Brazen Woman 2007: Carrie Sparrevohn
Carrie Sparrevohn always knew that she was destined to be a healer in this lifetime. As a child she equated this with “doctor”. As an adult, she found that midwifery is the path she’s supposed to be on.

Carrie is the mother of six children and grandmother of 4 Her first child was born in 1972. She was sixteen years old, in a military hospital, in Texas. She was given a full enema, a shave and a spinal, and was strapped down to the delivery table with leather restraints. She delivered a six-pound baby in just two hours – but was still subjected to a generous episiotomy and the use of mid-forceps. She had to wait ten hours before being allowed to see her newborn daughter. Although she was young and didn’t know any differently, she was sure she would never give birth that way again.

When her first child was six months old, she went to a La Leche League meeting and met a number of homebirth mothers. The idea intuitively appealed to her, so she got the name of the doctor who had attended their births. Two years later, pregnant again, she contacted him. Her next birth was a “nice hospital birth at home” that included AROM, a mini shave and fleets enema as well as a pudendal block and an episiotomy. Shortly before the baby was born she heard the doctor say “I’m going to give you a little something for the pain” and she thought, “But I’m not in pain…” but was too busy pushing to say so. Her baby was dried and handed to the nurses before being given to her, but at least she never left the room and the separation was brief.

Her next three children were born at home with midwives – sweet, unmedicated and un-interfered with births. Her last child was born in the hospital after she developed an elevated blood pressure, but was caught by her midwife friend Tosi Marceline. Her last labor was also a two-hour labor, this time of a ten-pound baby. Having given birth to infants with such a wide range of sizes, she finds it easy to reassure women when faced with the common anxiety about a “too-big” baby.

Carrie first thought about becoming a midwife in 1977. She attended a weekend seminar with Tonya Brooks and began classes at Tonya’s school: ACHI. When she got married and became pregnant with her third child, she realized that she could not risk the very real possibility of going to jail for the practice of midwifery, so she decided to go to medical school. She spent a year and a half in the university before biochemistry dissuaded her from her plans for medicine. She got her degree in anthropology instead. She worked as an archeologist for a short while, but was dissatisfied with the long hours, hard work and poor pay. So she decided to reconsider midwifery.

Carrie attempted to contact all the local women on her old ACHI class list. Only one of them still had a working phone number in the area – Diane Smith; and she just happened to need an apprentice. She attended about forty births with Diane between 1984 and 1987. She then apprenticed with Tosi and Jan McNabb for another three years, attending approximately 100 births before they deemed her competent to practice on her own.

Carrie became licensed in the first wave of twenty-five women immediately following the passage of the legislation. She received her license in January of 1997 and at that point, stopped doing home deliveries and began working in clinics. She describes this choice as partially financial, and partially a push from the universe. During her final year as a homebirth midwife she attended eight births and had to transport seven of them, including a fifth time mom whose previous births had all been straight-forward. She took this as a sign that it was time to take her energy in another direction.

Her first clinical job was in a feminist health clinic in Sacramento, where she did a lot of pre-menopausal gynecology. She then worked in a prenatal clinic where she did well woman care and prenatal care up to 32 weeks, at which point women switched their care to the doctors. She moved on to a private practice, which she really enjoyed because she was able to build a very strong relationship with the doctor. He grew to trust her and was open to her learning new skills. She was able to work with conditions such as uterine prolapse. She provided care for everything from menopause to high-risk pregnancies. Her current boss is a woman who was a homebirth midwife for years and delivered her nephew 25 years ago. She works per-diem, which gives her the flexibility needed for all the other work she does.

Carrie first became involved in CAM twelve years ago. She began as the regional rep during the time that they were putting in place the regulations needed to carry out licensure. She was the merchandise chair for several years before becoming chairwoman in 2001. During that time she was also coordinator for the Seattle Midwifery School California Challenge Process. Not only did she put together the practical exams, but spent endless hours reading the written exams and communicating the concerns and realities of California midwives to the administrators and midwives at SMS.

Carrie was the chairwoman of CAM for five years. During that time, she feels that her biggest achievement was the resolution of the standards issue. The creation of a Standards of Care document for California licensed midwives was a stressful process for the entire community. Not only did we have the Medical Board and ACOG’s positions to deal with, but there was considerable disagreement amongst midwives as to how the document should be worded, what and how much should be included. Carrie was instrumental in negotiating a compromise amongst the disparate parties, and creating a final document that was acceptable to all.

Carrie was also very involved in the creation and implementation of SB 1950 – the recent legislative action that put into place the Midwifery Advisory Council of the Medical Board and the reporting procedures for licensed midwives. The Medical Board had drafted original language that was unacceptable to midwives: without measures to ensure that a midwife’s statistics could not be used against her in the event of future Medical Board actions. Carrie wrote much of the language for the final bill, eliminating the aspects that midwives could not accept.

Carrie has also worked hard over the years to try to end the impasse between midwives and MediCal. She wrote extensive comments in response to the current MediCal regulations, which prevent LMs from billing directly. So far, this has resulted in little more than incredible frustration, but she has not given up. The latest front in the MediCal battle is the need to become Comprehensive Perinatal Services providers. The exclusion of LMs from this program is the result of negligent oversight; but as with all MediCal regulatory issues, change will be slow in coming.

In 2006 Carrie resigned as CAM’s Chair but agreed to continue as CAM’s legislative chair, a position that enables her to continue the legislative advocacy work she began as chairwoman. She is one of three LMs on the Midwifery Advisory Council. She is in regular contact with CAM’s lawyer. She persistently struggles with MediCal. She continues to work with the Medical Board and the legislature to address the many barriers to safe, effective practice that still haunt California LMs. She has one of the strongest understandings of regulatory and legislative language in the midwifery community, and midwives regularly contact her to field questions about legislation and licensing issues.

Carrie reminds us all that the Medical Board is not the entity to turn to when we have questions or concerns about regulation. They are there to police us, not necessarily to help us. They have no authority to make regulatory change unless the legislature enacts legislation that mandates it.

Currently, Carrie is actively attempting to resolve issues around medication ordering for LMs working under physician supervision in hospital settings. A number of LMs have been working under standard procedures and protocols in clinic and hospital settings, a practice which some facilities are now calling into question. Some of the LMs involved in this issue have had hospital privileges for over ten years, and suddenly the way they have been practicing all this time is at risk of being terminated.

In addition to all of this strenuous and often aggravating legislative work for California midwives, Carrie has taken on an incredible new project to bring midwifery care to women in desperate need internationally. In 2005 she began a venture that has blossomed into WITH WOMAN-Healthcare and Education, a California non-profit dedicated to providing healthcare and other services to the women and families around the world. Their current work is being done in Uganda.

Carrie first traveled to Uganda in the fall of 2005, knowing she wanted to do something related to midwifery there, but unsure of what. She discovered that there are plenty of midwives in Uganda, but that they are inaccessible to many of the nation’s poorest women. They are centrally located in facilities in major metropolitan areas. Women in rural villages are forced to either travel long distances – walking for hours while in labor – or to stay home. Traditional birth attendants who assist women at home are so rare that in all her subsequent trips to Uganda, Carrie has yet to meet one.

While planning her first trip to Uganda, Carrie was blessed to meet a Ugandan woman in Davis, a friend of a friend, who offered her a connection with a “place to stay” for her journey. Upon arriving, Carrie discovered that her hostess, Joan Kakwenzire, was more than just a kind local. She is also the head of the national Poverty Alleviation Department, and a senior advisor to the president of Uganda. Together, Carrie and Joan designed a plan to get healthcare clinics into villages where the Poverty Alleviation Department is already active. In March of 2006 they began fundraising to open a single clinic in one village. By July of that year, they had been gifted a house to use for the facility, but it needed tremendous restoration work, beginning with the removal of all resident rats and snakes. Joan got district officials (equivalent to county officials) to pledge help in opening the clinic, and in April of this year Carrie returned with the intention of continuing fundraising.

On the morning she arrived she received a call from Joan to attend the district meeting at 10 AM. The district wanted to move forward and open the clinic immediately, so they built an alliance between WITH WOMAN, the Poverty Alleviation Department, the district health department and the village. The district provided furnishing, supplies and two nurses (who are also midwives). Eight days after this meeting, and only one year after initial fundraising began, the clinic opened.

Since then, things have moved at an extraordinary pace. The nurse/midwives began giving immunizations at the opening ceremony. In the first forty days of operation they saw 1,400 patients! The two nurse/midwives see 100 patients a day with no running water or electricity. Although they have only done two births so far, Carrie just learned that they are becoming something of a battered women’s shelter. Women have spontaneously begun arriving there to seek refuge from unsafe circumstances.

The project is progressing with a “mind of its own” and every time Carrie gets stuck wondering what to do next, she remembers the miracles that have already occurred. Her next step is to begin grant writing to create a salary for all the work she has been doing. They are also working to hire at least one more nurse/midwife.

In addition to the clinic, WITH WOMAN is involved with funding scholarships for orphans to buy the supplies they need to attend primary school, and with micro-financing small loans for sustainability work in the village. The long-term goal is to use this village as a model for other villages in the area. Joan’s intention is to create one model village in each district that the surrounding villages can copy in providing these services. Carrie’s mission is to make the clinic both sustainable and portable.

Carrie is returning to Uganda in August, and this time she is bringing along her 14 year-old daughter and six other teenagers. The teens all had to design their own programs and raise their own money to go on the trip. They are planning amazing services including: building a kitchen garden for the clinic, teaching local women how to make and use solar ovens, helping children write biographies to put on the website for scholarship requests, and taking the children into the city to teach them how to use the internet.

Even while working so hard internationally, Carrie remains committed to California midwives. She is working tirelessly for the removal of physician supervision. In the long term, she wants to see midwives become autonomous practitioners with full scope privileges. Carrie believes that all of us as midwives need to embrace the next generation of women and the teaching of other midwives. We can’t exclude interested women from our circle. We have to seek them out and encourage their enthusiasm. Otherwise we will never meet the goal of a midwife for every mother.

Carrie is incredibly honored that her peers have given her the Brazen Woman Award. She says she felt too overwhelmed upon receiving it to fully express how grateful she is but is feeling incredibly Brazen these days.

*Disclaimer* 
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.

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