Brazen Woman 2000: Alison Osborn

   Alison Osborn was born in La Jolla, California.  Like many midwives of her generation, she came into midwifery after experiencing a “typical Dark Ages” hospital birth.  It was 1967 and she was eighteen years old.  She was tied down to the bed, unable to even go to the bathroom.  The staff was cruel to her because they knew she was adopting the baby out.  She decided then that she would never, under any circumstances, go back to the hospital to give birth.

   Alison had two more children.  Her first, Kali, was born in 1972 in a cabin in Guerneville, with Nancy Mills as the midwife.  Her second daughter, Daymora, was born in 1977 in a teepee in the woods in Humboldt County, with Kate Lannagan attending.  She explains that by then, the further out into the woods she could get, the safer she felt, so she opted for birthing in a teepee.  Both girls were born, after two hours labor, in just one push.

   When Alison was six months pregnant with Kali she heard Suzanne Arms speak at Sonoma State University.  She says she “knew immediately” that she was going to become a midwife.  In 1973 she was living in Colorado, where she met a couple of women who wanted to have their babies at a hot springs.  She called a wonderful doctor, who told her over the phone what to do at a birth.  She says that “this was back in the days when no one knew anything, except that they’d had a baby themselves at home.”  Home birthing took a lot of courage in that era.

   In 1978, Alison became involved with the Redwoods Rural Health Clinic in Southern Humboldt County.  Lorraine Carolan and Kate Lannagan began the clinic as a mobile medical trailer.  They hired a doctor and provided services in remote rural areas. Lorraine was Alison’s first teacher.  A long standing bastion of the Southern Humboldt community, Redwoods Rural provided prenatal care for women who then chose whether to birth at home with Lorraine and the midwives or in the hospital with Dr. Bill.

   Lorraine, Kate and Dr. Bill trained 5 student midwives at the clinic.  They attended births that were up to two hours away out in the hills.  Dr. Bill was open to flowing with the evolutionary process of establishing maternity care with the radical women of Southern Humboldt.  For example, he would tell a woman that she could not birth her twins at home.  She would reply that in that case, she’d birth them by herself, and he would relent and agree to let the midwives attend the birth.

   Alison attended about ten births a year for ten years while living in Southern Humboldt and raising her children.  In 1984 she moved to Nevada County with the intention of establishing her own practice.  She found that she needed more training, so in 1986 she went to Casa de Nacimiento, where she attended more births in three months than she had in the previous ten years. It was in Texas that she really learned how to deal with emergencies.

   Alison returned to Casa to teach whenever her homebirth caseload let her, eventually getting her Texas license.  She has taught over 40 women at Casa. It was not until two years ago that she finally let go of this aspect of her midwifery practice, and began to take time off when she was not on call.

   Alison maintains a full time practice in the Grass Valley and Nevada City area.  She has been to over 900 births and continues to attend up to five per month.  She has fully trained four students who have gone on to become licensed and wonderful midwives.  She also sends all of her students to Casa. She believes that students must have attended at least 100 births and caught 30-40 babies before they are ready to make all decisions at a homebirth.

   Alison joined CAM back when it was still split into the Northern and Southern California Midwives Associations.  She became involved in politics because of the need for homebirth to be recognized and get paid as part of the health care system.  Yet, she says “I laugh when I think of us in Sacramento in the old days.  We were so politically naive… But we knew what we wanted!”

   Alison was a regional representative and the president of CAM in the mid 1980’s. She was an exam coordinator for the CAM certification process.  She named the Brazen Woman award and presented the first one to Janice Kalman.  She remembers spending a lot of time on the phone and at meetings in the days leading up to the licensing act.  She remembers how decimating it was when the physician supervision clause was added.  Midwives were told then that “if the supervision language doesn’t work you can go back in there and change it.”  That was 15 years ago!

   By far, the strongest political work Alison has done for midwifery was through her court case.  The case is critical: it established that midwifery is not the practice of medicine.  It remains one of the most important and regularly referenced homebirth cases in the United States and Canada. Just recently, a judge in Washington concluded that women with a breech baby do indeed have the right to choose a non-surgical birth, including a homebirth, and the Osborn decision was one of the cases that set the precedent.

   The court case was centered on a breech birth that Alison attended in 1999.  Though the baby’s heart tones were excellent throughout labor, it died during delivery.  Local doctors turned her in to the Medical Board, who made nine counts against her and attempted to take away her license.  Her lawyer, John Kennedy, successfully demonstrated to “the awesome Judge Roman” that the midwives model of care is not the medical model of care.  As a result, all testimony received from obstetricians and hospital based CNMs was dismissed.  Judge Roman concluded that Alison’s care at that birth was within both the midwifery standard of care and her guidelines of practice.  He acknowledged the parents’ right to informed consent.

   The entire legal process took over a year; a time that Alison reports was “holy”.  Ultimately, she was exonerated on all nine counts because she was able to defend herself with her own guidelines of practice and clear informed consent.  Sometimes she wonders how she did it; “who was that person who had to walk that walk?”  She says that most midwives who have had court cases go through a depression afterwards.

   Alison believes it is critical for midwives to be able to defend themselves with midwifery guidelines of practice.  “If guidelines are nebulous, how can any midwife know what they are supposed to do when they step outside of them?”  Informed consent must include the parents’ right to refusal based upon the midwife’s experience, training and comfort level.

   She says that she is very on the bandwagon regarding the Labor Day Consensus document.  She believes it matches what the Bay Area Guild of Midwives originally wrote as guidelines for CAM certification in the mid 1980’s, and that there is nothing in them that anyone can’t live with.  She believes that it is also critical that each midwife knows the guidelines and that she reread them every six months, so that she always charts, with good informed consent, when she steps outside of them.  She believes that young midwives especially need guidelines to help them recognize when they are outside their comfort level.

   She says that times have changed.  When she began practicing, midwives were not trained and they did not charge money.  They were helping their girlfriends have babies, and mothers always knew the exact experience level of the women attending them.  Now according to the law, a novice with a new license can do all that a seasoned midwife with 30 years experience can do.  But in reality, midwives need extensive experience and training to take on unusual circumstance births.  They need to really know what a normal breech, for example, looks like so they will recognize when it has strayed from normal.  She recommends that any new midwife thinking of taking on an unusual circumstance birth speak with some seasoned midwives first to be sure she is thinking it through.

   Alison believes that the next couple of years are time to readdress the supervision issue, and that we ought to work together with CNMs to do so. The argument applies to all midwives that physician supervision is inappropriate because midwifery is not the practice of medicine.  We should join forces with each other to promote this change.

   Alison says that her Brazen Woman award is hanging above her desk.  She considers it an incredible honor.  It was given to her after she won the court case, and she believes it honors something way bigger than just herself.  She says that the Brazen Woman award is her favorite recognition as a midwife.

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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