighting for recognition of your profession. He got so mad he went to the chairperson, and told them I should be thrown out of the meeting, and shouldn’t have anything to do it. I was just too insulting to him and he just wasn’t going to put up with it and he wasn’t going to have any part of this and (on and on).

Thresholds: Really. That was true.

Barnes: Yeah but he didn’t want to hear it. They were “as good as anybody else.” It was like, yea, I agree you were.

Thresholds: That’s true.

Barnes: But anyway he didn’t like it at all. He was really, really angry that I brought it up. In this inner organizational meeting we had six ACM’s and six MANA members and six consumers and we fought for the consumers. MANA fought for the consumers. ACM did not want the consumers there. They didn’t want to waste time with the consumers.

Thresholds: What does consumers mean? People that had home births?

Barnes: Yes, consumers or consumer advocates is what we were wanting. People that were in support of what we were doing and we had some pretty articulate people because we got to choose three and they chose three. We had Barbara Katsrockman as one of our choices and she is an anthropologist that has written books on birth and women’s rights during birth. We just really had a good time with it. We proceeded to meet and both organizations had tremendous fear of each other. I cued all of my members, “I want you to come in and what we’re going to start with is an introduction of who you are and what brought us to this meeting and what brought us to become midwives.”
So the six women from my team came prepared with charts and graphs and pictures and music and a well prepared oratory to present. Of course the CNM’s were just told to show up and they were like the Ph.D.’s, the heads of Yale, the heads of Pennsylvania State -- you know very articulate, well read, well-papered women -- and they were aghast that they were totally unprepared. One of our members was from Seattle and wanted to start out by getting us all to sing a woman’s song. So these stiff-necked women were just like scared to death of the whole thing. We ended up filling the whole room all the way around the room with newsprint and writing what our fears were of each other and then consolidating them into general categories of fear and how we are going to address it and what we can do to work together. The poor consumers were just totally amazed, “I didn’t know you guys didn’t like each other. How come you don’t work together? We just want more babies at home. We just want more help.” One of them kept on saying, “You need to keep your eye on the ball; you’re losing it again.” She’d throw balls at us and oranges at us to get us to keep our eye on the ball. And about the third meeting one of them came to me and said, “Why aren’t you a CNM?” I said, “Well I’m not a CNM because there is no CNM school in Monett.”

Thresholds: What is CNM? Certified Nursing Midwife.

Barnes: I didn’t go that route -- number one because I had six children and a husband that lived here. I didn’t need to leave the state and go somewhere else for three years to become a certified nurse midwife plus it cost about $80,000 and I was already doing everything I needed to do so why would I want this piece of paper for $80,000. I mean what would I have to do to pay for that?

Thresholds: Right, because you wouldn’t learn anything new.

Barnes: Right. She said she thought she had a program that would be just perfect for me and then sent me her program a great deal of which was funded from a rural health grant which I qualified for because anywhere in Missouri except in-town Springfield is rural health. It was at-distance learning, a lot of modular at-distance learning, and just a specific amount of tenure. So then it was like this big decision. Do I do this? It was like succumbing to the enemy. If I do it can I do it and still keep my ethics intact or will I go over to the other side more? It became a big debate; in the MANA newsletter, at conventions. I was almost physically attacked but definitely verbally attacked in very heavy ways because there was a real fear that the president of MANA was going to turn the tables on this big group that includes everybody because now I’m going to become a CNM.

Thresholds: A fear you’d betray...MANA -- Midwife Alliance of North America.

Barnes: We have regional reps that go from Mexico to Canada -- one from Canada and one from Mexico -- and then the rest are from areas of the United States. So I ended up agreeing to go to this school. Basically I signed up in June, got my first course work in November, worked on it pretty much solid between births. Took an exam in December and dubbed out one year’s work from previous experience and took the exam and passed the exam. Then they sent a preceptor to come and observe me on site. They passed my skills portion of it and gave me credit for the first year. I left January 20th, went out there, and the first course was in common adult health complaints. It was eight hours a day, five days a week for a month. I finished that and then the same thing next month was inner-partum, ana-partum and post-partum the phases of pregnancy. Then they gave me a month to get my quota of births (20 births) that I had to have which you have to have to become a certified nurse midwife. One of the big arguments between American College of Nurse Midwives and MANA is that MANA supports apprenticeship and ACNM does not support an apprenticeship. They think you have to have didactors training, you have to have skilled preceptors, and you have to have all this. And I say, “A preceptor or a senior midwife that is providing the friendship, what is the difference?”
Twenty births and any MANA midwife has got at least 50 to 150 births before the senior midwife says you are qualified to go on your own. They sent me to three different hospitals and I delivered six babies in two twelve hour shifts at the first hospital. Then they sent me to another hospital where they ran me...there was a delivery room that had a partition separating two delivery areas and they would run me from one area to the other, back and forth, as heads crowned. It was to the point where I‘d say, “Could you at least tell me her name? I just don’t feel good about calling this midwifery it doesn’t quite feel good.” In three weeks I caught 26 babies. I can tell you a couple of stories about a couple of them but I could not remember any names and barely any faces. My recurring thought through it all was “high school graduate that spends four years in nursing school and then goes into midwifery school and catches 20 babies this way and then she can go out and deliver babies anywhere she wants?” It was unreal to me. But this was what they held in high esteem in this profession.
So I finished it. Took my comps and went home and prepared to take the national exams. I failed it. I went and flew back to California and failed the test. It was a new test, an untested test or something. Even though they threw out a great number of the questions, I still failed it. It was very medically oriented. It felt more like being what MANA members call ACNM’s physician extenders. It felt much more like being a physician extender than a midwife. There was not one question about normal pregnancy on the entire test. It was all pathology. So then I waited awhile and took it again in Chicago and I felt like I answered every question and I knew every answer. I failed it. I got a computer printout of what was wrong with the test that I had failed by one point. The areas of weakness were nurse midwifing management of anapartum, nurse midwifing management of intrapartum, nurse midwifing management of postpartum, and nurse midwifing management of family planning and low in gynecology and professional ethics. So it was like, “I missed by one point but I was weak in every single area.”

Thresholds: Right.

Barnes: I was ready to quit. To say this is it.

Thresholds: And this was after you had done how many births by now, 700?

Barnes: No, by then I had done about 1400 or 1500. It was becoming a real joke among MANA members.

Thresholds: I’ll bet.

Barnes: But I met with a CNM at a ACNM conference that I got invited to go to as MANA President. So I’m going as a CNM graduate student who’s failed the test twice to an ACNM convention as MANA President and it was like a little bizarre. This woman invited me to her room and said, “We’re going to get you to pass this test.” She said, “face me, put your knees in front of me and face me and hold my hands. Now repeat after me and say, ‘I love nurse midwifery management process.’” I said, “I don’t.” She says, “No! Repeat after me.” She said “that is the only constant in what you were missing was nurse midwifery management process.” So she challenged me to repeat that to myself over and over again. She called my office and told everybody as you pass her in the hall you tell her, “you love nurse midwifery management process”. It became this real silly joke that we went through and the last time I took it I went to Kentucky to the founding birthplace of the American College of Nurse Midwives and found it in Hayden, Kentucky, and in this little town and this little building. Debbie was doing affirmations to me all the way there. She did a relaxation thing for me the night before and it put me sound asleep. Then (she) told me I would wake up more ready to study and be prepared and I did. I put myself to the mind set of “Okay, I’m going in to this test. I am in a hospital. I have an obstetrician over one shoulder and a neonatologist over the other shoulder. I can yell for help anytime I want. I’m right there. I’m doing it their way in a hospital setting,” and I passed the test. I didn’t answer anything any different than I ever had. I wrote the thirteen steps of the nurse midwifery management process which is just a repetitious regurgitation that you go through but I passed it. It was like, okay, so that’s the trick! You have to think like you are in a hospital with physicians available to do surgery at any moment. You cannot be thinking that you are out...

Thresholds: It’s gotta be a disease.

Barnes: It’s gotta be a disease. So that is how I got to where I am now. But in the middle of all the stuff with the first political haranguing I opened the birth center in Monett. It was a little bizarre.

Thresholds: In what year?

Barnes: January of 1987. They (legal challenges) started in ‘84 and they finished in November of ‘87.

Thresholds: Started getting the building?

Barnes: No, they started the litigation against me in ‘84 then we made the settlement in ’87.

Thresholds: So then you opened a center.

Barnes: Yeah, opened a center in the first of January, 1987. So we were into it eleven months when they made settlement. They thought it was a little bizarre that they were trying to close me, stop me from doing anything and I not only continued but I made it more public and did more with it. They didn’t know what to do with me and I enjoyed it. I kind of enjoyed sticking it to them a little bit I think. I mean that’s not a very nice thing to say but it worked and we had a lot of community support. It’s been real gratifying to do it and to keep going. There was a lot of emotional stuff that tied between there and Monett and us to that building. I was really having a hard time letting go of them and leaving to come down here. But I love it here too so it’s okay.

Thresholds: And you moved down here because your husband was working in this area?

Barnes: Yeah.

Thresholds: What year did you...when did you move here and open this place up?

Barnes: Last November a year ago November. It’s been a much more welcoming neighborhood. The community here is much more open and more open to a variety of thought processes and Monett is really pretty closed. It was okay because I ignored them and they ignored me. It’s been real different here and it’s going to continue to be different. Last week when we had the one mother who went to the hospital for the C-section it was very frustrating because I got a phone call from the physician the next day and he said, “You know everything went fine and there was no medical indication for that C-section except the mother just absolutely insisted on it.” She’d had a previous C-section so he could go ahead and do it. He said, “But I didn’t know you were doing VBAC’s.”

Thresholds: What is a VBAC?

Barnes: Vaginal birth afterbirth Cesarian and I said, “Oh, yeah, I have”. He said, “This was unexpected you didn’t really plan to do this did you?” I said, “Yes I did. I do a lot of these. I have moms who want an alternative and want an opportunity to deliver vaginally.” He said, “Do you know how dangerous they are?” I said, “There are no statistics to support that.” He said, “Well, I saw a uterus rupture on a woman having a vaginal delivery after a C-section when I was in my residency and it’s an awful thing. You wouldn’t want that on your heart and your mind. You wouldn’t want to have to live with that.” I said, “No, I wouldn’t but the statistics show that the ones that have had ruptured uteruses are almost always in the hospital being given pitocin and labor that’s beyond their capacity to deal with and what we are doing is natural in letting women take their time and let it work through.” And all he could do is keep on repeating his scary story. Every time I said something he just kept on repeating the scary story. Finally he closed with well he’ll be meeting with Dr. Huffman soon and he’ll get back to me in the morning to make sure that he’d support me but you know it’s really a scary thing to do. I thought oh great, he is going to meet with the physician who signs my protocols and is going to talk to him that he is not going to be willing to support us if he doesn’t tell me that I can’t do VBAC’s. I mean I’m waiting for this to come back around and had myself frustrated throughout that day to the point where okay, I’m going to get told that I can’t do VBAC’s, do I agree to not do VBAC’s? Then the mother that I have been taking care of that is due to have twins in June is going to be told, “you are going to have to go to the hospital and have a C-section now even though you have had all these babies very easily and you are not going to have any problems.” Even though I won’t just arbitrarily say, “yes I will do her C-section,” the baby has to be in the right position in her delivery. The babies have to be in the right position and healthy and everything else. I can’t individualize my caring or I’m going to have to say “can’t do twins, can’t do breeches.” If I can’t do twins or breeches or VBAC’s I won’t be able to do anybody over forty, probably over 35 because that is the standard now you’re high risk if you’re over 35. I won’t be able to do anybody under 17 because that’ll be high risk. And I won’t be able to do anybody over 200 pounds because that would be high risk. We can just keep adding and adding and adding what all these things are that are scary -- until Debbie walked in and I said I won’t be able to do redheads because they bleed too much (laughs exasperatedly). Right on down the line you can’t do anybody.

Thresholds: All these nots and limitations.

Barnes: In my list I didn’t even think about babies that were too big that have to have C-sections. So this weekend we had the 13 and 11 pound babies and I felt like it was a gift to me. It was like “see these women would have had C-sections if they hadn’t been allowed to be here rather than at the hospital.” I just am supposed to remember that I didn’t become a midwife because I thought it was a good job. I didn’t go search out a profession that I started out going to school to do. I was dragged in really with my feet buried in the sand- dragging against that saying, “no, no, no I just want to stay at home and take care of my kids.” And every time the Board of Healing Arts threatened me or the nursing board threatens me or somebody else comes up and it’s like “fine take my license away and I’ll stay home and bake cookies for my grandchildren.” This is not an unhappy thing to me. I mean I might have some juggling to do to figure out what to do financially because of the commitments I’ve made but it would not be disastrous to me.
I am a midwife because I love what I do. I love being with the energies that surround it. I love supporting mothers to have births in a natural way. I love supporting mothers and dads to have a family-oriented relationship that’s not impeded by all the mechanical circumstances and the bells and whistles that go on in a hospital that tend to alienate dads from the birth process. Alienate mothers from their own bodies and all of it. If I can’t do it the way I know it was intended to be then I don’t want to do it anyway. I already had that opportunity. I worked in labor and delivery and I rejected it way back in 1984. It will either be the way I know is right or I won’t do it.

Thresholds: I’ve heard you say at least twice, something to the effect that birth is such a miracle and if it ever gets to the point where the miracle is gone...

Barnes: I try to tell that to nurses, students, midwifery students and physicians. Physicians can’t even explain it. They can’t even see it. But I have given talks for the last three conferences to remember why we do midwifery and that birth is a miracle. You know this. You know it in your mind but you’re going to know it in a deeper way than you have ever imagined in a little while after you have this baby. You’re going to know it and you will. You know it’s a miracle intellectually -- think about it -- you have this little bitty opening and how does this baby come through there? Where does it come from and how does it get there? Yet it is going to be a deeper understanding of that after the birth is over. And I get the privilege of being there at each birth and renewing that knowledge of a miracle everytime and if I ever lose sight of that and it becomes a mundane daily kind of job then I would quit the first time that it was a boring thing to go through. I really think that’s what happens to physicians. It becomes too mundane. It’s too...I mean come in, catch the baby, okay you’re done, we’ll see you later or whatever. When the excitement is on how much suturing you can do or some big tragedy then it’s wrong and I would quit. I couldn’t handle it because birth is a miracle. The whole process is a miracle. I love it.

Thresholds: It really is. It’s quite astounding.

Barnes: It really is. To see these little kids and their reactions that’s what it’s all about. Children, siblings at birth they see the miracle. They sit on my stool at the foot of the mom, watching mom, and dad is in pain wishing he could take that pain away from mom and mom is just concentrating on what she is doing. It’s hard to even pay attention to what you’re doing. But to see these little children just sitting over there just bouncing on the bed, just so excited they can’t stand it! They see beyond the mom’s pain. They see beyond the dad’s fear and it’s visible, it’s there. Their joy is so strong seeing that baby come out. The first time I had kids at a birth and they stood around my shoulder around this mom and it was the fifth baby. These four little kids were there and the oldest one was going, “Well, here comes the baby’s head. Push mom. You’re doing good, push again. See the baby’s hair. You can see the hair, it’s all kind of bumped up. Dad, mom’s doing okay.” And these kids were just kind of leaning on my arm and the baby was born up in their mom’s arms. They ran around and kissed the baby on the cheek and said, “we’re going to go play now.” It was just like...natural, so natural. That same mom is coming back now having her twelfth baby.

Thresholds: Wow.

Barnes: Her husband’s still saying, we have enough. We have enough. We don’t need anymore. It’s just fun.


Thresholds: So how would you define midwifery?

Barnes: Well the word midwife means “with woman,” just “being with woman.” To define midwifery...someone who has the skills and knowledge to maintain normal but be able to be patient enough to just be with woman. I have grandmothers come in and watch a stern labor like we are now. I had one comment to me once just after the baby was born, “I watched you through this whole labor and I was really starting to wonder if this is what you do to earn your living is just visit. And then when the time of birth comes you really put yourself in gear, get it all done, and then you just disappear and back off again like it was the normal thing to do.” That’s my job, to help it to remain as normal as possible. To observe for nuances that are moving us away from normal and help direct it back to normal and to put the empowerment toward the mother, first of all, and to empower the family unit. I feel like that is my definition of midwifery, to protect the normal and to empower the woman to become this mother and the family unit, to keep it intact and support both parts of it.

Thresholds: Do you think, or do you know, that there have always been midwives?

Barnes: Yes, I think there have always been midwives.

Thresholds: Make sense to me. So from what you know and your vantage point how did midwifery fall out of such favor, particularly in this country?

Barnes: In 1959 there was a major move all across the country in one weekend by the American Medical Association to put into legislation a law to either eliminate licensure of midwives in the states where there was licensure or to make it illegal. In one short span of time -- I’ve been told it was a weekend -- in 1959 it went across the country and where there were laws to license or regulate midwives they were wiped out. They ended up, like in Missouri, we have laws all over the books that say ”a midwife will --” or on birth certificates it says “a physician or midwife will have the birth certificate in by 10 days.” Under the health laws “a physician or midwife” will instill prophylactic antibiotics in the baby’s eyes. All these references to what midwives will do but the law that licenses the midwives is gone.

Thresholds: As of 1959.

Barnes: Yes, and it was a sunset law that came or went through. Just one by one the midwives that were licensed at that time kept practicing until they died or quit. But there was no new licensure. I co-authored a study with the public Health Department statistical division on out of hospital births from 1979 to about 1984. I got a list of the licensed midwives that were still licensed and then I knew all the underground midwives across the state and was given a copy of all of the birth certificates, a big giant printout, and contacted the midwives that were in the vicinity of where these births were to identify which births they’d attended. Some of them had gone quite a distance across state to take care of people and help to evaluate the outcomes and the quality of care given and at that point we were trying to prove that you didn’t have to be a nurse but that there was some recognition of standards. So we had the Missouri Midwives Association recognize midwives. It was like a weird term to put this all out there because we really didn’t do a certification but we recognized the skills of these ones that they had agreed to interaction and evaluation among peer pressure without any kind of university claim of what went on with it.
The statistics showed that, once we took out the miscarriages and births that weren’t intended to be outside of the hospital, then even with those in there we had better statistics than the hospital did. When we took the unattended births like the miscarriages and transfers in route we had much better statistics than the hospital. Then they were categorized by physicians, certified nurse midwives, and then they recognized midwives, and then other or not attended. The other-attended had the worst. There was a group in Kansas City that was promoting “do it yourself” and I think it is a religious group that still does practice. They believe that you shouldn’t have any care. That if you were truly in tune with God and you were truly doing what you should, the baby would just fall out. Whatever happens happens. You don’t need any help so they don’t do any heart tones. They don’t do any blood pressures. They don’t do any risking out and they have had several maternal deaths and fetal deaths because they have tried to have unattended births for diabetics. Two diabetics, the women died, and those were unnecessary deaths. Any of us would agree they were unnecessary deaths. But other than that particular group then the statistics went with the physicians had the worst statistics, the CNM’s had the next worst statistics, and then the midwives had the best...

Thresholds: CNM that stands for certified, the ones that were educated to do that.

Barnes: Right, and what we could identify they tend to take higher risks without the support that they’re trained to have in the hospital. The MANA midwives may take the same risks but we’re trained to take care of the risk that we are doing outside the hospital and not be able to say, “Hey, doc?” over the shoulder, “which one of these do we need to have?” They ended up having a couple of infant mortalities that could have been avoided if they had a little more training or experience.

Thresholds: So have you ever thought about doing any work to get that 1959 law repealed?

Barnes: Well, they are not going to repeal it but we have put in new laws every year since 1984. There’s been a bill submitted every year since 1984. I did a lot of work with steering committees, with legislative hearings, all kinds of things. Either the Board of Healing Arts or the nursing board has succeeded in killing the bill every year.
One year we got it through the House and then it went to the Senate. It was looking really good like it was going to pass and a physician from Joplin, Dr. Frank Clark, had been in attendance of a baby that I‘d transferred to the hospital who had beta strep and he’d accepted the baby and started the medication and then left the hospital. He assumed, later I found out, he assumed the baby died. We did transfer it from Joplin to Springfield to the neonatal unit and the baby survived and was alive and quite well. He decided to go back to school and become a neonatologist. While he was in Columbia becoming a neonatologist he was invited to be on the Board of Healing Arts. He was outspoken about not liking midwives and so they asked him to go testify to the legislature, to go and lobby against this midwifery bill. The senator that represented our bill and our lobbyist both called me, same day, saying, “Why didn’t you tell me you had a baby die?” I said, “I’ve never had a baby die.” “You haven’t?” I said, “No.” And they told me that this Dr. Clark was telling everybody that he knew that midwives killed babies and that he particularly knew one midwife that has killed three babies and the senator said, “I only know one midwife down in your area and that is Diane Barnes.” He said, “That’s right and she’s killed at least three babies that I know of and I can name one of them.” The name was Keith Adams and I said, “No Keith Adams is quite alive.” So he had done his damage and it was too late and the bill died.
The President of the Friends of Missouri Midwives was working as a paralegal for an attorney in Rolla and she invited me to come up and talk to him and tell him the story. Well my lawyer, Mike Wolfe, called Dr. Clark and taped the conversations. So I have this tape of him saying, “Yes, she killed babies,” and Mike said, “No, she didn’t kill babies. Keith Adams is quite alive and how did you identify? How do you know Keith Adams?” He said, “Well it was real easy for me to remember because the administrator for the nearby hospital, his name was Keith Adams and that is how we remembered his name.” “Well, Keith Adams happens to be very much alive.” He couldn’t name these other babies and he couldn’t swear that I had anything to do with these other babies that had died. Somebody had dumped a baby in a dumpster and he was sure that it was me that had attended this birth and abandoned the baby. When he started finding out that it was a lawyer talking, he started backpeddling the lot. But nothing ever came of it. I went up to visit this lawyer and he listened to the tape and said, “You’ve got grounds and if you want to pay me a retainer I’ll sue him.” I said, “I don’t really want to sue him. I want a retraction because I want to go back to the legislature with a retraction.” He said it would take at least a $5,000 retainer to go after him and since he’s in school because he’s already checked it out. He’d already transferred all his worldly goods to his wife’s name so he had nothing to be sued for. There was no way I was going to get anything out of him and I said, “I don’t care about money. I really want a retraction.” So I went back home and kinda forgot about it.
Did you notice the poster above the filing cabinet there?

Thresholds: Yes, I did notice that.

Barnes: One of our Jewish midwives went to an art store in New York when we had a convention there and came out with this beautiful painting that was this Hebrew midwife. We eventually got the artist to do a watercolor and have posters made as a fundraiser for MANA. It has this quote out of the Bible and it says, “And the midwives did not as the king commanded and save the boy children alive.” The next phrase after that is, “And he gave them houses.” I really know that’s true because my husband’s business had burned down and we had lost everything we had. We were living in an apartment above the Monett clinic and it was insane to live in this two bedroom apartment. I had two teenage boys and then my daughter Debbie came home from school and my older son came home from fishing. I had four adult-sized kids and us living in a two bedroom apartment. It was like this is not going to work. I used to drive around when I wasn’t at work looking for houses to rent. I found this nasty, nasty old house that I knew my husband could remodel. The guy was willing to do owner financing on it and he wanted $18,000 for it with $2,000 down. $2,000 was as far off as anything in the dreams I would ever have to come up with. $2,000 before he would sell it to somebody else. That day I got a letter from the lawyer in Rolla and unbeknownst to me he had followed up on it and threatened the Board of Healing Arts that he was going to sue, publically sue, the Board of Healing Arts en masse and individually and Frank Clark. The Board of Healing Arts talked to Frank, found out he was lying, and got him to write a retraction. They would give me the whole retraction and a check for $2,000 if I was willing to not sue them. If I was willing to do that I should sign this paper and send it back to him, and since it was such a piddly sum he wouldn’t even charge anything for the work he’d done to get it. So I had the $2,000 for the house then. And the retraction. He stated, “I fabricated the story without any shred of proof.”

Thresholds: Did you send that to all the Missouri State Senators?

Barnes: Yeah, we faxed it to every one of them.

Thresholds: Good.

Barnes: So that is clarified now and we continue every year to put in another bill. We got really close two years ago. Got it through the House and out of committee in the Senate and it was down to just the vote on the floor and if we would have gotten the vote on the floor we would have won. Senator Singleton who happens to be an ear, nose, and throat doctor in Joplin stood up and said if this bill comes to the floor he will filibuster and filibuster until they will go home on the filibuster. So they kept putting it off hoping they could wait ‘til he was out of the room and then run it. And he would not leave the room. It ran out of time and we didn’t get it on the floor. So we’re back on that one again. He is very vocal about being against any nurse practitioners, any advanced practice...

Thresholds: He’s threatened...

Barnes: Yeah, I’m very well convinced that if a doctor has to become a legislator then he must not have been a very good doctor in the first place or he would have been busy and happy where he was.

Thresholds: Like the country lawyers are.

Thresholds: That’s the truth.

Barnes: Yeah, I think that’s true of teachers. You know, the teachers that I’ve seen in midwifery school generally I wouldn’t want them delivering my baby. So that’s how I got from where I was to where I am. I just want to train other midwives and give them the opportunity to learn.


Midwifery Today

Thresholds: How many are you training now?

Barnes: Tracy (an apprentice in Diane’s clinic) is going to be a midwife sometime. I have a student coming next week that is in CNM school. I didn’t realize how much had gone out about me until other students started telling me that they’ve told people that they are going to come to my clinic. They tell me how lucky they are to get to come. Just ones who have heard me talk or given a slide show on birth so that they have had that impression of who I am. But I’ve been encouraged to go on and get my bachelor’s degree and a master’s degree in nursing so that I could go teach at a midwifery school. But it’s not worth the stress that school gives to me because I had terrific test anxiety. I absolutely killed myself that first semester in school because I wanted an A in Zoology because if I had an A I didn’t have to take the final. I sat down and bawled because I got an A- and I was going to take that final. Then I didn’t take the final and the only A in the class was the A- that I got. The stress that I had taken in school is just not reasonable. It’s not a reasonable thing to put myself through -- for the cost physically and financially and the reward that I get out of it, it is worth it.

Thresholds: So what do the MANA people, the midwives think of you now that you’ve got your midwife degree?

Barnes: We went through this over a period of time because I went through school and then I failed the test. It took me longer to pass the test than it did for me to go through the school. That was funny because you only take it six months at time and it took a year and a half to get the test done. I spent less than a year getting the school done. They trust me again and that’s good. They’re more open now to CNM’s because before CNM’s were members of our organization but when they came to our meetings they never mentioned they were CNM’s because they didn’t want to be attacked or vilified for having been on the other side. We really more clearly identified the lines between the two organizations as one is hospital birth and one is out-of-hospital birth rather than a delineation of titles that are given. So the support systems have changed.
MANA has grown up a little bit more. It’s more mature in that now we’re identifying that we do need certification of our own. So sister organizations have developed that are now providing certification of direct entry midwives without a nursing degree. The process has occurred so rapidly and we’ve gathered steam and membership so clearly that two years ago at the ACM convention one of their members got up and proposed that nursing no longer be a prerequisite to midwifery. They’re now trying to catch up, they’re trying to use our impetus and take over the steps we’ve made and create another entry into midwifery -- which if they do succeed it will become the American College of Midwives rather than the American College of Nurse Midwifery.

Thresholds: Okay.

Barnes: The nursing board would be violently opposed to that because they like the control they have over midwives. Physicians surprisingly are in favor of it, for the most part. The higher ups are because then midwife would be an independent practice and they won’t be held responsible for what midwives do. It’s kind of a self protective thing. There’s a recognition in the government that midwives have such a tremendously lower C-section rate and better outcomes and lower malpractice suits that they would be more cost effective if we go to a national insurance to have midwives during the normal births and reserving obstetricians for the complications that do occur. And midwives are great for when there are complications and you need a C-section we’re really glad the doctor is there and we don’t have to do that. We want to do normal things but that makes a big difference.

Thresholds: What’s the future? What does the future hold?

Barnes: For midwifery?

Thresholds: Yes.

Barnes: Well my vision of the future is that instead of midwives doing 3% of the births midwives will do 97% of the births and obstetricians can do complications and the hysterectomies and the other things that they do. Our C-section rate will drop and match the rest of the world and we’ll be down to three to five percent rather than 35 percent. That prenatal care will be offered to all women instead of United States being 39th or 40th on the list for the World Health Organization for maternity care. And women will take over the rights to their bodies and have more support in making decisions of what they are going to do, make more informed consent on what they’re doing instead of being impressed with bells and whistles and technology. That’s my dream of what’s out there. I think there will be national health care somewhere down the line and I think midwives will be employed because it will be cost effective. It’s going to be up to midwives to protect midwifery in a pure state and not just become physician extenders. It’s out there.

Thresholds: And what’s the future hold for you? What is your vision for your Self?

Barnes: For me right here? Stay right here in this birth center until I retire which I don’t think will be too many years off because I don’t think I can keep up the pace I’ve been keeping without needing more help. I’d like to work actively until I’m about 59 or 60 and then I’m going to do more administrative work and take over for vacations for other midwives. I’d like to find at least two or three midwives who will take over this practice. I think by the time I’d retire there’d need to be three ‘cause I think the numbers will keep growing.

Thresholds: Yeah.

Thresholds: And how long once you take on apprentices would you call it, take on someone you’re training?

Barnes: A student.

Thresholds: Student. What’s the time length they would need to train in order to be able to be in the position or role that you have?

Barnes: I have a hard time with students that want to come in because they’re trained in the didactic thing of everything’s hurried and it’s by a certain semester level or something going that way. I have 26 births in a month. But I have to explain to all students who come here you won’t get 26 births in a month. You won’t even get to deliver a baby in the first month you are here because this is a private practice. Mothers have to get to know you and they have to invite you to catch their baby. This is a private practice, this isn’t a welfare hospital where they’re just running the crowd through and you get to do your numbers in practice and get your numbers of everything in that you have to do.

Thresholds: It’s now how much gross production you can produce in a month.

Barnes: Right.

Thresholds: Like a Soviet socialist system.

Barnes: No, ‘cause most midwives are going to get their umm skills training in welfare hospitals and the mothers have to take what’s there.

Thresholds: Right.

Barnes: This isn’t that kind of mentality and the midwives that choose to come here as students under me, they know that to begin with. They know that their learning here is an attitude - a mentality - in addition to skills. They’re not coming here to demonstrate skills but also to learn some skills. They have the didactic training. They have the theory.

Thresholds: What do you mean by didactic?

Barnes: Bookwork learning. The basic theories and stuff. They do learn all the theory and things in school. They have little skill workshops but they don’t actually do hands on until they complete everything and they’re basically graduated. Then they have to go get their births, come back with their evidence of their births and what they’ve learned, and present case studies. Then they can take their comps and go for the National Certification Test. I explain to students that they need to be here at least six months to a year to think that they’re gonna get 20 births, which is the minimum number ACM requires. The preceptor has to be able to say, “you’ve got enough births, you’re done, you’re good enough,” or “no, you still need more practice on a particular area.”

Thresholds: Why wouldn’t they have 20 if they were here for six months? How many did you do in the last six months here?

Barnes: That’s not the point of it. If I had a student come in today, would you be willing to have somebody you’ve never met before deliver your baby?

Thresholds: No.

Barnes: That you know was a student and had never delivered a baby?

Thresholds: No.

Barnes: Okay, that’s why they’re not going to get that many births in a short period of time.

Thresholds: So the first six months they’re going to be helping you more or less.

Barnes: Yeah, they’re going to be helping and they’re going to be observing. They’re getting to get to know how to labor with a woman. They’re going to be catching some babies along the way because it takes a certain number of prenatals to meet people and get to know them. I mean that’s what’s been upsetting this last couple months here because we had such a big turnover with everybody. (Of Diane’s three assistants at WomanCare: one, a nurse, had her second child, Diane’s daughter Debbie became pregnant and wanted time off, Tracy went to weekends while pursuing a nursing degree full time.--Ed.)

Thresholds: Right, same time.

Barnes: I mean a lot of mothers were going “aughh!” We had two mothers transfer out. They would rather go the hospital and take a total unknown than have the upset of the turnover we had. It was like that makes sense? Okay. I had to back down myself because I was upset by the turnover and the change. But I’m the one constant so far as long as I stay healthy we’re all right for now. And yet I realize I have to take a break and I’ve already contacted another midwife to come in in March and give me a long weekend off. Because I can’t plan to take off.

Thresholds: Right.

Barnes: Because I could be called in at any time, so I have to leave town if I go. I can’t be here at all.

Thresholds: So what about the people you would train to do what you’re doing and to take over and run the Women’s Center here. What type of background or degrees or training do you require in order to do that?

Barnes: Right now, in order to be legal in this state they would have to be a CNM. To be legal in this state they’d have to be a CNM.

Thresholds: Which means they would have to go out to California...?

Barnes: Go off someplace to school.

Thresholds: Where else do they offer it besides California?

Barnes: Well, right now there is a student in Springfield that is going to be coming here in May. She will finish her didactic portion in May and she is going to a midwifery school in Kentucky that is affiliated with the university in Cincinnati.

Thresholds: The University of Cincinnati?

Barnes: No, it’s by another name I can’t think of what it is. But it’s in Cincinnati and it’s a university. It’ll come to me. But she has been working labor and delivery at St. John’s (Hospital in Springfield, Missouri) for five years. It’s just that she is working at the hospital doing what she has to do to make her income so that she can afford to go to school and just enduring it. Once they knew she was becoming a midwife they set her up for failure several times. One of the physicians that I know, that I don’t like very much ,came in with a drop in. Drop ins don’t get treated real well, particularly Medicaid drop ins don’t get treated very well- in general- by some physicians and this particular physician is worse. But he checked this woman and she was seven centimeters and moving along very quickly and had already had two kids. I mean her labor could have gone from seven to complete in a couple of minutes. But he decided he was going to leave the floor and he told this student midwife, “I’m gonna leave the floor, I’ll be on my beeper.” She said “But she’s seven centimeters. She’s almost ready to push.” He said, “I said I‘ll be on my beeper.” “Well, where are you going to be?” I said, “I’m going to be on my beeper.” When he left the floor, immediately after he went out the door, the mother started calling to the nurse. She went in and she (the mother) was complete and she called him on the beeper and said, “You’re needed stat.” He didn’t come. Called him a second time. He didn’t come. Called him over the intercom, over the whole floor of the hospital. He didn’t come. And she ended up catching this baby on the bed in the labor room. She got put on report for having midwifery values and allowing this women to precept. So she got put on report and maybe lose her job over it, and he really did it on purpose. He knew exactly what was going to happen. He knew the mom...

Thresholds: He should have been put on report for being irresponsible.

Barnes: Right. But it doesn’t work that way. What makes it even worse is that the nursing staff don’t like midwives either. They think they’re uppity and that they’re going beyond the call of nursing and that nurses are supposed to be there to serve physicians. They’re not supposed to get independent and do their own thing. There are a lot of nurses think that way. The midwife’s worst enemy all over the country are nursing staffs. The nursing staff will foul them up more than anybody. So that’s what she’s finding and having a very difficult time coping with it because they put her on report for allowing this woman to precept which was pretty silly. But she’ll be here and probably work with me for a couple of months before she’s been around enough to have moms feel confident enough to say “I’ll catch your baby.” Even though she’s got all the skills and she’s caught babies at the hospital already because labor and delivery nurses do catch babies, she’ll have all of the theory and everything else behind her. But the women that I’m going to end up having here and work with me, it’s even harder for me because there are all different kinds of midwives all over the country. There really are a real variety just like there are in any other area or profession or anything. I’m pretty stiff and rigid in the way I want things done. (laughs) As far as I don’t want a lot of intervention but I want them to be able to do intervention if it’s needed and know when that is and when it isn’t. I don’t get along well with real loud boisterous people, they’re just too loud. They need to know when to be quiet. I mean I talk a lot, and when I do talk I don’t mind talking, but during birth there’s a time to be quiet. Attitudes toward women I feel are really, really important and because of where we are here in this part of the country there are certain things that won’t fly. Like one midwife that really wanted to come work here who was lesbian. I don’t hve anything against them, I mean I don’t think, I myself would not become a lesbian and my religion has a basis against lesbianism but I have also an even stronger belief in free agency. Everybody has to choose their own path and go their own way but many, many of the people I care for would not be comfortable. A person’s sexual choice is their own business but when they wear it on their sleeve and that becomes the emphasis of their fight for their life then that’s not what I want to do. I want midwifery to be at the forefront. That was one of my vilifications I went through with MANA, because a woman who had “support lesbian midwives” (on her shirt) and a mohawk haircut wanted to come work with me, and I said, “It just won’t be comfortable in Monett.” It’s not anything against you personally but it will not fly. It’s gotta be somebody who is willing to live in the middle of the country without a lot of diversity. There are a lot of midwives who really want a lot of cultural diversity around and there’s not. There’s not a lot of options here. Mostly middle class, white Americans. Where on the west coast the midwives take care of most of the population. Most of the births are done by midwives.

Thresholds: On the West Coast?

Barnes: I was up in Oakland I only had one person who spoke English out of six births in twelve hours. It was like crazy. And in southern California it was mostly all Hispanic, and some Oriental, but it was just a culturally diverse group of people and that just doesn’t occur here. But I love the amount of diversity we do have.

Thresholds: So what kind of women seek you out?

Barnes: Everybody. There isn’t really a stereotypical person. The richest of the rich or the poorest of the poor, so its really not financial. Primarily before I became a CNM it was the self-employed that had a hard time finding insurance but made enough they didn’t qualify for Medicaid. So it was that one that fell through the cracks in the middle- that was the majority. But now insurance covers us and Medicaid so it is like a new direction. A majority have some college education. A majority, like on the West Coast people that are looking for out-of-hospital birth experiences, it’s the yuppies and people of an alternative lifestyle really looking for something different and they’re wanting to buck the system. When I go to conferences people have a real hard time. In El Paso, it’s Mexicans coming across the border wanting an American birth certificate. So there’s reasons for these pockets of midwives that have big numbers of births. In Chicago it’s a lot of Arabs that are not wanting, or Muslims, that do not want any male attendants at all so they look for the midwives. Here it’s people believe birth is normal. You know this is the Midwest. We see animals. We know that this birth works and is basically healthy. Nobody’s doing anything weird or different. We have a few who are looking for an alternative but the majority of them are just wanting health care. I was closest. I was cheapest. Then once they have a birth experience they get a little bit of a testimony that it’s something different.

Thresholds: Most of them tell their friends too.

Barnes: 98% of the people who come here come from word of mouth. We did surveys several years ago. We asked everybody, “How did you know about us?” Like we used to put pretty good size ads in the phone book trying to make sure, but nobody ever looked in the phone book. They had no idea that there was a midwife in the phone book. So we laugh about that now. We don’t now. We just have single line ads now. So we’re in there but we’re not making any big deal about it. And it is word of mouth. It still frustrates the physicians.

Thresholds: ‘Cause you’re doing so well you mean? So many people come here?

Barnes: Well one person will transfer from a physician’s office and traditionally women when they get pregnant will go to their friends and say “who are you going to?” ‘Cause they want to go to somebody that they feel like there is some degree of trust even if they have to borrow it from their friends. So quite often if somebody transfers from a physician’s office and comes to us and then likes us and then tells the friends about us then their friends will transfer.

Thresholds: So he loses all their business.

Barnes: So all of sudden I get a call from a physician, “I had four of my patients transfer to you this week. What are you doing down there? Are you legal? What is it that you do that they like?” (laughs) “Ask them.”

Thresholds: But you’ve gotta legally have, what you called before protocol, which is back up... or what is that?

Barnes: Well it’s a confusing bunch of terms that it took a long time to get the nursing board and the political entities to understand what they were asking. I have to have standing orders signed by a physician for the medical part of my practice: for injecting medications, for carrying drugs, for prescription privilege. And the standing orders are very short. They basically are letting me do episiotomies and suturing and then using medications. He has to review my protocols which are my practice plans. For this situation this is what we do. This is how we identify it. These are the signs and symptoms. This is the title and what that process is being called and how we treat it. So my protocol manual is about six inches thick now. And I keep adding to it. Some midwives have like little short ones. Missouri wants everything detailed. So I just made it as completely thorough as I could. When the nursing board wanted me to present a case for the breech they thought they were going to have me and I said well, “It’s according to my protocol and it’s right there in my protocol.” They have a copy so they’re like, “Oooo it is in there. She has breeches in there. It’s right in the protocol.” So it’s there.
The biggest threat of having such a detailed protocol is that I still believe in individualized care, so there is the possibility that I won’t do exactly what a protocol will say. And that they could hang me on any one specific point. So we have a disclaimer at the end but we do individualize our care -- this is the typical protocol but it’s not everything.

Thresholds: Other than the obvious medical care of surgical intervention and crises mangement, how does the care you offer as a certified nurse midwife differ from that of a physician or a nurse in a hospital?

Barnes: Well, nurses do the same thing as the physicians in as far as men have to be doers; they have to be fixers and doing it. Nurses have a hard time to not also do. Like Dr. George just didn’t show up until the last minute so he wasn’t doing a lot of things and even when he came he would go off and go to sleep. But nurses in hospitals -- they’re employed -- and you’re not supposed to work and sit around on your duff. You’re supposed to be doing things. So to earn their money they have to actively participate in doing something for this person so they are in there either hooking up monitors or watching the monitors or running around checking the I.V.’s or giving medications or offering medications or getting very actively involved in the beginning part of the birth process after the mother is complete getting the mother to push and push too soon. This (is) regimented and authoritative kind of behavior. There is some frustration too at being a female and having a lot less leeway to spend with the patient. It becomes territorial. Last time I went to the hospital one of the nurse managers told me I was going to wait outside while her nurses checked her in and I said, “No I’m not. I am with the patient and the patient wants me with her and the physician told me I could be with her.” She told me that when the physician runs this ward then I can do what the physician says but that she was in charge there. And it was like “oh, I’ve got to keep this in mind -- how we approach things.”

Thresholds: So did you end up having to wait outside?

Barnes: No.

Thresholds: Did you keep on insisting?

Barnes: I stared her down actually. But finally with a flourish she said go ahead. Then after I talked to the mom and got mom settled down I was able to retalk to the nurse and say I have no intentions of usurping your authority or interfering with your process. I’m here solely to participate with the mother, to support her and provide interaction that will facilitate a transition from a birth center atmosphere to the hospital atmosphere and from a change in plans of what she is planning to do. Then the nurse settled down some. She had had a bad day. But she wasn’t happy with me for pushing her and for not accepting her authority. We did a little tap dance on who had more authority.

Thresholds: See I would call that, what you were saying, the difference between men and women that the men tend to want to be doing something I call it the aggressive quality and the women where they need to be there for support or whatever as the receptive quality.

Barnes: That’s something that I have really been paying attention to lately. As women we accept things but a lot of times we just want to talk it to death. You know just talk it through and talk it through, and men don’t want to talk a lot, in general.

Thresholds: Right.

Barnes: It’s like haven’t I talked about this enough...

Thresholds: I’ve caught myself saying all those exact same words. I’ve sat here over an hour now and I’m tired of sitting and I want to go do something.

Barnes: I’ve been married for 29 years now and probably in the last three years we finally figured this out. I can talk to him just so long then I have to take a break so that he can go. A friend of mind says he can watch my husband’s eyes when the garage door goes down and we know that we’re done. We can’t talk to him anymore. We have to do something else and talk again later. It’s fun to see it finally and to be mature enough and far enough down the road that we can understand the differences and to recognize it’s okay.

Thresholds: There is actually real differences between men and women. They are two halves of a whole.

Barnes: Right, there is no way we can legislate equality there. They are totally different.

Thresholds: Well, in most cases when they talk about equality they don’t mean equality they mean sameness. Everybody being the same like you’re a clone. Everybody’s a clone of everybody else and nobody is a clone of anybody else so that never works.

Barnes: But there are an awful lot of similarities between men and a lot of similarities between women that aren’t similar to each other.

Thresholds: Yes.

Barnes: Particularly in prenatal classes I see it over and over when we talk about accepting the differences in the women during pregnancy. Because there is a shift in thought process and the direction we’re going. There is an innerness that comes up in pregnancy. Don’t you think? When you become pregnant a lot of times the thought processes kind of turn towards inner thoughts.

Thresholds: I think so.

Barnes: There is a lot of awareness of the body changes. It’s like you can’t miss them and they are so real to us because we are enduring them every day.

Thresholds: Right.

Barnes: You want to talk about them and men are kind of like well just live with it. You know, it’ll pass. You only have nine months of it. It’ll go away.

Thresholds: That’s true.

Barnes: But it’s so amazing we want to talk about it and revel in it and you know go with it. A friend of ours just had a baby out of wedlock and gave it up for adoption and she did not talk about any of her body changes. She did not give in to any of the normal complaints of pregnancy. She just ignored them. But when we’re happy in the relationship we’re in and what we’re wanting to do it’s like let’s experience every nuance. Let’s do it all.

Thresholds: That’s what has been great about Barbara. I’ve given thanks in my own mind to it because she’s described to me when changes were happening in her body and how she would observe them. That plus having a background in metaphysics and having taught thousands of people about the mind and about how to get to know themselves. She’s able to describe it pretty well... what is going on. That’s been very educational and helped me to understand what is going on with her too.

Barnes: It’s fun to see it happen and understand. I think the closest men can get is a glimmer, and for some women the closest they get is a glimmer. Because they are so unintuned with their own body. So afraid to touch their own belly or anything else that they can’t even imagine exactly what is happening. They are fearful of hurting the baby if they rub on their stomach too hard. So that’s been fun educating women along the way that it’s okay. Our bodies are okay.•
©1995 Vol. 13 No. 2

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