Kate Bowland is one of the pioneer midwives who rode on the first wave of the midwifery and homebirth movement. She became a midwife by accident. It was the concurrence of several events that led her down the midwifery path with passion. Those events were the advent of a strong feminist movement, a natural birth movement, and an optimism that “our generation believed that we could change things if we just would ‘do it’.”
In 1972 she left her home in Oregon to visit her art school friend Raven Lang in Santa Cruz CA, and when she arrived, Raven was on her way to a birth and invited Kate along. It was a long, hard posterior labor. On the way to the birth Raven told her that mother had contracted toxoplasmosis in pregnancy, and the baby might not be normal. Awed by the magic and miracle of the energy Kate stayed awake all night giving back pressure to the mom. When the baby was born with extreme molding, “I thought that he was deformed and fell in love with him anyway, I saw him as perfect. I knew that I had to go to another birth. I had graduated from art school with a BFA in painting and spent the last 3 summers as a fire lookout for the Forest Service. I had learned how to observe and wait patiently. My mother had birthed naturally and given me an appreciation of the human body and of nature. I knew that midwifery was for me as soon as he slid out.”
Over the next three and half decades, Kate has continually had a homebirth practice, educated the public in schools and the media, taught seminars and workshops on midwifery, trained apprenctices, lectured to medical, nursing and chiropractic schools and written articles on midwifery. She helped to start seed groups of midwives in Minnesota and Montana, which eventually lead to midwifery legalization in Montana.
She has been politically active and has said, “Since midwifery was essentially illegal she and her sisters had to change the laws, create schools and then go to them.” Kate, she is one of the founding mothers of CAM and the Bridge Club (a liaison group between ACNM and MANA). She is a member of CAM, CNMA (California Nurse Midwives Association), MANA, and ACNM. She often met with her legislators advocating for favorable midwifery laws. For many years she has been Chapter Chair for ACNM and CNMA advocating to keep homebirth protected.
After attending her first birth with Raven, Kate joined the Santa Cruz Birth Center, which was started in 1971 by Raven Lang. It was a collective of women who wanted to help women have choices in childbirth. The Birth Center met every Wednesday and pregnant women received prenatal care and education from the lay midwives, and the midwives would attend their births at home. Very quickly the lay midwives were doing about 20 births a month, and soon after Kate joined she hosted the Wednesday clinic in her home.
“The second birth I attended, the midwives did not arrive in time for the delivery. The father caught the baby, and the mother had a partial separation of her placenta and hemorrhaged. I didn’t know what to do. I tried to look up the answer in Myles' Midwifery. I treated the mother for shock, but she was unconscious when the midwives arrived. I lifted the woman into my arms, carried her to the car, I feared that she was going to die. I stayed behind with this little baby boy in my arms, thinking he might be a motherless child. I promised him and myself that if women were going to have babies at home I would learn how to help them. I promised that I would never be ignorant again. The mother didn’t die, she did get a surgical removal of her placenta and received a transfusion of 3 pints of blood. I realized that birth was “serious business”. Women were choosing to have their babies at home, and to increase safety they needed help from educated midwives.”
So she set about becoming educated. While researching for her book Immaculate Deception, Suzanne Arms called a meeting to connect the “underground” midwives in the greater San Francisco Bay Area. “These lay midwives began to meet for seminars and created a “school with out walls” where doctors and professional midwives came to give all day classes to us. Don Creevy, OB at Stanford and Michael Witte, Dr. William Silverman- known as the father of neonatology, midwives from other countries including Ireland, England and Holland, midwives Rosemary Mann, Kathleen London, June Whitson, Judy Flannigan, and many others were among our generous teachers. Suzanne photographed and recorded these clandestine meetings for posterity, despite our desires to be anonymous and our fears of being illegal.”
“We also reviewed births and talked story late into the night. It was an exciting time for the homebirth movement. The first wave of midwives were a dynamic brave group of activists, who were educated and committed to making birth more empowering, humane and safe. We created what was to be an excellent education. Most of those involved went on to become doctors, nurse midwives, acupuncturist, nurses, chiropractors and several wrote books and made movies.”
In 1973 Kate attended a birth for a young doctor, Lewis Mehl and his wife Gayle Peterson, suggested that a study be done on the Birth Center data and we handed over 350 files and the first study on lay midwives homebirth outcomes in the country. When it was done the published study showed outcomes just as good as planned hospital births. Common sense and prudent transfers to the hospital seemed to be safe care for low risk women. Kate has continued to participate in research over the years, contributing to several published studies that show good outcomes from planned homebirths.
One of the sentinel events of Kate’s life was the infamous Birth Center Bust. In 1973 the State Department of Consumer Affairs sent a pregnant undercover agent to the birth center and on March 6, 1974 raided the Santa Cruz Birth Center and arrested Kate Bowland, Linda Bennett and Jeanine Walker. They were charged with practicing medicine without a license. Kate was a few weeks pregnant with her first son.
The court case dragged on through both of Kate’s pregnancies and she had more court dates than prenatal appointments. “I was term pregnant with my second son when I stood in front of the 9 California Supreme Court Judges dressed in black and heard them tell me that I could not have the midwife of my choice between my legs when my baby was being born. I defied them. I had two wonderful homebirths with my midwife Carol Brendsel and my friends.”
The Bowland case worked its way through the courts all the way to the California Supreme Court, which ruled that although a woman could choose to give birth at home, the attending lay midwives could be charged with practicing medicine. As a result of that ruling, the powers that be began arresting and charging midwives all over the California and the country when ever there was a “sad outcome”, that is when a baby died. It was a disastrous decision for home birth movement and the midwives.
“After the Supreme Court decision we made our last legal move. With our lawyers we wrote our last plea to the court to reconsider the case. It was written as a proclamation, for we knew that as our lawyers said, a rehearing of the case didn’t have ‘a snowball’s chance in Hell.’ In our appeal we stated that birth was a sexual act. That in the privacy of our home it was protected act between two consenting adults.” The local DA had became the Judge in our case and dismissed charges against us for lack of evidence. (Rumor had it that his wife threatened divorce if he took us to trial. Love small town gossip.) They had the test case that they wanted to control the lay midwifery movement.
Nurse-midwifery became legal the same year that Kate was arrested. CNMs had held out for eleven years, because the CMA and legislators wanted to legalize them for practice in hospital only. The CNMs would kill the bill every year rather than allow homebirths to become excluded. Schools for CNMs began to spring up in California.
At the time she was arrested, Kate had been involved in talks with the Maternal and Child Health Department of the state about legalizing direct entry midwifery. She helped create the first legislative proposal in 1976, but she knew the process would take a long time, and she didn’t want to wait. She wanted to be in the birthing rooms, not back in the courtroom. So she went to school to become a CNM. In nursing school she was asked why she wanted to be a nurse. “I replied that I never wanted to be a nurse, that I was a midwife and sentenced to nursing school.”
“I had already been practicing midwifery for 12 years by the time I completed nursing school and went to midwifery school at UCSF. I continued going to homebirths the whole time I was in school, and my professors were very supportive. I feel like CNM education was excellent and served me very well. I took everything as an opportunity to learn. I scrubbed in on as many cesareans as I could, so I could practice skills that I did not have, like manual removal of a placenta. I attended breech and twin deliveries, and any birth that I thought I could learn something new, which is every birth. I learned as much as possible. Jim Green OB/GYN and head of the department held a seminars every week where the students could ask him anything. It was Kate's favorite class. After my arrest one of my mottos was, “Teach me and test me- don’t arrest me.”
“The only hospital births I have ever had privileges for were during my studies at UCSF. My very first night on call at San Francisco General, my supervisor was a midwife and a nun whom I knew from study groups. She said, “Well Kate, I’m sure you’ll have a good night” and left me there alone! I caught five babies that night, winging it the entire time. I had never worked in hospital before that night.”
Kate loved her professors who were the pioneers of the CNM movement and they were completely dedicated to natural birth and the women they served. , It was a different time. In her hospital experiences in the early 80s, women came in active labor and most pushed their babies out without any medication. Natural birth was the “in” thing. It was before they started selling epidurals in every childbirth class.
There are many barriers to practice for homebirth midwifery, and the requirement to have a supervising physician is one of the greatest. “As I was a lay midwife, several doctors in the county called into their offices and said, “Call me if you need help.” She did.
“I had better back up as a lay midwife than as a CNM. When I first graduated I enjoyed “supervision” from a group of dedicated doctors. The first time I lost my back up doctors was because I read a poem about birth at the awards ceremony of Outstanding Women in Santa Cruz County. In the poem I quoted Sheila Kitzinger’s research on the language that women used after traumatic hospital birth as being the same language they used after being raped. Then I described home birth as being inside a warm water reef with colorful life teeming around and being in the hospital was like have waves crashing on the outside ofthe reef. One of the doctors was outraged, felt it was personal and didn’t want to do backup anymore. It was a big misunderstanding and I did get my backup back back due to the support of midwives and doctor friends. The next times were all due to the many malpractice crises.”
“Although I have never had trouble with my CNM license for doing homebirths, I do on occasion get reprimanded by the hospital for not following doctor’s orders after a transport. This usually involves my efforts to keep babies and moms together, or advocate for my clients. The hospital I transport to has a level 3 nursery and ICU nurses are often eager to take whisk babies off, so I have to be very proactive to keep them in their mother’s arms.”
Kate has always pushed the envelope in her involvement with the hospitals. She remembers standing with her foot in the delivery room door at Dominican because the father was not allowed in. She argued so much with staff that they called security on her, but then decided to let the father in the delivery room. Another time, the laboring mom wanted Kate in the delivery room so much that she in her very vocal protest she announced that “If you don’t let Kate in here to be with me I’m leaving!” and actually got off the delivery table and began to walk away. The staff hedged about not having the right papers for Kate to sign, but when the mom wouldn’t give up, they suddenly found papers to sign and let her into the delivery room. This was a first.
Another time at Stanford hospital she stood outside the operation room and listened to the doctors while they scrubbed for a planned cesarean. She had requested that they let the father hold the baby while the mom was in recovery. “That crazy midwife," she heard the pediatrician mutter to his colleague, "She wants the dad to bond with the baby! Mothers bond with babies, not fathers.” Kate had about a millisecond of doubt about her suggestion.
Over the years hospitals have begun to give a little more humane care. Kate sees herself as part of a movement across the country, driving this shift. Hospitals created birth centers and homey birthing suites so they could advertise: “just like home”. Ironically homebirth has became the gold standard for care in the hospital.
For the last 20 years Kate has enjoyed a partnership with Roxanne Cummings they have done over 2500 births between them.. Their office includes a group of woman practitioners, an acupuncturist, a homeopath and a medical doctor. They have kept a sign up on a busy Santa Cruz road saying: “Midwives of Santa Cruz” for a generation. Pregnant women often enter her office saying, ”I’ve wanted to come in here since I was a little girl.“
“Today we do have a very supportive medical community. My midwife partner Roxanne Cummings and I are enjoying well-established relationships with the medical community and a good reputation – after 35 years of practice filled with good luck and timely transports. We are very grateful for the doctors and hospitals and quality nursing care in our area.”
These days she and her midwife partner do about 50-60 births a year. Currently, she is putting together data from 500 planned homebirths for a study she hopes to see published in the midwifery journal.
My vision for women and midwives:
-Would began with true prenatal care and education. Beginning with paid maternity leave for at least 1 year beginning in pregnancy at 28 weeks.
-Direct entry midwifery with many routes to licensure, from apprenticship model to bachelor and/or masters level education.
-Community-based education using the local community colleges and universities and at distance learning programs.
-Every midwifery practice would be a site where student midwives may have a mentor/ preceptor with midwives who are kneeling in the brine of life.
-A system that makes it easy to practice in all settings according to the desires and needs of the women, their babies and their midwives.
-A woman’s first contact would be with a midwife and midwives would refer to doctors as needed.
-A system that instead of malpractice insurance there is “mal-occurrance insurance”. The families and their babies who are injured by giving birth or being born have their basic needs taken care of. Instead of lawsuits and insurance companies and lawyers getting the money, there would be a pool of money collected for the general risk of birth injuries. In this system there would be a strong peer review of truly open and honest, with education for good practice and the elimination of bad practice and/or practitioners.
-Midwives would legal, licensed, well-educated midwives giving quality care and truly supported politically, economically and socially. This includes integration with modern medicine, ancient wisdom and spiritual practice. This is the work for this next generation.
The next generation of midwives will wonder why we risked jail and our freedom and struggled for so little. It is in the hope that our grandchildren and great grandchildren will be born without fear, safely, surrounded by love.
CAM celebrates the hard work and dedication of the awardee in midwifery activism. In no way should this award be construed as a determination of the midwife's skill nor as a recommendation to use her services.